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
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0917264
Sex: F
Age: 33
State: WI

Vax Date: 12/01/2020
Onset Date: 01/02/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: Niacin-itching

Symptoms: Left arm pit. Swollen painful lymph node

Other Meds: Viibryd 60mg q morning Cyclobenzaprine 2.5 mg q HS Clonazepam 0.5 mg q HS Birth control q morning Ibuprofen PRN

Current Illness: None

ID: 0917265
Sex: F
Age: 61
State: OH

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: Sulfa

Symptoms: Had redness and welt at injection site. Unmediated and arm sore for week. Redness and soreness leftwithin 5-6 Days. On day 8 injection site became red, raised, slightly warm and itching.

Other Meds: Lexapro, eye vitamin, d3, alieve, bio flex, Claritin, anastazole, HCTZ, zinc, magnesium, omeprazole

Current Illness: None

ID: 0917266
Sex: F
Age: 68
State: NH

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: NONE

Allergies: pcn,keflex,asa,effexor, ,,,lobster,shrimpvomiting also vomiting from sulfa,emycin

Symptoms: VERY SORE LEFT SHOULDER EVEN WHEN I LIFT MY ARM AND MY GLANDS ON MY LEFT SIDE OF NECK SORE NONE

Other Meds: tylenol,metoprolol,synthroid, calcium, vit d claritin

Current Illness:

ID: 0917267
Sex: F
Age: 35
State: MD

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: Moderate headache at night 12/30/20 Dry cough nonpersistent (AM), chills (PM) 12/31/20 Lost of taste/smell 01/02/21

Other Meds: Vitamin B-complex, Vitamin C

Current Illness: N/A

ID: 0917268
Sex: F
Age: 66
State: NY

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: none

Allergies: Pennicillin, Sulfa,Macrodantin,

Symptoms: Moderna COVID-19 Vaccine EUA fatigue,headache,chills,fever, aches tenderness at injection sight, pain

Other Meds: Daily Vitamin, Prozac,Tegretol,Dexilant,baclofen

Current Illness: none

ID: 0917269
Sex: F
Age: 22
State: FL

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: Penicillin

Symptoms: Fever, chills, muscle pain

Other Meds: Vyvanse 40mg, Balcoltra birth control tablets

Current Illness: None

ID: 0917270
Sex: F
Age: 55
State: OH

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Sore arm at site of vaccine, body aches, headache, nausea, fever, chills , muscle soreness

Other Meds: Daily Multi-Vitamin

Current Illness: None

ID: 0917271
Sex: M
Age: 80
State: FL

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Nothing yet

Other Meds:

Current Illness:

ID: 0917272
Sex: F
Age: 30
State: TX

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Wrist swelling - Intense pain while wrist was at rest, starting 2 says after the surgery. Pain dramatically decrease to tender the following day. Arm soreness - started a few hrs after injection. More intense pain and firmness at injection site the next day. Difficult to raise arm. Resolved the following day.

Other Meds: Syeda Birth control

Current Illness: None

ID: 0917273
Sex: F
Age: 30
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: Shellfish in 2011, anaphylactic reaction, bee sting allergic reaction as a child; carries Epi pen

Symptoms: Within 5 minutes of patient receiving the vaccine during her monitoring period, she complained of nausea and dry mouth, then dizziness; initial blood pressure 172/98, HR 126, RR 24 and O2 Sat 99% RA; activated EMS at 2:13pm; patient assisted to lie down on a cot, at 2:18 pm BP 142/88, HR 109, O2 sat 97%; c/o difficulty swallowing and feeling tightness in throat, no rash or hives seen; EMS arrived on site at 2:23 pm and evaluated patient in vehicle and then transported; contacted patient by phone at 7 pm on 3/31/2020 - was transported to Seton ER on 38th Street and received an antihistamine and medication for nausea, discharged at 5:00 pm and given new prescription for Epi pen since the one she had was expired; pt stated she felt much better

Other Meds: Nexplanon, diphenhydramine and acetaminophen on 12/30/2020 at night for headache

Current Illness:

ID: 0917274
Sex: M
Age: 83
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: none

Allergies: NKA

Symptoms: No adverse reaction. the staff were given what appeared to be COVID-19 vaccine based on tracking sheet. the label was not clear as to what the medication in bottle was. the medication in the bottle matched the color the medication was to be and the lot numbers

Other Meds: Lisimopril 40mg, daily; Plavix 75 mg. daily; Pravastatin 80 mg. daily; Atenolol 10 mg daily; ASA 81 mg daily

