VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1815324
Sex: F
Age: 40
State: CA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Not done

Allergies: no

Symptom List: Dysphagia, Epiglottitis

Symptoms: Right arm (injection site) sore.Currently BREASTFEEDING: Baby had upper respiratory symptoms (congestion and cough) NO fever that started ~6 hours after booster administration and lasted for about 24 hours.

Other Meds: none

Current Illness: no

ID: 1815325
Sex: F
Age: 74
State:

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 10/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1815326
Sex: F
Age: 43
State: UT

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815327
Sex: M
Age: 69
State: VT

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: CT, MRI, ENT and audiology referrals, OTC motion sickness medication

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dizziness ever since

Other Meds: Losartan

Current Illness: None

ID: 1815328
Sex: F
Age: 48
State: OH

Vax Date: 01/07/2021
Onset Date: 01/17/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Bloodwork, CT, MRI, VNG, nerve conduction test, hearing test

Allergies: none

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vertigo, extreme loss of balance, deafening tinnitus, numbness in hands and feet that radiate up arms and legs, nausea, visual disturbances, moments of intermittent cognitive impairment. Tx: contacted PCP, went to the ER, also consulted an ENT and a Neurologist Outcomes: symptoms still persist

Other Meds: none

Current Illness: none

ID: 1815329
Sex: M
Age: 13
State: IN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: No adverse events reported by patient. Vaccine was given three days past the beyond use date of 30 days from when the vial had been thawed and placed in refrigerator. Beyond use date was 10/11/21. Vaccine dispensed 10/14/21.

Other Meds:

Current Illness:

ID: 1815330
Sex: M
Age: 14
State: UT

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815331
Sex: M
Age: 41
State: FL

Vax Date: 02/25/2021
Onset Date: 03/11/2021
Rec V Date: 10/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data: 5/17/21 - MRI Brain 5/22/21 - MRI Brain Lumbar puncture - 5/18/21

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Acute demyelinating encephalitis; patient presented with fatigue, dizziness, dysarthria, diplopia, and gait imbalance that progressively worsened during his hospital admission, requiring ICU admission. He was successfully treated with plasma exchange and displayed improvement in MRI findings.

Other Meds: None

Current Illness: None

ID: 1815333
Sex: F
Age: 51
State: MN

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: x-ray done on right shoulder and left foot Physical therapy

Allergies: Deltoide Appendicitis

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Had pain at the injection site. Numbness at the numbness site. Diagnosed with deltoide appendicitis- started in my left foot. Spot on right thigh that has increasing pain. Left rib has a spotted that feels irritated. Have had a cough since vaccination.

Other Meds: Zyrtec; Dazeltec; Otezla; Omeprazole; Vitamin D; Gabapentin; Dulera; Dymista Nasal Spray; Singular; Vasotec; Centroid

Current Illness: Celebrex; Bacterium Suphurs

ID: 1815334
Sex: M
Age: 33
State: UT

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815335
Sex: F
Age: 49
State: MI

Vax Date: 09/25/2021
Onset Date: 10/02/2021
Rec V Date: 10/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Eye Dilation and saw the bleed and eye surgery and got injection to stop the bleeding.

Allergies: n/a

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: 09Oct2021 - I was walking and just blinked my eye, I had like a cloudy cotton ball blocked my eye sight. Went to the doctor on 13 and 14 Oct2021 - Retinal specialist . On 19Oct2021 and got surgery - Cryopexy Surgery

Other Meds: Novolog, Metoprolol Succinate ER, Atorvastatin Tabs, Plexus, Vitamin D, Vyzenfe, Plaquenil, zanaflex.

Current Illness: no

Date Died: 10/24/2021

ID: 1815336
Sex: F
Age: 76
State: AL

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient received vaccine 3 days prior to ER arrival at another unknown location.

Other Meds:

Current Illness:

ID: 1815337
Sex: F
Age: 28
State: OK

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Swelling under right arm in lymph nodes pain radiating into and chest and swelling into collar bone

Other Meds: Cymbalta 60m once daily, Phenetermine 37.5mg daily

Current Illness: none

ID: 1815338
Sex: M
Age: 72
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815339
Sex: F
Age: 30
State: OR

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: No

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Dizziness/Vertigo

Other Meds: Aspirin 325mg Daily

Current Illness: No

ID: 1815341
Sex: F
Age: 70
State: UT

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815342
Sex: F
Age: 65
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815344
Sex: F
Age: 63
State:

Vax Date: 10/12/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient has a swollen knuckle on her hand. Patient has elbow pain in the joint., as well as pain throughout the whole arm. All of this is occurring in the same arm the patient received her vaccine in.

