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: 1826312
Sex: F
Age: 61
State: IN

Vax Date: 10/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/a

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Increasing levels of fatigue since the booster shot. Also increasing muscle aches in arms and legs

Other Meds: Escitalopram Iron supplement

Current Illness: None

ID: 1826313
Sex: M
Age: 59
State: CO

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Contrast Dye

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever 101 ? Chills ? Muscle ache and headache ? Flu-like symptoms SKIN HURT. It hurt to wear clothes and to lie down on the bed. I had to urinate frequently a teaspoon or so but it was painful enough to wake me up.

Other Meds: Levothyroxine 0.075 mg Montelukast 10 mg Otezla 30 mg 2 x per day Vitamins A, B, C, D Fish Oil

Current Illness: ?

ID: 1826314
Sex: F
Age: 44
State: OH

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: Yes

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

Symptoms: This Covid shot has me so sick. I?m having the shortest of breath, bad back pain, joint pain and body aches. Chills, fever of 101.1, I felt faint today, sharp lower abdomen pain, sharp pain going down my arms and migraine headaches

Other Meds: No

Current Illness: No

ID: 1826315
Sex: M
Age: 65
State: FL

Vax Date: 10/27/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: left eye -inner muscle pain corner of eye socket and towards the nose upwards during mid sleep, light redness, pain lasting all day, vision blurred. Never had an eye problem before or computer/tv before sleep. I avoided sleeping on left arm, on my back, and woke twice with soreness building by 8am., eye was red and painful to touch the inner corner socket and nose muscle. After washing the pain stayed and the lid was slightly dropped, vision 25% blurred and pain during closing of eye, muscles felt tighten. All lasted the full day.

Other Meds: early 9am, 1-vitamin d/2000 and a potassium 595mg pill.

Current Illness: none

ID: 1826437
Sex: F
Age: 69
State: TX

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: PATIENT RECEIVED MODERNA BOOSTER VACCINE MONDAY AFTERNOON, THEN STATED THAT SYMPTOMS STARTED THE FOLLOWING DAY. PATIENT'S INJECTION SITE BECAME SWOLLEN, RED, HARD AND PAINFUL TO TOUCH AND PATIENT IS STILL EXPERIENCING THESE SYMPTOMS AS OF TODAY (THURSDAY). PATIENT DID NOT REPORT ANY SYMPTOMS OF FEVER, CHILLS OR PUS AT THE SITE. PATIENT WAS ADVISED TO CONTACT DOCTOR TO DETERMINE IF IT IS A HYPERSENSITIVITY REACTION OR CELLULITIS AND ALSO ADVISED INTERIM MANAGEMENT OF SYMPTOMS WITH ICE PACK, ORAL ANTIHISTAMINE, ARM ELEVATION AND MONITORING OF REDNESS PERIMETERS.

Other Meds:

Current Illness:

ID: 1826438
Sex: M
Age: 73
State: CO

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: The patient presented to the health clinic on 10/25/21 for a Moderna booster. The RN administered a (.5ml) full dose Moderna vaccine. The patient was notified of the error and denied any side effects at that time. He was advised to call the health department with any questions or concerns.

Other Meds:

Current Illness:

ID: 1826439
Sex: F
Age:
State: NM

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: 10/28/21

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: VACCINE WAS GIVEN ON 10/04/21 AND PT EXPIERENCED PAIN ON BACK OF LEFT KNEE. CALLED PHARMACIST AND PRIMARY DR AND BOTH TOLD HER HAD A HIGH CHANCE OF BEING AN ADVERSE REACTION TO MED. PAIN DID NOT GO AWAY . SHE WENT TO ORTHOPEDIC ON 10/28/21 AND WAS DIAGNOSED OF HAVING A BAKERS CYST. SHE CAME TO PHARMACY AND I INFORMED HER WE WILL FILL OUT VAERS FORM . SHE HAS NEVER RECEIVED THIS VACCINE OR A HIGH DOSE PREVIOUS TO THIS .