Current Illness: none stated

ID: 0917275
Sex: M
Age: 72
State: FL

Vax Date: 12/23/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: Creatine 1.67, CBC and chem profile basic normal. Sed rate 14

Allergies: Localized rash with Trulicity

Symptoms: Developed rather sudden onset of neck stiffness and pain and then subsequent occipital and then frontal headache. Over next 6 hours became exceedingly painful as to prevent sleep or finding a comfortable position to rest my head. Went to Hospital ER at 2am on 12/31/2020. Had normal CT brain scan and labs. Given IV reglan, then ativan(1 mg) then 25mg benadryl and a liter of fluids. BP was slightly elevated 150/90 (?). Had oral temp of 99.1. When ativan didnt help they gave me a dose of dilaudid and zophran and additional dose of ativan. Then sent me home with instructions to take valium 5mg tid, orphenadrine 100mg Bid, Tylenol 650mg to 1300 mg q8hr prn and lidocaine patch on neck 5%(also started in ER) q 24hrs. Discharge diagnosis was headache, intractable neck pain and torticollis.

Other Meds: Tresiba 19 units daily, Victoza 1.8 mg daily, Metformin 850mg Bid, Losartin 25mg Bid, atorvastatin 20mg daily,

Current Illness: None

ID: 0917276
Sex: F
Age: 39
State: IL

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Fever of 101, headache, sore arm

Other Meds: calcium, buproprion, fluoxetine

Current Illness: none

ID: 0917277
Sex: F
Age: 38
State: NJ

Vax Date: 12/26/2020
Onset Date: 12/27/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: 24 hours after injection, sore arm that lasted a day. day 4- lymph nodes around armpit of injection arm sore day 6 - bump on injection site still experiencing soreness on the left arm

Other Meds: nuvaring

Current Illness: none

ID: 0917278
Sex: M
Age: 73
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: sore arm for 2 days, no big deal

Other Meds:

Current Illness:

ID: 0917279
Sex: F
Age: 37
State:

Vax Date: 12/22/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Overwhelming fatigue/weakness

Other Meds: Dexilant, vitamin d, bentyl prn

Current Illness: None

ID: 0917280
Sex: M
Age: 54
State: IL

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vaccine received at ~830 on 12/30/20. At 1220am on 12/31, woke up shivering and freezing. Temperature was 103.1. Took a couple of Tylenol and retook my temp 40 mins later and it went up to 104.3. Then took some Advil and was able to get it back down to 103.1. was like that until about 530am and it started coming down 102, 101 and by 630 was 98.7. Had COVID in August. Feel perfectly fine by 0930 on 12/31.

Other Meds:

Current Illness:

ID: 0917281
Sex: F
Age: 36
State: TX

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: Nkda

Symptoms: Fatigue that night and the following 36hrs

Other Meds: Metoprolol 100mg daily, nifedipine 30mg daily, medroxyprogesterone 10mg q8h, prenatal vitamin 1 daily, vitamin d 5000 IU daily, vitamin c 1000mg daily

Current Illness: Menorrhagia

ID: 0917282
Sex: M
Age: 27
State: NJ

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Patient demonstrated adverse symptoms after covid vaccination manifested by: chills, headache, neck pain/stiffness, eye pressure.

Other Meds: N/A

Current Illness: None

ID: 0917283
Sex: F
Age: 97
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: Walnuts

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: None

Current Illness: gout, wears oxygen at home

ID: 0917284
Sex: F
Age: 28
State: PA

Vax Date: 12/26/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Diffuse rash on legs, buttocks, arms

Other Meds: None

Current Illness: None

ID: 0917285
Sex: F
Age: 50
State: TX

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Light-Headed

Other Meds:

Current Illness:

ID: 0917286
Sex: F
Age: 60
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: none

Allergies: None

Symptoms: headache within minutes of receiving the vaccine. Lasted 2 days

Other Meds: Zyrtec allergy

Current Illness: None

ID: 0917287
Sex: F
Age: 84
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Donepezil, Oxybutynin, Metoprolol, Divalproex Sodium

Current Illness: None

ID: 0917288
Sex: F
Age: 35
State: OR

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: POC rapid PCR Covid test negative today (01/02/20, ID Now machine) with no respiratory symptoms and no known exposures. No other risk factors or clinical explanation for symptoms.

Allergies: Mild kiwi fruit allergy

Symptoms: Fatigue, headache, chills, sweats and nausea beginning the day after vaccination 12/29. Symptoms constant, but intermittently waxing and waning in intensity. Did limit normal activities. Reported check ins. Currently day 5 of a symptoms and was sent home from work today.

