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: 1821693
Sex: M
Age: 80
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821694
Sex: F
Age: 54
State:

Vax Date: 09/24/2021
Onset Date: 10/07/2021
Rec V Date: 10/27/2021
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: COVID 19

Other Meds:

Current Illness:

ID: 1821695
Sex: M
Age: 83
State: NY

Vax Date: 04/20/2021
Onset Date: 05/12/2021
Rec V Date: 10/27/2021
Hospital: Y

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: Creat is 9.

Allergies:

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

Symptoms: The patient developed ANCA-associated vasculitis, and developed kidney failure despite aggressive treatment. He had pulmonary hemorrhage as well. He is now permanently on dialysis as a result of the vaccine.

Other Meds:

Current Illness:

ID: 1821696
Sex: M
Age: 34
State: TX

Vax Date: 10/24/2021
Onset Date: 10/24/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1821697
Sex: F
Age: 78
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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 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: 1821698
Sex: M
Age: 84
State: NJ

Vax Date: 01/04/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
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: Rapid test positive for Covid on 10/25/2021.

Allergies: none known

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

Symptoms: Client was vaccinated with 2 doses of Moderna vaccine for Covid in January 2021 (beginning and end of January). Developed Covid symptoms on 10/13/2021 - nasal congestion, cough, fever at night x 3 days. Tested rapid positive for Covid on 10/25. Has not yet received booster dose of Moderna.

Other Meds: none known

Current Illness: none known

ID: 1821699
Sex: F
Age: 42
State: TX

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: No tests. Read that it was called Covid Arm online and didn't go to doctor.

Allergies: None Known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The injection site was sore much faster. By the next morning my upper arm started swelling and the muscle swelled so much my skin was tight. There was also muscle pain and the skin itched. Skin felt like it was going to bust open. It lasted about 6 days then was better each day until day 9 when it was back to normal.

Other Meds: Hydrocortisone, Lasix, Adderall, Cymbalta, Flonase, Symbicort.

Current Illness: None

ID: 1821701
Sex: M
Age: 42
State: MA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: N/A

Allergies: Amoxicillin, penicillin

Symptom List: Pharyngeal swelling

Symptoms: Patient received his second Pfizer dose under observation in our office on 10/21/21. Pt premedicated with Prednisone 50mg at hour 13, 7 and 1 before he received the Pfizer vaccine in our office. He also took Zyrtec 10mg about 20 minutes before receiving his vaccine. He required epinephrine in our office shortly after receiving the vaccine. See below for timeline of events: Baseline vitals: P 111, SpO2 98%, RR 20, T 99.1 F 1. 10:17a - Pfizer dose given. 2. 10:20a - Within 3 minutes of receiving the Pfizer vaccine he noticed the same sensation in his throat (swelling & difficulty swallowing) that he experienced with his first dose of Pfizer. Dr. notified. 3. 10:26a ? Dr. gave epinephrine 0.3mg IM and listened to his lungs (clear to auscultation). SpO2 = 97%, Pulse 115, RR 22. 4. 10:30a ? SpO2 = 97%, Pulse 118, RR 22. Pt felt a sensation in his throat now in the clavicle area. He took a sip of water and had some more difficulty swallowing it. 5. 10:35a - SpO2 = 97%, Pulse 115, RR 22. Sensation in clavicle area now improved, water slightly easier to swallow. 6. 10:40a ? BP 158/84, SpO2 = 97%, Pulse 118, RR 22. Sensation in his clavicle area/throat now feels worse. He had some more difficulty swallowing water. 7. 10:50a - BP 142/80, SpO2 = 97%, Pulse 122, RR 22. Sensation in clavicle area/throat and difficulty swallowing water are all the same as previously stated. Gave liquid Zyrtec 10mg. 8. 11:10a - BP 142/70, SpO2 = 98%, Pulse 114, RR 20. Sensation in throat slightly improved. 9. 11:30a - BP 134/78, SpO2 = 98%, Pulse 110, RR 20, T 98.4 F. Sensation in throat slightly improved. 10. 11:54a - BP 122/86, SpO2 = 98%, Pulse 105, RR 20. No changes. 11. 12:15p ? BP 126/84, SpO2 = 98%, Pulse 107, RR 20. Pt walked to the bathroom, a little lightheaded, but it improved after standing and walking around. Throat sensation mostly improved and Dr. OK?d him to leave. He had two epi pens with him and instructed to use it if throat symptoms worsen, then call 911.

Other Meds: Prednisone, Zyrtec, Amlodipine, famotidine

Current Illness: Swelling of lymph nodes, colon polyps

ID: 1821702
Sex: M
Age: 73
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821703
Sex: M
Age: 31
State: TX

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1821704
Sex: F
Age: 56
State: NM

Vax Date: 10/22/2021
Onset Date: 10/24/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies: Melons, peaches, shrimp, wheat, apricots, bananas

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

Symptoms: pain and swelling right arm pit. Treated with warm compresses. At this point it seems to be resolving.

Other Meds: Vitamin D, Allegra

Current Illness:

ID: 1821705
Sex: M
Age: 83
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821706
Sex: F
Age: 28
State: CA

Vax Date: 04/27/2021
Onset Date: 10/08/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data:

Allergies: NA

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

Symptoms: Expected due date 12/6/2021. Experience unexpected heavy bleeding on 10/08/2021. Hospitalized for 4 days, cause of bleeding was unknown. Potentially placenta tear or blood vessel burst. No issues with pregnancy up until this event.

Other Meds: Prenatal vitamins

Current Illness: NA

ID: 1821707
Sex: F
Age: 78
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821708
Sex: F
Age: 78
State: WI

Vax Date: 08/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data:

Allergies: Melon, Niacin, Cilantro, Fire ants, pineapple, wasp venom, tramadol, papaya derivatives, sulfa antibiotics, amoxicillin-pot clavulanate, fosamax, hydroxyzine, lotensin

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

Symptoms: Pt received 3 doses of the Pfizer COVID-19 vaccine (initial 2 dose series and immunocompromised 3rd dose. Received on 2/4/2021, 2/24/2021, and 8/18/2021 respectively). Pt still contracted COVID and was ill enough to be hospitalized. Symptom onset of 10/13/2021, tested positive 10/18/2021 and admitted to hospital. **Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient with symptom onset 10/13/2021 with positive Covid test 10/18/2021. Patient is up-to-date on SARS-CoV-2 mRNA vaccine series including recent booster dose, but notably patient is immunosuppressed on chronic immunosuppressive medications. Patient with rapid respiratory decline, initially on room air, progressed rapidly to higher needs. Initial chest x-ray with bilateral opacities, right greater than left with progressive bilateral airspace opacities on repeat chest x-ray 10/20/2021. -Started on dexamethasone 6 mg daily on 10/18/2021, but with progressive respiratory decline, increased to 10 mg twice daily 10/20/2021. Decreased to 6mg twice daily, by mouth, on 10/27. -Remdesivir initiated 10/18, completed 5-day course on 10/22/2021 -Continue baricitinib, started 10/20/2021 with progressive respiratory decline. Plan for 14-day course or until discharge (whichever shorter) -prone positioning as tolerated -Continue supplemental O2. If progressive O2 requirements, would likely need transition to PAP therapy, but not agreeable to intubation if needed for further respiratory decline. -Symptomatic therapies with as needed Tylenol, albuterol -CRP and D-dimer have down trended. No ongoing monitoring needed at this time. -Saline nebulizer treatments, Aerobika, and guaifenesin for mucolytics

Other Meds: azelastine nasal spray, calcium citrate w/ vitamin D, denosumab, diclofenac, dicyclomine, fluticasone-salmeterol, gabapentin, levoceterizine, losartan, mycophenolate, omalizumab, sertraline, trazodone, vitamin D

Current Illness:

ID: 1821709
Sex: M
Age: 60
State: MN

Vax Date: 04/22/2021
Onset Date: 05/15/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Z-Pac Antibiotics for 5 days; Prednisone; Cardiologist; Nuclear Cardiac stress test; COVID Test; Blood Panel

Allergies: Sulfate Drugs and Atorvastatin Calcium

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

Symptoms: It started with a fever, cough, congestion, shortness of breathe. It had me feeling rotten. It was a lot of upper respiratory. Tried and muscle aches, pain and fatigue.

Other Meds: Tylenol; Vitamin D3; Amiloride; Vitamin C; Atenolol; Citalopram; Clonazepam; Ibuprofen; Viscera; Lisinopril; Loratadine; Singular; Pseudoephedrine; Simvastatin; Trazodone and Impresa Ellipta.

Current Illness: Bronchitis and Allergies

ID: 1821710
Sex: F
Age: 78
State: UT

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 10/27/2021
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: 1821711
Sex: M
Age: 73
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821712
Sex: F
Age: 57
State: AL

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: N/A

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt. states that after receiving the 2nd dose of Moderna 09/30/2021, started experiencing symptoms 10/01/2021 of dry skin at the injection site, discoloration, nausea, fatigue, and loss of appetite. Primary visit noted for 11/03/2021, still continuing to experience symptoms.

Other Meds: Over the counter Allergy Medicine

Current Illness:

ID: 1821713
Sex: F
Age: 60
State:

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

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

Lab Data:

Allergies: None.

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

Symptoms: Anxiety, itching in the right arm, odd sensation in the right side of face and neck.

Other Meds: None.

Current Illness:

ID: 1821714
Sex: F
Age: 23
State: MI

Vax Date: 05/01/2021
Onset Date: 08/13/2021
Rec V Date: 10/27/2021
Hospital: Y

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: CT scan blood work stool done.

Allergies: latex, tree nuts, z-Pac, fruits

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

Symptoms: I had serve colitis. I had pain, lost weight, and diarrhea. I also had a fever. My whole gastrointestinal system was swollen. These symptom lasted for about a month. I was hospitalized for 4 days. I had a CT scan, blood work, and stool sample done. It went away and now it is back.

Other Meds: Cingular, keratin , omeprazole, birth control

Current Illness: N/A

ID: 1821715
Sex: F
Age: 33
State: TX

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/27/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1821716
Sex: M
Age: 66
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: Chills, Dizziness, Injection site pain, Myalgia, 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: 1821717
Sex: F
Age: 92
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821718
Sex: M
Age: 90
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821719
Sex: M
Age: 91
State: UT

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

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, 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: 1821720
Sex: F
Age: 61
State: MI

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/27/2021
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: No Adverse Event. Vaccination Administration Error: We received Moderna Vaccine on 9/2/2021 from our local health. The expiration date for Lot # 005C21A was 10/22/2021. We were under the impression that we had until 10/22/2021 to use the vaccine. The vaccine was properly stored in the refrig. with the data logger to ensure temperatures remained within range. No excursions occurred. We learned today (10/27/2021) from the local health department, that we should have discarded the vaccine (Lot # 005C21A) on 10/2/2021 (30-days after receivership with refrig. storage). We were instructed to contact Moderna, this was done today. During this call the writer was informed that we would hear Medical Affairs Team with further instructions on how to handle this matter. We have informed out local health dept of our contact to Moderna regarding this issue.

Other Meds:

Current Illness:

ID: 1821721
Sex: M
Age: 41
State:

Vax Date: 10/13/2021
Onset Date: 10/15/2021
Rec V Date: 10/27/2021
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: Patient called the pharmacy on 10/15/21, 2 days post vaccination, to report rash on shoulder area above injection site. Reports it is not red and can not be seen unless looking at it the "right way". Not painful, swollen or itchy. Just bumps about size if his hand.

Other Meds:

Current Illness:

ID: 1821722
Sex: F
Age: 71
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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 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: 1821723
Sex: F
Age: 83
State: PA

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/27/2021
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: Patient entered the pharmacy and asked for a flu shot. She was given the paperwork and she marked influenza. She was given a flu shot. When she was scanning her label out she told the cashier she already had her flu shot and wanted a COVID vaccine.