Other Meds: Amoxicillin

Current Illness:

ID: 1826441
Sex: F
Age: 53
State: IL

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: no tests were performed, throat was clear on exam, on self exam felt residual lymph nodes enlargement and tenderness on day 3, improving.

Allergies: Penicillin, Ibuprofen

Symptom List: Pharyngeal swelling

Symptoms: Stingling for over 2 hours at the site of injection. The next day deltoid tenderness and axillary tenderness, pain on lifting the arm, tender swelling in the axillare are on side of the injection, that lasted for for the next day, but started to go away on day 3. Also had vague headache and sore throat with dysphagia the next day after injection and feeling tired- all resolved on day 3.

Other Meds: DIM, Omega3/CoQ 10, Probiotic, Zinc, Multivitamin, Iodine. Testosterone and Estrogen sq pellets for over 3 years, Progesteron oral capsule for over 3 years

Current Illness: none

ID: 1826442
Sex: F
Age: 44
State: MA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: Morphine, Lactose Intolerant

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe itching that started at injection site to my whole body. Pain, swelling, redness, and lump at injection site also. Noticed a big red circle on opposite arm (left) that was very itchy. The itching started maybe an hour or so when I took bandaid off after injection to present, just not as bad. Took Benedryl per pharmacist and spoke with triage nurse at doctor's office. Also been in contact w/ Dr. via portal. Advised to call office the next am if needed (too late to be seen) and/or go to ER if throat closes or sob. Dr. Sent script for Hydroxyzine for the itching. As of today, 10/23, feeling much better. Some itching but very mild. Lump on arm going down as well as redness and swelling. Left arm appears to have improved also.

Other Meds: Aspirin Pantoprazole Bupropion Paroxetine Lorazepam Verapamil Potassium Citrate Norethindrone BCP Hydrochlorothiazide Vitamin B6 Vitamin B12

Current Illness:

ID: 1826443
Sex: F
Age: 62
State: CA

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 10/28/2021
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: Klonopin -tachycardia in early 30s. Flea bites ,

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Approx 13 - 14 hours after 0900 injection , low grade fever under 100 deg F and great fatigue. Next morning continued fever, gradual increase in substantial joint pain, muscle ache and slowly intensifying headache. By evening could not tolerate intense headache and took Ibuprofen 400mg. Symptoms worsened the following day but tried not to take medication since advisories were not encouraging it so vaccine would work at that time. By Tuesday began feeling better and each day felt better, but L arm still sore and edematous. By Friday, felt fine. Vaccine symptoms switched off like a light switch. Returned to work following Monday 1/11/21 without a problem. I will describe Dose 2 in another report.

Other Meds: Calcium, D3, Vit C

Current Illness: none Verifiable: Never called in sick to work as outpatient Physical Therapist for 10 YEARS.

ID: 1826444
Sex: F
Age:
State: MO

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A.

Allergies: N/A

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

Symptoms: Fainted three times the morning after vaccine (between 6:45-7:15 am); slight fever and chills following fainting episodes. I drank water, took ibuprofen and went back to bed. Then I got up at 2 pm, no further fainting or dizziness.

Other Meds: N/A

Current Illness: N/A

ID: 1826445
Sex: M
Age: 60
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Client received Pfizer as first dose and Moderna as second dose in primary series. Pt was monitored post vaccination for 15 minutes, no adverse events noted.

Other Meds: None

Current Illness: None

ID: 1826446
Sex: F
Age: 50
State: MD

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: I did not report the symptoms to my physician at the time or seek medical attention. The symptoms were similar to the ones I would get after taking a flu shot. I only got a mild tingling of the tongue after the first two doses. The reactions I got after this booster shot are way more pronounced and now I am developing a generalized rash. I have not had a rash of any kind prior to now. I work as an LPN. Routine COVID-19 testing was done on Thursday 10/14/21, it was negative.

Allergies: None

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

Symptoms: Tingling of the tongue, racing pulse (104 to 112 resting), abscess in left armpit for a week, difficulty walking for two days (was off Tuesday 10/12/21 ) - I work nights and had to call off work on the night of Wednesday 10/13/21 because I found it difficult to walk or stand.

Other Meds: Vitamins D3, C, Iron, allergy

Current Illness: None

ID: 1826447
Sex: F
Age: 63
State: MD

Vax Date: 10/24/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: no real adverse reactions symptoms the side effects listed for the vaccination- fever

Other Meds:

Current Illness:

ID: 1826448
Sex: F
Age: 72
State: CA

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: Diagnosed Shellfish, but I eat them with no problem

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

Symptoms: A bump like swelling over my right clavical

Other Meds: 6 mg. Atorvastatin, Hyaluronic acid capsules, calcium, Vit D, half multi vitamin, CQ10, Vitamin C.

Current Illness: No

ID: 1826449
Sex: F
Age: 32
State: NY

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: None

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

Symptoms: Extreme tooth sensitivity. Temperature doesn?t matter. Drinking room temp water causes extreme discomfort as well. I?ve never had sensitive teeth prior to this.

Other Meds: None

Current Illness: None

ID: 1826450
Sex: M
Age: 67
State: CO

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: The patient presented to the health department on 10/25/2021 for a Moderna booster. The RN administered a full- dose (.5ml) Moderna vaccine. The patient was notified of the error. He denied any side effects at that time and was advised to call the health department with any questions or concerns.

Other Meds:

Current Illness:

ID: 1826451
Sex: M
Age: 42
State: NY

Vax Date: 05/21/2021
Onset Date: 10/01/2021
Rec V Date: 10/28/2021
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: Tinnitus

Other Meds:

Current Illness:

ID: 1826452
Sex: F
Age: 55
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. All patients were notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826453
Sex: M
Age: 72
State: NE

Vax Date: 09/29/2021
Onset Date: 09/01/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: No known food or drug allergies per Informed Consent to Receive Vaccine form

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

Symptoms: Bruising around injection site in days following vaccine administration. Tremor in arm in days following that.

Other Meds:

Current Illness:

ID: 1826454
Sex: F
Age: 42
State: MO

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/28/2021
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: HAD NUMBNESS AND TINGLING DOWN THE ARM THAT LASTED <24 HOURS

Other Meds:

Current Illness:

ID: 1826455
Sex: F
Age: 69
State: TX

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Unevaluable event

Symptoms: SWELLING AND REDNESS AT INJECTION SITE

Other Meds:

Current Illness:

ID: 1826456
Sex: M
Age: 17
State: OR

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: elevated troponin I 1813 ng/L

Allergies: none

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

Symptoms: chest pain, shortness of breath, likely myocarditis

Other Meds: none

Current Illness: none

ID: 1826457
Sex: M
Age: 70
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. All patients were notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826458
Sex: F
Age: 84
State: CO

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Woman presented to the Health Department on 10/25/21 for a Moderna booster. The RN administered a full-dose (.5ml) Moderna vaccine. The patient was notified of the error and denied any side effects at that time. She was advised to contact the health department with any questions or concerns.

Other Meds:

Current Illness:

ID: 1826459
Sex: M
Age: 70
State: AZ

Vax Date: 03/13/2021
Onset Date: 10/09/2021
Rec V Date: 10/28/2021
Hospital: Y

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: diagnosed with acute metabolic encephalopathy, myelitis with acute ascending lower extremity weakness, fever chills tremors headache, West Nile virus IgM positive, in serum and CSF, status post Plex treatment as CSF not indicative of GBS. Afib with RVR.

Other Meds:

Current Illness:

ID: 1826460
Sex: M
Age: 72
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: none

Allergies: UNKNOWN

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt received 0.5ml should have recieved 0.25ml

Other Meds: NONE

Current Illness: UNKNOWN

ID: 1826461
Sex: M
Age: 67
State: OH

Vax Date: 04/12/2021
Onset Date: 05/03/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: She said that 3 weeks to the day after she had the J& J shot on 4/12/21 she woke up with a sore left outer leg and then the pain went away and moved to her chest and then moved to her head. She wondered if she had a blood clot or was having a stroke and then the pain went away within a half an hour.

Other Meds: unknown at time

Current Illness:

ID: 1826462
Sex: F
Age: 35
State: WI

Vax Date: 04/16/2021
Onset Date: 05/01/2021
Rec V Date: 10/28/2021
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: Amoxicillin

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

Symptoms: Changes to menstrual cycles after vaccination. Heaviest cycles ever experienced in my life. Still experiencing 6 months later.

Other Meds: Multivitamin

Current Illness: N/a

ID: 1826463
Sex: F
Age: 15
State: MO

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/28/2021
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: Numbness and tingling went down the arm. It resolved in less than 24 hours.

Other Meds:

Current Illness:

ID: 1826464
Sex: F
Age: 34
State: LA

Vax Date: 09/30/2021
Onset Date: 10/05/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Video call appointment with dermatologist 10/25/2021

Allergies: Adhesive

Symptom List: Injection site pain

Symptoms: Pityriasis rosea, steroid cream, ongoing

Other Meds: Senna tablets

Current Illness: N/A

ID: 1826465
Sex: F
Age: 91
State: IA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Patient received 1st Pfizer dose on 1/14/21 and 2nd dose on 2/4/21. RN arrived to assisted living facility to vaccinate residents. Was given patient's vaccination card which listed Pfizer doses #1 and #2 and administered Pfizer boost dose on that day--10/28/21. After arriving back to office and entering vaccination into IRIS immunization system, noted patient had received a Moderna vaccine on 9/13/21. Notified RNs at assisted living facility and instructed to monitor patient. Assisted living RN reported no signs/symptoms/concerns per patient on 10/28/21 at 6pm.

Other Meds:

Current Illness:

ID: 1826466
Sex: F
Age: 69
State: CA

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin

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

Symptoms: Woke up at 3am with a very severe headache 10 hours after the shot. Lasted all day and I was nauseated and vomiting I called the doctor on call and was told to take Tylenol which I did and started to feel better. The headache lasted for two more days but not nearly as intense

Other Meds: Actos Benicar Dulera Lipitor Metformin Norvasc Pepcid Singulair Wellbutrin Zoloft Vitamin D

Current Illness: None

ID: 1826467
Sex: F
Age: 42
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. All patients were notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826468
Sex: F
Age: 77
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. All patients were notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826469
Sex: F
Age: 80
State: MI

Vax Date: 03/05/2021
Onset Date: 10/24/2021
Rec V Date: 10/28/2021
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: Augmentin [Amoxicillin-pot Clavulanate]Joint Pain GabapentinDizziness Lisinopril [Ace Inhibitors]Cough Reglan [Metoclopramide]Agitation Pravastatin

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

Symptoms: Hospitalized (10.24.21); COVID-19 positive (10.24.21); Fully vaccinated Discharge Provider: MD Primary Care Provider at Discharge: MD Admission Date: 10/24/2021 Discharge Date: 10/25/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia [E87.1] Generalized weakness [R53.1] Diarrhea, unspecified type [R19.7] COVID-19 [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is an 81-year-old female who presents with complaints of diarrhea and weakness. The patient tested positive for COVID on admission which is likely the cause of her diarrhea. Patient was also noted to be hyponatremic on presentation. Patient's hyponatremia was likely secondary to hypovolemia. With IV fluid administration the patient's sodium return to a normal range. The patient was feeling significantly better and reported improvement of her diarrhea. She was tolerating a normal diet and eager to be discharged home today. We discussed recommendations for follow-up including a repeat BMP. Questions have been answered to the patient's satisfaction and she is being discharged home in stable and improved condition. The patient recovered faster than anticipated leading to a faster than anticipated discharge Plus another ED visit on 10.26.21 - for COVID-19 and acute lower urinary tract infection