Other Meds: Multivitamin

Current Illness: None

ID: 0917289
Sex: M
Age: 81
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: maybe PCN

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: high blood pressure, baby aspirin, allergy pill

Current Illness: None

ID: 0917290
Sex: F
Age: 31
State: FL

Vax Date: 12/22/2020
Onset Date: 12/29/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Developed pruritis and erythema surrounding the site of injection lasting approximately 48 hours before completely resolving.

Other Meds: None

Current Illness: None

ID: 0917291
Sex: F
Age: 29
State: NY

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: NONE LISTED

Symptoms: PATIENT COMPLAINED OF FUNNY FEELING AROUND THE NOSE AND INCREASED HEARTRATE SEEN APPROXIMATELY 20 MINUTES AFTER BEING VACCINATED. PATIENT THEN TOOK TWO BENADRYL 25MG TABS AND WITHIN 2 MINUTES HEARTRATE RETURNED TO NORMAL AND NO LONGER FELT FUNNY FEELING AROUND NOSE AREA.

Other Meds:

Current Illness:

ID: 0917292
Sex: F
Age: 52
State: SC

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: none

Allergies: sulfa drugs

Symptoms: After receiving the vaccine, my eyes got severely dry to the point I had to use drops. They felt like sand was blown in them.

Other Meds: cellcept, aspirin , plaquenil ,losartan, and norvasc

Current Illness: none

ID: 0917293
Sex: M
Age: 81
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Humalog, potassium, furosemide, isosorbide, eliquis, metoprolol, oxybutynin, synthroid, spironolactone

Current Illness: None

ID: 0917294
Sex: F
Age: 23
State: IL

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Palpitations, nausea around 0745, chills and headache around 1330, fever of 101, extreme fatigue, flushing, and nausea 1930 and on

Other Meds: None

Current Illness: None

ID: 0917295
Sex: M
Age: 63
State: AR

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: Nka

Symptoms: Deltoid muscle pain at injection site began D1; involvement extended to all upper arm musculature and elbow on around D3 and to distal arm around D5. Presently (D10) muscle involvement and severity is unchanged. Muscle pain is dull ache whereas injection site pain is sharp. No swelling or redness is noted. No fever, chills or other signs of infection, just myalgia and questionable arthralgia of joints.

Other Meds: Finasteride Pravastatin Tizanidine Omeprazole Famotidine Loratidine

Current Illness: None

ID: 0917296
Sex: F
Age: 54
State: TX

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache

Other Meds:

Current Illness:

ID: 0917297
Sex: F
Age: 37
State: IL

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data: NA

Allergies: NA

Symptoms: soreness in left arm (site of injection) vertigo on 1/1/2021 at 5:30pm (dizziness that prevented standing, nausea, extreme fatigue). Pt has never experienced vertigo before. On 1/2/21 some mild dizziness remains though the pt can resume normal activity in the home.

Other Meds: NA

Current Illness: none

ID: 0917298
Sex: F
Age: 87
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: PCN

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Amlodipine, hydrocholorathiazide, lisinopril, aspirin, metformin, sotalol, apixaban

Current Illness: None

ID: 0917299
Sex: F
Age: 38
State: IL

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: SEASONAL

Symptoms: IPSILATERAL TRAPEZIUS MUSCLE SPASM TREATED WITH IBUPROFEN AND HEAT STARTING ON 1/1/21 AND WORSENED ON 1/2/21

Other Meds: ZYRTEC FLONASE

Current Illness: NONE

ID: 0917300
Sex: F
Age: 42
State: NJ

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: Gluten sensitivities, Levequin, Keflex, Athmanex

Symptoms: Immediately: headache, feeling off/loopy, mild shortness of breath 45 min later: dry mouth, tongue swelling, mild fatigue, sinus pressure , shortness of breath 1 day later: redness injection site, moderate swelling or arm, mild head cold 2 days later: mild fatigue, sinus pressure, pain arm and redness of injection site

Other Meds: Symbicort, Allegra, Montelukast

Current Illness: Abscess in tooth was on amoxicillin for infection

ID: 0917301
Sex: F
Age: 77
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: NOne

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: blood pressure, cholesterol

Current Illness: None

ID: 0917302
Sex: M
Age: 81
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Parkinsons, blood pressure, cholesterol

Current Illness: None

ID: 0917303
Sex: F
Age: 38
State: ME

Vax Date: 12/26/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: PCN and Vancomycin

Symptoms: Injection given started to swell some and itch slightly after injection, better with band aid removed. Arm sore and bruised with in a few hours of injection on December 26th. Arm remained very sore and bruised at injection site until Wednesday December 30th around 1400 itching started at injection site, lasted about an hour and subsided. January 1st I woke up with the site really itching. Around 1400 on January 1st I noted a raised area around the injection side, no erythema noted. Erythema started around 1800 and was much darker by morning on January 2nd. Did not appear to be increasing in size. Left eye was also itchy on the same side as the injection in my left deltoid. These symptoms subsided some with 10 mg of Claritin.

