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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 0917314
Sex: F
Age: 52
State: MA

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

Lab Data: none

Allergies: none

Symptoms: Body Aches Swollen Arm at injection Headaches Chills High Fever for 24 hours

Other Meds: Citalopram HBR 20mg

Current Illness: none

ID: 0917315
Sex: F
Age: 52
State: PA

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

Lab Data: none

Allergies: flagyl

Symptoms: headache, chills, fatigue, nausea starting 1-2 hours after vaccine dose and lasting 7 days

Other Meds: synthroid, claritin

Current Illness: none

ID: 0917316
Sex: F
Age: 79
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, Metoprolol, Amlodipine, Cilostrazol

Current Illness: None

ID: 0917317
Sex: F
Age: 37
State: PA

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

Lab Data: None

Allergies: Allergic to penicillin

Symptoms: About 24 hours later I started having chills, then body and head aches with a swollen lymp node, low grade fever

Other Meds: None

Current Illness: None at the tome of the vaccine. After the vaccine I had a low grade fever, chills, head and body aches.

ID: 0917318
Sex: M
Age: 92
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: Warfarin, anxiety

Current Illness: None

ID: 0917319
Sex: F
Age: 85
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 WV 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 WV 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: Norvasc

Current Illness: None

ID: 0917320
Sex: F
Age: 85
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 WV 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 WV 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: Pantoprazole 40mg, Citalopram 10mg, Atorvastatin 80mg, Carvedilol 3.125mg, Magnesium 400mg, Vitamin D2 1.25mg, Levothroxine 75mcg, Prednisolone AC 1% eye drops, OTC Multivitamin, OTC Preservision, Zyrtec, Aspirin 81mg, Dimenhydrinate 50mg

Current Illness: None

ID: 0917321
Sex: F
Age: 35
State: MA

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

Lab Data:

Allergies: sulfa

Symptoms: slightly hardening of the skin with slight irritation, no treatment needed so far

Other Meds: prenatal multivitamin, 81mg ASA

Current Illness: none

ID: 0917322
Sex: F
Age: 40
State: OK

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

Lab Data:

Allergies: Vancomycin Levaquin Penicillin

Symptoms: Severe headache same day lasting for 36 hrs. Severe fatigue starting next day lasting 24 hrs. Severe headache starting again on day 4 lasting through day 5. Unable to focus, eat because of headache. Sore arm for 24 hrs post vaccine.

Other Meds: Spirinolactone Bupropion

Current Illness: No

ID: 0917323
Sex: M
Age: 56
State:

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data:

Allergies: lisinopril, morphine

Symptoms: abdominal pain starting two days after injection, testicular pain

Other Meds: Allopurinol, flonase, levothyroxine, loratadine, losartan, sildenafil PRN, tamsulosin

Current Illness: n/a

ID: 0917324
Sex: M
Age: 85
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 WV 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 WV 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: Levothyroxine 75mcg daily, Warfarin Sodium 2mg daily, Simvastatin 10mg daily, Amlodipine 5mg daily

Current Illness: None

ID: 0917325
Sex: F
Age: 64
State: CO

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

Lab Data: 12/31/2020 Covid 19 test-POSITIVE

Allergies: none

Symptoms: Hours after the vaccine developed cough, tiredness, neck aches, chills, headache, orbital pain, nausea. By that evening had fever 100.6 in addition to other symptoms. Next morning same symptoms. That afternoon, extreme tiredness along with prior symptoms. That evening fever 102.8. Next morning, exteremely dizzy, head foggy, orbital pain, minor cough. By Thursday no better so got covid test.

Other Meds: atorvastatin, citalopram, Vitamin C, B and zinc

Current Illness: none

ID: 0917326
Sex: F
Age: 68
State: NC

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

Lab Data: None

Allergies: Penicillin, Sulfa, Cipro

Symptoms: Usual vaccine response: swollen, red area on arm around injection site. Unusual response: aches throughout body, chills, perhaps mild fever. Aches prevented usual activities.

Other Meds: Yuvafem, Gabapentin, Aleve, Centrum Silver, Zyrtec, Tamaflex, Ipratropium Bromide Nasal Solution, Restasis, Systane Balance

Current Illness: None

ID: 0917327
Sex: F
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: 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: Allergy, aspirin, cholesterol

Current Illness: None

ID: 0917328
Sex: F
Age: 21
State: OH

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

Lab Data: N/A

Allergies: N/A

Symptoms: 1 week after receiving the vaccination, a red welt appeared on my arm where the injection was given. It was hot, raised and itchy and about an inch and a half wide and long. I drew a line around it. The next day it was less itchy and hot but had gone about half an inch outside the initial lines. The third/ fourth day it was barely raised at all but had gotten even larger, now about 1.5-2inches outside the initial lines in some areas. It is now barely raised, barely red and has not gotten any larger since yesterday.

Other Meds: Arnuity (asthma), Tilia FE (birth control),

Current Illness: N/A

ID: 0917329
Sex: F
Age: 76
State: TX

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

Lab Data:

Allergies:

Symptoms: Headache , Lightheaded

Other Meds:

Current Illness:

ID: 0917330
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:

Current Illness: None

ID: 0917331
Sex: F
Age: 38
State: NC

Vax Date: 12/20/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: NA

Allergies: azithromycin

Symptoms: delayed intermittent ache in L upper arm/shoulder/neck area.

Other Meds: b-complex, vitamin D, adderall, ginko, st. john's wart, colace, iron sulfate, flax seed oil, turmeric, CBD oil (THC-free)

Current Illness: NA

ID: 0917332
Sex: F
Age: 33
State: CA

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

Lab Data: n/a

Allergies: allergies to sulfa, walnut, allergic rhinitis

Symptoms: Within 2 hours of receiving the vaccine, patient had itchy throat, swollen lip which was confirmed on exam by ED physician and she received benadryl which resolve the event.

Other Meds: none

Current Illness: none

ID: 0917333
Sex: M
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: 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: Aspirin, Norvasc, Lisinopril, Hydrocholorthiazide, Iron, Protonix, Metoprolol,

Current Illness: None

ID: 0917334
Sex: F
Age: 38
State: GA

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

Lab Data: PR high 90s Diastolic BP high

Allergies: Dust mite

Symptoms: Heart rate raced, felt light headed hungry and sleepy. I looked pale and clammy. Paramedics took pulse ox, bp and heart rate. HR was high in 90s and BP was 120/97 They make me breath deep and gave me water and crackers to eat. Waited for 15-20 mins. Pulse rate came down in 70s and BP came down to 110/80

Other Meds: Women?s One a day Lamotrigine 100 mg

Current Illness: None

ID: 0917335
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: 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: Atenolol, Simvastatin, Tamsulosin, Losartan, Aspirin, Finasteride

Current Illness: None

ID: 0917336
Sex: F
Age: 42
State: IL

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: NA

Allergies: NA

Symptoms: Initial: Cold sensation and tingling in left arm and hand Next 3-5 days mild tingling in Left arm, Left hand/wrist, Left fingertips and some on left side of face

Other Meds: Probiotic

Current Illness: NA

ID: 0917337
Sex: F
Age: 80
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: Blood pressure, Vitamin D, Zoloft

Current Illness: None

ID: 0917338
Sex: M
Age: 41
State: NJ

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

Lab Data: none

Allergies: IV contrast (Visipaque 320) Anaphylaxis

Symptoms: 5 minutes post vaccine administration I started to feel palpitations, numbness on both arms and went up the nape/head, flushing, tingling in both arms dizziness, then dysphagia but able to talk. Hives at torso after 10 minutes. I was assessed by to physicians working at the site. Epi pen was given to me by a physician and taken by ambulance to hospital by EMTs who were there at the site. At the hospital I was given 40mg steroids by mouth. After observation for 4 hours I was feeling better, and was discharged home. Ordered to take 40mg of steroids for 2 more days. After one day post vaccination, I have significant pain at the site and body ache.

Other Meds: Benadryl 50mg PO, Claritin 10mg PO, Pepcid 20mg PO one hour prior vaccination

Current Illness:

ID: 0917339
Sex: F
Age: 37
State: TN

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

Lab Data: None at this time - referred to Emergency Department 1/2/21

Allergies: None

Symptoms: Pt. states woke up on 12/31/20 at around 8:00 and had blurry vision. States can see some things far away but can't see close up... Denies having any blurry vision prior to vaccination. States blurriness has neither improved or worsened. Denies any other symptoms or problems. Referred to Emergency Department for care regarding blurry vision. Encouraged pt. to call and notify health department of emergency departments assessment.