Other Meds: acetaminophen (TYLENOL) 500 MG tablet ALPRAZolam (XANAX) 0.5 MG tablet Calcium Acetate, Phos Binder, (CALCIUM ACETATE PO) cholecalciferol (CHOLECALCIFEROL) 1000 units famotidine (PEPCID) 40 MG tablet Ferrous Sulfate (IRON) 325 (65 Fe) MG TA

Current Illness: 10.15.21: ED - vaginal infection ; infected pessary

ID: 1826470
Sex: M
Age: 77
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster at Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. Patient was notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826471
Sex: F
Age: 36
State: NJ

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: Shot at 930 am. 8 pm started getting sharp cramps / pain in lower stomach. By 930 I had chills, teeth chattering, body aches. Stomach pain increased. Felt similar to birthing contractions. Woke up with headache, body so sore I could hardly walk around or sit. No appetite or energy all day. random stomach pangs throughout the day.

Other Meds: Levotheroxin

Current Illness: None

ID: 1826472
Sex: F
Age: 69
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. Patient was notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826473
Sex: M
Age: 30
State: DE

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: none reported

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

Symptoms: patient became lightheaded within minutes of receiving vaccine and had to lay down. he began to feel better a few minutes later

Other Meds: unknown

Current Illness: unknown

ID: 1826474
Sex: F
Age: 86
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: Unknown

Symptom List: Pain in extremity

Symptoms: Patient received 0.5mL full dose instead of 0.25mL.

Other Meds: Unknown

Current Illness: Unknown

ID: 1826475
Sex: F
Age: 37
State: CA

Vax Date: 07/02/2021
Onset Date: 08/16/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: amoxicillin

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

Symptoms: My periods for the month of August and September were extremely heavy.

Other Meds: None

Current Illness: None

ID: 1826476
Sex: M
Age: 81
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster at Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. Patient was notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826477
Sex: F
Age: 86
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. Patient was notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826478
Sex: F
Age: 85
State: MI

Vax Date: 06/08/2021
Onset Date: 10/21/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data:

Allergies: Labetalol [Beta Adrenergic Blockers]Other LisinoprilOther Penicillins Sulfa Drugs

Symptom List: Vomiting

Symptoms: Hospitalized (10.24.21 - still admitted); COVID-19 positive (10.21.21); fully vaccinated HISTORY OF PRESENT ILLNESS: Patient is a 86 y.o. female with past medical history significant for atrial fibrillation, hypertension, and CKD stage 3 who presented initially to the hospital. The patient tested positive for COVID-19 on 10/20/2021. Her symptoms started on 10/14/2021 with cough. The patient denies any shortness of breath or chest pain. She denies any nausea, vomiting or abdominal pain. The patient typically gets checked on regularly by her neighbors her neighbor went to check on her today and the patient was "more less collapsed in her arms". EMS was notified. When EMS arrived, the patient was hypoxemic with oxygen saturation of 79% on RA and HR was greater than 170. In the ED, her HR was was in the 170s. Systolic BP was in the 80s to 90s. She was afebrile. Labs were significant for Na-133, K-3.2, BUN-53, and Cr-1.85. Pro-BNP was 7,051 and lactic acid was 3.0. WBC-12.06. CXR showed prominent lung markings bilaterally may represent inflammatory changes secondary to COVID-19. No gross lobar infiltrates. Cardiomegaly with right heart prominence. EKG showed A. Fib with RVR. HR was 156. The patient was started on amiodarone gtt. She was given decadron. She was transferred to another Hospital for further evaluation and management. The patient is a poor historian and history was obtained from the emergency department physician and medical records. Acute hypoxic respiratory failure-likely secondary to COVID-19 pneumonia CXR shows prominent lung markings bilaterally may represent inflammatory changes secondary to COVID-19. No gross lobar infiltrates. Cardiomegaly with right heart prominence Will cont supplemental oxygen to maintain SaO2 greater than 90 The patient is on 6L of oxygen The patient has received Janssen vaccine on 6/8/21 Onset of symptoms: 10/14/21 COVID-19 PCR positive on 10/20 Will continue Decadron Daily COVID labs Will order Mucinex and benzonatate Albuterol inhaler Will monitor respiratory status closely Severe Sepsis-likely secondary to COVID-19 pneumonia Will follow-up blood ctx Monitor VS and CBC Lactic acid was 3.0 Will repeat lactic acid now. Progress note from 10/28/21: Acute hypoxic respiratory failure-likely secondary to COVID-19 pneumonia CXR shows prominent lung markings bilaterally may represent inflammatory changes secondary to COVID-19. No gross lobar infiltrates. Cardiomegaly with right heart prominence Will cont supplemental oxygen to maintain SaO2 greater than 90 Weaned to 2L The patient has received Janssen vaccine on 6/8/21 Onset of symptoms: 10/15/21 (had called PCP's office so note confirms that) - ok to remove isolation 10/27 COVID-19 PCR positive on 10/20 Will continue Decadron Daily COVID labs Will order Mucinex and benzonatate Albuterol inhaler Will monitor respiratory status closely

Other Meds: Bimatoprost (LUMIGAN) 0.01 % SOLN carvedilol (COREG) 25 MG tablet Coenzyme Q10 (COQ-10 PO) hydroCHLOROthiazide (HYDRODIURIL) 25 MG tablet losartan (COZAAR) 100 MG tablet rivaroxaban (XARELTO) 15 MG tablet saline (AYR) 0.65 % (Soln) SOLN

Current Illness: 10.24.21: ED - Patient is an 86-year-old female the past medical history significant for fibrillation. She recently was tested positive for COVID-19. Her symptoms started her on the 14th of October with a cough. The patient self cannot provide much in the way of additional history. She typically gets checked on regularly by her neighbors who more less of taking responsibility for her. Her neighbor went to check on her today and she ?more less collapsed in his arms?. EMS was notified. Upon arrival patient is found to be hypoxemic with oxygen saturations of 79% on room air and a heart rate of greater than 170. The patient herself cannot provide much in the way of additional history.

ID: 1826649
Sex: F
Age: 37
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: Problem: Patient was given the incorrect dose of 0.5 mL for Moderna Booster in Drive-thru Vaccine Clinic. Nurse was given the incorrect dose dispensed by the pharmacist. This inadvertent incident happened due to a lack of communication in training given to the Nursing staff from the Pharmacy team. Corrective Action: Nursing and Pharmacy has since been given a vaccine dose chart with correct dosing amounts listed for Moderna, Pfizer and Johnson & Johnson vaccines. Second, trays have been given to both teams to separate vaccine doses to prevent future error events. Lastly, Pharmacy is only preparing the Pfizer vaccine since it is standardized to 0.3 mL presently. Going forward, Pharmacy and Nursing will continue to work together to maintain open communication. Patient was notified of the incorrect dosing and given an opportunity to be seen in clinic by a provider if they remained concerned.

Other Meds:

Current Illness:

ID: 1826650
Sex: M
Age: 82
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: NONE

Allergies: NKA

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

Symptoms: NONE

Other Meds: ZOCOR, PRILOSEC, FLONASE

Current Illness: NONE

ID: 1826651
Sex: F
Age: 69
State: CA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: none

Allergies: unknown

Symptom List: Injection site swelling, Limb discomfort

Symptoms: patient recieved 0.5ml instead of 0.25ml

Other Meds: unknown

Current Illness: unknown

ID: 1826652
Sex: M
Age: 48
State: AZ

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Codeine

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

Symptoms: Chest pain, Difficulty breathing

Other Meds: Tamsulosin 0.4mg, Percocet 5/325, Amitriptyline 10mg, Duloxetine 30mg, duloxetine 60mg, Prazosin 5mg, Metformin ER 750mg, Pravastatin 40mg, Lidocaine/Prilocaine2.5/2.5% cream

Current Illness: Pain

ID: 1826653
Sex: F
Age: 69
State: MI

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Lost all motor function in legs and extreme weakness in arms, extreme headache

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am