Other Meds:

Current Illness:

ID: 1821725
Sex: F
Age: 67
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821726
Sex: M
Age: 28
State: AZ

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/27/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient received .5ml instead of the recommended .25ml of moderna

Other Meds: Unknown

Current Illness: None

ID: 1821727
Sex: M
Age: 79
State: KY

Vax Date: 03/31/2021
Onset Date: 10/19/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Covid positive out of town travel....town

Other Meds:

Current Illness:

ID: 1821728
Sex: F
Age: 61
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821729
Sex: F
Age: 72
State: NY

Vax Date: 10/24/2021
Onset Date: 10/24/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Had a fever of 101 the nights following each of my first two previous Moderna vaccines, as well as soreness at the site of the injection. All was resolved in about 24 hours. The reaction to this 3rd dose was MUCH greater, even with 100 mg/Tylenol every 6 hours. The vaccine was administered at 2:30 pm. last Sunday. By midnight I had a fever of 102 with tremendous chills, and shakes so bad I could hardly walk or hold a cup of water. I also had nausea and diarrhea so was up all night. The next morning my fever was down to 100, and I was mostly just tired with minor body aches. Fever was gone by the afternoon. I slept well that night and was fine by the next day.

Other Meds: Losartan 50 mg daily

Current Illness: None

ID: 1821730
Sex: F
Age: 52
State:

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
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: Sulfa drugs

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

Symptoms: Lightheadedness, fever, low temperature, night sweats, headaches

Other Meds: VIVELLE DOT twice weekly

Current Illness:

ID: 1821731
Sex: F
Age: 68
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821733
Sex: F
Age: 50
State: KY

Vax Date: 04/16/2021
Onset Date: 10/19/2021
Rec V Date: 10/27/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Covid positive family contact.

Other Meds:

Current Illness:

ID: 1821734
Sex: M
Age: 69
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 1821735
Sex: M
Age: 44
State: VA

Vax Date: 06/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/27/2021
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: I don't have a doctor, so I can't get it treated. If I had a doctor and healthcare, I would go see them.

Allergies: none

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

Symptoms: After the 2nd shot, I couldn't lift my arm above my head for about 2.5 days. Then, it seemed to go back to normal. About a month later, I started getting a pain or stiffness in my neck that ran down to my shoulder on the side I got the shot. It's been constant; it hasn't gone away. It has lasted for about 4 months. It hasn't gotten worse, and it hasn't gotten better.

Other Meds: None

Current Illness: None

ID: 1821736
Sex: F
Age: 69
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: Pain in extremity

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: 1821737
Sex: M
Age: 49
State: MD

Vax Date: 04/23/2021
Onset Date: 08/30/2021
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: COVID test, positive result; They did a scan, they determined I had pneumonia; they admitted me to hospital.

Allergies: None known

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

Symptoms: I started to have chills and bad cough. I had a lot of fatigue. I thought it was seasonal allergies at first. We did COVID test, positive result. I ended up in the hospital for four days. It got much worse, I was struggling to breathe and was coughing a lot. I went to a local hospital ER. They treated me and they gave me an inhaler of Albuterol and something for the pneumonia when I went home. I went back to work after 6 weeks. But I still have shortness of breath and lots of fatigue. I am not taking any meds at this time specifically for COVID. I have had a follow up doctor appt and that's when he cleared me to go back to work.

Other Meds: Atorvastatin; hydrochlorothiazide; cholesterol meds; fish oil; vit D; loratadine; multivitamin

Current Illness: No

ID: 1821738
Sex: F
Age: 47
State: TX

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/27/2021
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: With the booster shot my lymph nodes on the same side as injection are swollen and painful

Other Meds: None

Current Illness: None

ID: 1821739
Sex: F
Age: 66
State: NJ

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: NA

Allergies: iodine, pneumococcal 23 vaccine

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

Symptoms: spoke with patient she is experiencing an itchy arm, redness around the site, and soreness. she did notice a little swelling and has a lump the size of a plum. per Dr apply a cold compress, monitor for a fever, take ibuprofen and Zyrtec for pain and itching.

Other Meds: NA

Current Illness: NA

ID: 1821740
Sex: F
Age: 38
State: MD

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa

Symptom List: Vomiting

Symptoms: I was vaccinated on Wednesday, 10/20/21 at about 11am and woke up with a headache and chills on 10/21/21. At about 6pm on 10/21/21 I felt like my heart was racing, and my fitness watch showed that my heartrate was in the 120s-140s with little to no activity. I did not have any chest pain, shortness of breath, or dizziness, and the tachycardia had resolved by the following morning. I also noticed the night of 10/21/21, around 8pm that I had lymphadenopathy in my left axilla. It improved significantly by 10/23/21, but has not yet fully resolved.

Other Meds: Multivitamin, Krill oil

Current Illness: none

ID: 1821741
Sex: M
Age: 61
State: UT

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/27/2021
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: 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: 1821742
Sex: F
Age: 85
State: MI

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/27/2021
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: No Adverse Event Vaccination Administration Error: We received Moderna Vaccine on 9/2/2021 from our local health department. The expiration date for Lot # 005C21A was 10/22/2021. We were under the impression that we had until 10/22/2021 to use the vaccine. The vaccine was properly stored in the refrig. with a data logger attached to ensure temperatures remained within required range. No excursions occurred. We learned today (10/27/2021) from the local health department, that we should have discarded the vaccine (Lot # 005C21A) on 10/2/2021 (30-days after receivership with refrig. storage). We were instructed to contact Moderna Tx, LLC. this was done today. During this call this writer was informed that we would hear from the Medical Affairs Team to obtain further instructions regarding how to handle this issue.

Other Meds:

Current Illness:

ID: 1821743
Sex: F
Age: 21
State: NC

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/27/2021
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: Blood work, CT scan, chest x-ray, and EKG performed on 10/26/21. All negative for heart attack and pulmonary embolism.

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: A couple hours after receiving the vaccine chest pains started. Originally thought was heartburn but that did not respond to medication. Went to urgent care who sent me to the ER for further tests. My heart rate and blood pressure where extremely high upon arrival. The doctors ordered blood work, EKG, chest x-ray, and CT scan to rule out heart attack. My blood pressure and pain was brought down by dosage of nitroglycerin. My heart rate remained high and was slightly lowered by 2 liters of saline IV. I was sent home with a heart monitor that I have to wear for two weeks and a follow up with a cardiologist for tachycardia.

Other Meds: Birth Control--Larin Fe 1.5/30

Current Illness: none

ID: 1821744
Sex: F
Age: 68
State: LA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/27/2021
Hospital:

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

Lab Data: Not necessary

Allergies: Nsaids

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

Symptoms: Large egg size hard lump at injection site. Red and sore, painful to touch. Noticed about 5 hrs. after injection. Got larger around 3 am. 24hrs later still hard and red. Painful to touch. 3 days later lump is smaller and not as hard. Still red and not as sore Muscle aches and fatigue lasted about 36 hrs.

Other Meds:

Current Illness:

ID: 1821745
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/27/2021
Hospital: Y

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

Lab Data: CT, CTA, MRI, MRI with contrast, and echocardiogram- (all performed on 10/21/21) - all had no findings.

Allergies:

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

Symptoms: Woke up with global speech aphasia and left sided weakness at 5:45 am the morning after injection. Saw primary care provider with also high blood pressure (145/104 ). Referred to ER for possible stroke and had CT, CTA, MRI, and echocardiogram performed. All had negative findings. Transferred to another hospital for observation and follow up MRI same night with contrast- negative findings. Hospitalist prescribed aspirin 81 mg for 30 days with discharge diagnosis of possible flu vaccine reaction and TIA.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am