Other Meds: Daily women's multivitamin

Current Illness: No

ID: 0917304
Sex: F
Age: 44
State: CO

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data: N/A

Allergies: N/A

Symptoms: I had a series of symptoms that culminated with a 103.9 fever at around 3:00 a.m., the morning after my first vaccination. Most symptoms were in the list of common side effects. What seemed different was how extreme my symptoms were extreme shivering and very high fever. The fever lasted several hours and seemed to go don rather quickly after shedding the layers I put on to manage the extreme shivering/chills, took two Advil, and used a cold compress on my head.

Other Meds: N/A

Current Illness: N/A

ID: 0917305
Sex: M
Age: 81
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us by National Guard. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and CDC website for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call from National Guard that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Oxybutynin 10mg, Synthroid 75mcg, Rosuvastatin 40mg, Ezetimibe 10mg, Mirtazapine 30mg, Doxazosin 1mg, Metoprolol ER 100mg, Losartan 100mg, Amlodipine 10mg

Current Illness: None

ID: 0917306
Sex: F
Age: 39
State: TN

Vax Date: 12/23/2020
Onset Date: 01/01/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: intolerant to foods due to inflammatory bowel disease-- no specific allergies

Symptoms: Moderna COVID-19 Vaccine EUA Flare-up of GI symptoms, including nausea, starting on 12/31/2020. Rash at and around injection site- red, raised, itchy, and hot to touch began 7:00 pm 1/1/2021, continuing at present time(1/2/2021 1:00 pm)

Other Meds: Budesonide 3mg, Lexapro 20 mg, Spironolactone 50 mg

Current Illness:

ID: 0917307
Sex: M
Age: 46
State: TN

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies:

Symptoms: Running 102.1 fever, Very sick Feeling Throwing up Very achy in the legs Very fatique Pain in Arm

Other Meds: Amlodopine Beyeselate, Amlodopine, Celexa, Prednisone, Ropinirole, Vitamin D3 IU2000

Current Illness: Tested positive for Covid10 on November 7th 2020

ID: 0917308
Sex: F
Age: 81
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: OTC Vitamins

Current Illness: None

ID: 0917309
Sex: F
Age: 36
State:

Vax Date: 01/02/2021
Onset Date: 01/02/2021
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient felt nauseated and dizzy; HR went from 48 (Normal for patient) up to 58 and remained at 58 until discharge; BP=80/42 and went up to 92/58 (normal for patient); patient given juice, water and crackers and stated she felt better; discharged with co-worker; alerted to contact ED with any excerbation of symptoms

Other Meds:

Current Illness:

ID: 0917310
Sex: F
Age: 64
State: NY

Vax Date: 12/09/2020
Onset Date: 12/09/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: biaxin

Symptoms: Patient started developing sore arm on 12/9/20. She states that there was no redness or swelling and that there isn't a specific sore spot, but it's the whole arm. She called to tell us about the soreness, we advised she contact her MD. MD advised her to alternate between ice and heat. She has been doing this but as of today's date, she still has the soreness. She states that it is temporarily relived by ice/heat, but not long-lasting.

Other Meds: famotidine 40mg alprazolam 1mg gabapentin 600mg buprenorphine 15mcg/hr prednisone 10mg cimizia 200mg/ml

Current Illness:

ID: 0917311
Sex: M
Age: 82
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: Plavix, Aspirin

Current Illness: None

ID: 0917312
Sex: F
Age: 41
State: FL

Vax Date: 12/01/2020
Onset Date: 12/24/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: First 48 hours -insertion site myalgia. 4-5 days later-dizziness, fatigue.

Other Meds: Levothyroxine, Paxil, spironolactone

Current Illness: None

ID: 0917313
Sex: F
Age: 93
State: WV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: No adverse event. We picked up what was supposed to be COVID-19 Moderna vaccine. Lot numbers and expiration date matched tracking sheet given to us. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers for the Moderna vaccine. Instead, the medication in the vial was actually COVID -19 antibodies meant for hospital use. After administration for 44 individuals, we received call that the medications had been mixed up. The vials and box that medication came in had no identifying factors to indicate it was not the Moderna vaccine.

Other Meds: blood pressure, synthroid, trazodone

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm