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: 1818470
Sex: F
Age: 84
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

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: 1818472
Sex: F
Age: 84
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
Hospital:

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: 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: 1818473
Sex: F
Age: 74
State: MD

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 10/26/2021
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: Canola Oil

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

Symptoms: I experienced high fever, body aches, nausea, diarrhea and back pain.

Other Meds: Blood Pressure Medicine

Current Illness:

ID: 1818474
Sex: M
Age: 66
State: CA

Vax Date: 03/25/2021
Onset Date: 04/13/2021
Rec V Date: 10/26/2021
Hospital: Y

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

Lab Data: Biopsy 5-5-2021 on shin. surgery performed 5-27-2021. Biopsy of shoulder 5-18-2021. Surgery on shoulder to remove spot and adjacent lymph node 6-2-2021. Healing of Shin is still ongoing.

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Noticed 2 different kinds of spot on skin sometime between 4-13-2021 and 4-28-2021. 1 Diagnosed as Squamous Cell Carcinoma 5-13-2021. The other diagnosed as Merkel Cell Carcinoma 5-26-2021.

Other Meds: Famotidine Rosuvastatin DIPROLENE AF Clobetesol Allopurinol Terazosin Calcium Citrate Aspirin

Current Illness: None

ID: 1818475
Sex: F
Age: 67
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vaccine error - Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1818476
Sex: F
Age: 29
State: NJ

Vax Date: 10/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818477
Sex: M
Age: 38
State: OK

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/26/2021
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 preformed

Allergies: NO

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient reports insomnia and palpitations approximately 12 hours after vaccination lasting around 6 to 8 hours.

Other Meds: CAFFINE (PRE-WORKOUT), POST-WORKOUT (BCA'S), COFFEE

Current Illness: NO

ID: 1818478
Sex: F
Age: 46
State: FL

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: None

Allergies: none known

Symptom List: Pharyngeal swelling

Symptoms: The client complained of "Feeling detached from her surrounding, nausea, dizzy, fatique, feeling heart rate and breathing had increased. Client was oriented, skin color pink, Vital signs: 12:59- b/p 140/100, p 92, regular rr 22, 1:00 pm b/p 140/95 p 80 rr 24. Client was moved to another room so she could put her head down. 1:15 b/p140/85 p 85 rr 22 . Client expressed she was feeling better. She expressed concerns about her daughter becoming sick once again with COVID and that she was going to be tested. She also expressed that she was going to a co-workers funeral the next day. Pt refused further medical care however was encouraged to go home early. She agreed and was escorted to her Supervisor for discharge home.

Other Meds: Metformin 600 mg twice daily Lisinopril 40 mg once daily

Current Illness: Bipolar Diso HTN Diabetes Mellitus

ID: 1818479
Sex: M
Age: 32
State: NC

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient had Pfizer booster. 1st dose was Johnson & Johnson. Reaction occurred after dose of Pfizer: swollen lymph nodes in left axillar.

Other Meds: Metoprolol, Zoloft

Current Illness:

ID: 1818480
Sex: M
Age: 61
State: CO

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Developed huge monkey bubble, (size of golf ball under skin where shot was injected). 5 days of pain until the bubble started to go down. Took Ibuprofen to help reduce the swelling. Pain went away in about 5 days, bubble finally reduced after 2 weeks.

Other Meds: NONE

Current Illness: NONE

ID: 1818481
Sex: F
Age: 75
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
Hospital:

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: Vaccination site erythema, Vaccination site pruritus, Vaccination 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: 1818482
Sex: F
Age: 47
State: NY

Vax Date: 10/17/2021
Onset Date: 10/17/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: None, I never reported any of this to the doctor, I told her I had a heart issue and she told me to take the vaccine anyway.

Allergies: Birch tree fruits, cats, dust

Symptom List: Rash, Urticaria

Symptoms: Dizzy for 3 days, Numb Tongue for 3 days, Sore Arm for 7 days, Trouble walking for 5 days, Nausea for 3 days, shortness of breath for 3 days, cramps for 2 days, and feeling very tired for 5 days.

Other Meds: None

Current Illness: Enlarged Aortic Root, heart murmur, high blood pressure, Osteogenesis Imperfecta

ID: 1818483
Sex: F
Age: 35
State: NJ

Vax Date: 10/15/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818484
Sex: F
Age: 48
State: MT

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/26/2021
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: Sore throat, runny nose, shortness of breath

Other Meds:

Current Illness:

ID: 1818485
Sex: F
Age: 87
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest 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:

ID: 1818486
Sex: M
Age: 71
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 1818487
Sex: M
Age: 70
State: NJ

Vax Date: 10/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818488
Sex: F
Age: 39
State: NC

Vax Date: 09/16/2021
Onset Date: 10/17/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: EKG - Abnormal (Heart Arrhythmia) ECG - Abnormal Chest X-ray - Abnormal (small left plural effusion and left Basilar Atelectasis, Trace right plural effusion Bloodwork - Normal

Allergies: Sulphur drugs, Gluten and Dairy

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I experienced Jaw pain that went up to her left ear; therefore, she went to Urgent Care and my ears were fine. They were more concerned with the chest pain and sent me the ER (had a chest X-ray, EKG, and some bloodwork). Chest X-ray reveal left and right contusions, EKG showed an abnormal and was referred to a Cardiologist for additional tests. The Cardiologist also noticed that I had inflammation in my chest and that my blood pressure was elevated. My PCP prescribed 500mg Naproxen and 25 mg Hydrochlorothiazide on 10/19/2021 for the symptoms that I experienced and for the chest inflammation. I have a appointment for a Echo Cardiogram and ECG is scheduled on 10/29/2021, Ultrasound will be the end or beginning of the 1 or 2 week in November. I

Other Meds: No

Current Illness: No

ID: 1818489
Sex: M
Age: 65
State: MI

Vax Date: 05/12/2021
Onset Date: 10/17/2021
Rec V Date: 10/26/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Hospitalized 10/17/2021; COVID-19 positive 10/17/2021; fully vaccinated BRIEF OVERVIEW: Hematologist/Oncologist: No care team member to display Admission Date: 10/17/2021 Discharge Date: 10/21/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 HOSPITAL COURSE: No notes on file This is a 66 y.o. patient with a past medical history significant for HTN, CAD, Atrial Fibrillation, Depression, DM type II, neuropathy associated with MM, HLD and Multiple myeloma who presented with symptoms of weakness and near syncope at home per spouse at bedside 10/17/21. In the ED, patient was found to be hypoxic and nauseous, and improved with 2 L NC and Zofran. A CXR revealed patchy diffuse bilateral airspace opacities, compatible with COVID 19 pneumonia and his lactic acid ws slightly elevated, covid swab was positive. Patient was admitted for further tx. ID followed. Patient was placed on dexamethasone 6 mg daily, Remdesevir, and monoclonal antibodies given 10/18/21. Weaned off 2L to RA. MRI of lumbar/sacrum 10/18/21 no aggressive focal lesions, no fracture or mass. Mild progressive facet arthropathy L3-4. Multilevel lumbar spondylosis. PT/OT evaluated while inpatient. Patient also had coffee - ground emesis 10/18/21, GI followed. Protonix gtt started -- transitioned to PPI PO BID for 8 weeks, then will have EGD on outpatient basis when covid pna resolves. Eliquis initially held, then restarted as hgb stayed stable. Also noted hyperbilirubinemia 10/17 of 1.9 and had RUQ US which showed hepatic steatosis and mild splenomegaly, no biliary tree dilation. While inpatient team followed and adjusted insulin tx.

Other Meds: acyclovir (ZOVIRAX) 400 MG tablet apixaban (ELIQUIS) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet Cholecalciferol (VITAMIN D3 PO) DARATUMUMAB IV dexamethasone (DECADRON) 4 MG tablet empagliflozin (JARDIANCE) 10 MG tablet FLUoxetine (

Current Illness:

ID: 1818490
Sex: M
Age: 94
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 1818491
Sex: F
Age: 57
State: NJ

Vax Date: 10/07/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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:

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

Symptoms: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818492
Sex: F
Age: 76
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: Unevaluable event

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: 1818493
Sex: M
Age: 66
State: FL

Vax Date: 02/18/2021
Onset Date: 07/04/2021
Rec V Date: 10/26/2021
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: N/A

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 02/18/2021, started experiencing symptoms 07/04/2021 (Breakthrough Case) Covid + 07/04/2021, bladder control issues, Neuropathy in both knees, and accelerated Arthritis throughout the limbs.

Other Meds: N/A

Current Illness: N/A

ID: 1818494
Sex: M
Age: 68
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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:

ID: 1818495
Sex: F
Age: 79
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
Hospital:

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: 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: 1818496
Sex: M
Age: 27
State:

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
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: NONE

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

Symptoms: DID NOT LOOK AN ADVERSE REACTION. IT WAS MORE THE PATIENT HAD NO BREAKFAST AND VERY NERVES. HIS SYMPTOMS WERE, LIGHT HEADED, UNCONSCIOUSFOR A FEW MINUTES. Emergency services WAS CALLED , BLOOD ORESSURE WAS LOW, BLOOD SUGAR WAS LOW , AND CARDIAC ARRYTHMIA SKIP OF BEATS. Emergency services CONCLUDED MOST LIKE A PANIC ATTACK , OR NERVOUNESS.

Other Meds: BENADRYL SYRUP 30ML

Current Illness: NONE

ID: 1818497
Sex: M
Age: 81
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 1818498
Sex: F
Age: 87
State: NJ

Vax Date: 10/08/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818499
Sex: F
Age: 76
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: Vaccine error - Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1818500
Sex: M
Age: 68
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818501
Sex: F
Age: 79
State:

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient received a Pfizer covid vaccine dose that is 18 hours after the vaccine is prepared. Called Pfizer and they said stability is still ok 24 hours after preparation if vaccine has been stored under refrigerated temperatures, which it is. No reactions reported by patient.