Other Meds:

Current Illness:

ID: 1815345
Sex: M
Age: 16
State: IN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: No adverse events reported by patient. Vaccine was given three days past the beyond use date of 30 days from when the vial had been thawed and placed in refrigerator. Beyond use date was 10/11/21. Vaccine dispensed 10/14/21.

Other Meds:

Current Illness:

ID: 1815346
Sex: M
Age: 73
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies:

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815347
Sex: F
Age: 31
State: CO

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: na

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: MODERNA was stored in colder temperatures than recommended.

Other Meds: na

Current Illness: na

ID: 1815348
Sex: F
Age: 57
State: AR

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: I am going to the doctor tomorrow.

Allergies: No

Symptom List: Unevaluable event

Symptoms: Heart palpitations that continued for the rest of the day. The next day was very tired. 72 hours later still have a tightness in chest with heart palpitations on and off during the day. They last about 15 minutes and ease up when I rest. I am notifying my doctor today.

Other Meds: Daily womens vitamin

Current Illness: None

ID: 1815349
Sex: M
Age: 62
State: GA

Vax Date: 07/31/2021
Onset Date: 08/01/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Stool sample taken some time in August. Gastroenterology. Gave 1st round of antibiotics. When it was noticed that he continued to have diarrhea, another round of antibiotics was prescribed.

Allergies: Codeine

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Had vaccination at approximately 10:30am., on 7/31/2021. At 2:00 am on 8/1/2021, pt reports he had diarrhea which continues until today. He states that he has taken 2 rounds of two weeks of antibiotics. He can not tell me what antibiotic he has taken or who prescribed the antibiotic.

Other Meds: pt is blind; only knows that he takes 2.5mg blood pressure; and take neurontin for nerve pain.

Current Illness: None

ID: 1815350
Sex: M
Age: 55
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

Date Died: 09/19/2021

ID: 1815351
Sex: M
Age: 77
State:

Vax Date: 02/09/2021
Onset Date: 09/09/2021
Rec V Date: 10/25/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt admitted to hospital with c/o SOB, fever, malaise; positive for COVID; pt's O2 saturations decreased eventually requiring intubation; pt's condition worsened on 9/19 with maximum vent support; he continued to experience refractory hypoxemia; attempted to place pt in a prone position and he went into cardiac arrest; expired in the hospital

Other Meds:

Current Illness:

ID: 1815352
Sex: F
Age: 44
State: SC

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Codeine, erythromycin

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Chills 10 hrs after injection which became much worse through the next day. Approximately 24 hours after injection my fever increased to 102.7 despite taking ibuprofen.

Other Meds: Losartan HCT, Metformin, wellbutrin, multivitamin

Current Illness: None - flu vaccine on 10/22/2021

ID: 1815353
Sex: F
Age: 71
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815354
Sex: F
Age: 58
State: AZ

Vax Date: 02/12/2021
Onset Date: 03/19/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data: Tested for Covid 19 was negative on short and long test, X-rayed lungs- no issue

Allergies: Codeine, Eggs and Bananas.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Asthma aspiration Prednesone cleared it

Other Meds: Atorvastatin 20mg 1xday, Losartin Potassium 50mg 1x day, Victoza 1.8mg injected once in morning diabetes, Metformin 1000mg 2x dy, Glipizide 10mg 2x dy diabetes, Pregabalin 45 mg 3x day -Neuropathy, Montelukast 10mg night for allergies, Se

Current Illness: None

ID: 1815355
Sex: M
Age: 29
State: IN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: No adverse events reported by patient. Vaccine was given three days past the beyond use date of 30 days from when the vial had been thawed and placed in refrigerator. Beyond use date was 10/11/21. Vaccine dispensed 10/14/21.

Other Meds:

Current Illness:

ID: 1815356
Sex: M
Age: 77
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815357
Sex: F
Age: 48
State: NM

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Fever of 100?F onset about 18 hours after injection, body aches, joint pain, chills. Lasted about 8 hours. Started to fell better about 24 hours after injection. Treated with ibuprofen and bed rest.

Other Meds: Birth control pills, Estroven, moringa, glucosamine/chondroitin, curcumin turmeric, ibuprofen

Current Illness: none

ID: 1815358
Sex: U
Age: 79
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815359
Sex: F
Age: 46
State: NC

Vax Date: 10/02/2021
Onset Date: 10/03/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: blood work - xray - ekg-

Allergies:

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: body ache, headache, fever, coughing, trouble walking, difficulty breathing, blood pressure fluctuating, weak, difficulty keeping food down dehydrated, covid 19

Other Meds: blood sugar meds, blood pressure meds

Current Illness:

ID: 1815360
Sex: F
Age: 72
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815361
Sex: M
Age: 57
State: KS

Vax Date: 08/10/2021
Onset Date: 09/29/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Vesicular eruption nose, cheeks, forehead. Vesicular eruption plantar surfaces (arches and toes) both feet

Other Meds:

Current Illness:

ID: 1815362
Sex: F
Age: 64
State: CO

Vax Date: 04/29/2021
Onset Date: 09/03/2021
Rec V Date: 10/25/2021
Hospital: Y

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: cefaclor, Soma

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Moderna COVID-19 Vaccine EUA: Five months after COVID-19 vaccination patient presented to emergency department with nausea, vomiting, and diarrhea. Hospitalized for c diff infection and hyponatremia and found to be COVID-19 positive. Patient improved with antibiotics and IV fluids and maintained oxygenation on room air. Discharged medically stable.

Other Meds: albuterol, aspirin, cyclobenzaprine, Zestoretic, metoprolol, potassium chloride, trazodone

Current Illness: edema

ID: 1815363
Sex: F
Age: 59
State: CO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: na

Other Meds:

Current Illness:

ID: 1815364
Sex: F
Age: 47
State: SC

Vax Date: 04/11/2021
Onset Date: 06/01/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: September 8, 2021 - Hearing test performed by audiologist. Significant hearing loss in left ear. Right ear was fine. September 16, 2021 - MRI performed to see if tumor in ear. No tumor. All clear in ear. Referred to audiologist to be fitted for a hearing aid.

Allergies: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Gradual hearing loss over several months in left ear with continuous white noise inside ear. Hearing loss does not run in family and previous audiology tests before showed no hearing loss in left or right ear. Patient now wears a hearing aid in the left ear.

Other Meds: Trazadone

Current Illness: NA

ID: 1815365
Sex: F
Age: 66
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1815366
Sex: F
Age: 73
State: TN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Milk NSAID Not a true allergic reaction but untoward effect such as: inflamatory ressponse such as painful joints for short period of time, brain fog

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: Weakness and fatique,painful joints of left knee and hip and right hip severe, generalized mucular aches and pain . brain fog, canot concentrate.

Other Meds: Amlodipine 10mg Collagen powder VitaminD Beet root powder Digestive enzymes

Current Illness: Flu vaccine

ID: 1815367
Sex: F
Age: 56
State: MT

Vax Date: 03/31/2021
Onset Date: 10/11/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Had shots in my stomach. Revadear (not sure on spelling)

Allergies:

Symptom List: Pain in extremity

Symptoms: Really tired and ackey. Bad headache

Other Meds: one a day daily

Current Illness:

ID: 1815368
Sex: M
Age: 17
State: NC

Vax Date: 09/29/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Given to 17 year old. No adverse event reported by mother

Other Meds:

Current Illness:

ID: 1815369
Sex: M
Age: 86
State: CA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient received booster of Moderna (025ml) on 10/25/21. According to website specific lot number has an exp of of 10/24/21. LOT 026C21A. I reached out to manufacturer for guidance if patient should receive an additional booster dose -still waiting on contact from manufacturer.

Other Meds:

Current Illness:

ID: 1815370
Sex: F
Age: 36
State: IN

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: No adverse events reported by patient. Vaccine was given three days past the beyond use date of 30 days from when the vial had been thawed and placed in refrigerator. Beyond use date was 10/11/21. Vaccine dispensed 10/14/21.

Other Meds:

Current Illness:

ID: 1815371
Sex: M
Age: 65
State: CO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: moderna was stored in temperatures below what was recommended.

Other Meds:

Current Illness:

ID: 1815372
Sex: M
Age: 26
State: MN

Vax Date: 04/15/2021
Onset Date: 05/15/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Echocardiogram, X-rays and blood work 05/23/2021

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Myocarditis; Severe chest pain and inflammation around the heart. Lasted about a week and a half and symptoms occurred 2-3 days after the second dose.

Other Meds: citalopram, albuterol inhaler (not consistently)

Current Illness: none

ID: 1815373
Sex: M
Age: 80
State: CA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Patient received booster of Moderna (025ml) on 10/25/21. According to the website specific lot number has an exp of of 10/24/21. LOT 026C21A. I reached out to manufacturer for guidance if patient should receive an additional booster dose -still waiting on contact from manufacturer.

Other Meds:

Current Illness:

ID: 1815374
Sex: F
Age: 59
State: MD

Vax Date: 04/21/2021
Onset Date: 06/14/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Urgent Care - 6/15 - Urgent Care - UA (Urinalysis) - negative; did bloodwork (normal) - liver function and lipase function within normal range and sent me for an abdominal CT scan - small hiatal hernia - no evidence of anything else; no evidence of diverticulitis at the time. 6/16 - saw my primary care doctor. They told me to go see a gastroenterologist. Ultrasound: Small gall bladder polyp - small - and some fatty liver (non alcoholic) 6/28 - got the EGD - and that just showed some gastritis and they took a biopsy of my piece of my a-antrum and the antrum. Which were no significant pathological abnormalities - no celiac; no h-pylori; minimal chronic gastritis Hida scan - do not have an acute things; no bioduct obstruction; - low to normal gall bladder fractions is what they called it. Fiber scan on liver: showed a fatty liver - 7/13/2021 7/20/2021 - Patient First Urgent Care - COVID test - negative result CT scan of abdomen ( showed - sigmoid Diverticulitis - and a small umbilical hernia) -after that my surgeon, - put me on - Ciprofloxacin and Flagyl. 9/29/2021 - colonoscopy - which showed - took biopsies of the mucosa - mild diverticula in the sigmoid colon.

Allergies: no except - cats; seasonal allergies; mold; dust, grass

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Two episodes - one in June: abdominal pain. Really bad. Which my provider thought might be a gall bladder issue, but after subsequent CT scans and all kinds of tests, we don't think it is. Second episode in July - pain again but on the left side of abdomen. This time it was diagnosed as Diverticulitis. They put me on Dicyclomine and my doctor put me on Pantoprazole. He sent me for an upper quadrant ultrasound and to see a gastroenterologist doctor. Digestive disorders: Saw a nurse practitioner there. She added Vit E daily; Ordered: Hida scan of my gall bladder; and Fiber scan for my liver - and scheduled an EGD. 7/20/2021= chills, fever, really bad left side pain. Went to Urgent Care - so I could get a COVID test - I was COVID negative. Ciprofloxicin and Flagyl - prescribed by my surgeon my new gastroenterologist - saw him on August 11th - ordered colonscopy. October 18th - Diverticulitis symptoms again - Doctor called in Augmentin - it's generic for that. I'm still taking that. That is helping with my symptoms but I'm not finished with the 10 day course yet. Had a flu shot just recently: September 24th, 2021

Other Meds: Krill Oil - 2 softgel; Multivitamin with Iron every other day; Calcium/Magesium/Zinc - one pill (Combo pill); Probiotic Singulair at night;

Current Illness: no

ID: 1815375
Sex: M
Age: 56
State: CA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Patient received booster of Moderna (025ml) on 10/25/21. According to moderna website specific lot number has an exp of of 10/24/21. LOT 026C21A. I reached out to manufacturer for guidance if patient should receive an additional booster dose -still waiting on contact from manufacturer.

Other Meds:

Current Illness:

ID: 1815376
Sex: F
Age: 29
State:

Vax Date: 08/05/2021
Onset Date: 09/22/2021
Rec V Date: 10/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: period delayed for 7-8 days after 1st dose and bad pain, and then 2 period post 2nd dose, I experienced vomiting, diarrhea, worst cramps. I've never vomited with my previous period, and only light to no cramps before.

Other Meds: No

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am