Other Meds:

Current Illness:

ID: 1818502
Sex: M
Age: 67
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 1818503
Sex: F
Age: 73
State: MA

Vax Date: 04/19/2021
Onset Date: 04/26/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: Retinal exam

Allergies: NO

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

Symptoms: Branch retinal vein occlusion within 2 weeks of vaccine- this was incidentally noted on routine eye exam

Other Meds: Vit D, synthyroid, pravastatin

Current Illness: No

ID: 1818504
Sex: M
Age: 67
State: MS

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
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: EGG

Symptom List: Tremor

Symptoms: NO ADVERSE EVENT OCCURRED. ADMINISTRATION ERROR.

Other Meds:

Current Illness: ASTHMA ,DIABETES

ID: 1818505
Sex: M
Age: 37
State: HI

Vax Date: 01/06/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
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: Fully vaccinated and tested positive for COVID-19

Other Meds:

Current Illness:

ID: 1818506
Sex: M
Age: 76
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
Hospital:

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:

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

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: 1818507
Sex: F
Age: 83
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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: Dose administered past refrigeration time

Other Meds:

Current Illness:

ID: 1818508
Sex: M
Age: 59
State: ID

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/26/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Body Ache Headache Mental Fog

Other Meds: Multi-Vitamin

Current Illness: None

ID: 1818509
Sex: F
Age: 55
State: PR

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: Inform to the doctor, but did not do any study.

Allergies: Sulfa

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

Symptoms: Bone pain, positional vertigo for a month and a half, now I notice memory forgetfulness, little concentration.

Other Meds: Cardizem; Multivitamins; Vitamin C

Current Illness:

ID: 1818510
Sex: M
Age: 40
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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:

Allergies:

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

ID: 1818511
Sex: F
Age: 30
State: FL

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: N/A

Allergies: Shellfish-anaphylaxis

Symptom List: Pain in extremity

Symptoms: 13:37: 90BPM (140/100)One emesis, nausea, light-headedness, tired, fatigue; 14:41 70 BPM (114/80), headache pressure/tired

Other Meds: Client confirmed none

Current Illness: None noted

ID: 1818512
Sex: F
Age: 26
State: CA

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
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: Approx 30 min after receipt of vaccine, pt reported throat itching. Denied SOB, swelling, or generalized pruritis. No WOB, no facial/lip/tongue swelling, no hives. Throat itching remained persistent x 1h during prolonged monitoring, no change, no new sx. No therapeutics administered. Pt then sent to urgent department for immediate f/u, counseled on s/sx anaphylaxis

Other Meds:

Current Illness:

ID: 1818513
Sex: M
Age: 43
State: CA

Vax Date: 10/24/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
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: None

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

Symptoms: Large red rash around the site of the Moderna Booster injection on the right arm. The patient had a similar rash after the 2nd Moderna dose.

Other Meds: Tirosint, rosuvastatin, compounded T3, multivitamin (Nutrient 950 with K), TMG, fish oil, magnesium

Current Illness: None

ID: 1818514
Sex: F
Age: 67
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 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: 1818515
Sex: M
Age: 53
State: FL

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/26/2021
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: Dust, ragweed

Symptom List: Vomiting

Symptoms: Soreness at injection site Arm weakness Dizziness Feeling of being violated Stress due to mandatory vaccine against my will

Other Meds: Amlodopine valsartan Triemtpere

Current Illness: None

ID: 1818516
Sex: F
Age: 23
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Dose administered past refrigeration time.

Other Meds:

Current Illness:

ID: 1818517
Sex: M
Age: 61
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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: 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: 1818518
Sex: F
Age: 13
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/26/2021
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:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine error - Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1818519
Sex: M
Age: 22
State: FL

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/26/2021
Hospital:

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

Lab Data: Unsure what they did at urgent care but telemetry was applied when EMS arrived 10/25.

Allergies: PCN, peanuts, shellfish

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

Symptoms: Complained of L arm pain and tingling about an hour after administration but stated this was a reaction he had in past to flu vaccine. Several hours later he complained of chest pain and feeling short of breath. Visibly shaking and tearful. Able to speak in full sentences. Emergency services was called. O2 sat was normal. No hives/rashes. He was sent to an urgent care via emergent transport (fire dept) where he was monitored for several hours. He was told he had a panic attack with dehydration and syncope. Today, 10/26 he is only complaining of usual symptoms of increased fatigue and muscle aches. He is working today.

Other Meds: Advair inhaler as needed

Current Illness: Reactions to other vaccines.

ID: 1818520
Sex: F
Age: 31
State: NJ

Vax Date: 10/15/2021
Onset Date: 10/01/2021
Rec V Date: 10/26/2021
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:

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

Symptoms: Dose administered past refrigeration time

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am