Other Meds: Aleve PO daily, Vit. D PO daily, Vit. E PO daily, Hormone patch

Current Illness: None

ID: 0917340
Sex: F
Age: 33
State: CA

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

Lab Data: none

Allergies: sulfa drug allergy, walnut food allergy, also has allergic rhinitis to environmental allergens

Symptoms: within 2 hours of the vaccine, patient had angioedema of lip and itchiness in throat which was verified by physlcal exam by the ED physician. She was given benadryl and symptoms improved.

Other Meds: none

Current Illness: none

ID: 0917341
Sex: F
Age: 68
State: TX

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

Lab Data:

Allergies:

Symptoms: Hot across the chest area, given benadrily 50mg orally and discharged @ 12:32pm with symptoms relieved.

Other Meds:

Current Illness:

ID: 0917342
Sex: M
Age: 75
State: TX

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

Lab Data:

Allergies: nacain

Symptoms: after i sneezed friday morning i lost all sight in my right eye. the emergency room did not know what was wrong and i see a eye specialist on monday.

Other Meds: several blood pressure, chroestrol, prostate, stomach.

Current Illness: none

ID: 0917343
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 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: Allopurinol, Furosemide, Simvastatin, Amlodipine, Cacecitanine, Metformin, Lisinopril, Celebrex

Current Illness: None

ID: 0917344
Sex: M
Age: 64
State: IL

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

Lab Data: None

Allergies: None

Symptoms: Chills, fever, headache, started about 9hrs after injection Fever peaked @ 100.8? injection site very sore. And continues to be sore. Fever broke the following day. Weakness, fatigue, headache persisted until afternoon of 1/1 2021

Other Meds: 1000mg vitamin C Losartan/ HTC 100-25 Nifedapine 60mg

Current Illness: None

ID: 0917345
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: High Blood Pressure

Current Illness: None

ID: 0917346
Sex: F
Age: 26
State: WI

Vax Date: 12/24/2020
Onset Date: 12/30/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: labs pedning

Allergies: none

Symptoms: 7-10 days injeciton site tender painful and redness not resolving size about the size of iphone xr picture available

Other Meds: none

Current Illness: none

ID: 0917347
Sex: F
Age: 44
State: CA

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

Lab Data: see above

Allergies: asthma, food allergies, and environmental allergies

Symptoms: Within 2 hours of the vaccine, patient had shortness of breath, urticaria, nasal congestion and EKG and CXR were normal in ED and she was given albuterol, decadron, famotodine, and epinephrine and resolved.

Other Meds: none

Current Illness: none

ID: 0917348
Sex: F
Age: 90
State: WV

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

Lab Data: None

Allergies: Lisinopril

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 the agency. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and regulatory authority 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 the agency 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: Metorpolol, Lasix, Insulin

Current Illness: None

ID: 0917349
Sex: F
Age: 88
State: WV

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

Lab Data: None

Allergies: Eggs

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 the agency. Color of medication also matched what was stated on Fact Sheet for Healthcare Providers and regulatory authority 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 the agency 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: Hydrocholorothiazide

Current Illness: None

ID: 0917350
Sex: F
Age: 20
State: WY

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

Lab Data: Blood work and ultrasound - emergency dept.

Allergies: None

Symptoms: 27Dec2020 - patient developed some swelling (went about 1 inch out from injection site) and discomfort at the injection site - had taken Advil and was using a cool compress. 29Dec2020 - patient had to leave work early since she was not feeling well - very fatigued and a little dizzy (able to eat/drink) - denied any COVID illness s/s (no cough, fever, loss of taste/smell, etc). She ended up going to the local ED - since she was still very fatigued and was feeling like she was going to pass out - blood work and U/S done - this is where she found out she had been pregnant but had lost the pregnancy (no heart beat). Per her report - all other blood work was unremarkable. No other medications given to her during this visit and was just told that she would be 'passing the products of conception within this next week'.

Other Meds: None

Current Illness: None

ID: 0917351
Sex: F
Age: 39
State:

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

Lab Data:

Allergies:

Symptoms: shortness of breath, difficulty breathing, chest tightness. She administered epinephrine and recovered quickly

Other Meds:

Current Illness:

ID: 0917352
Sex: F
Age: 92
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 WV 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 WV 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:

Current Illness: None

ID: 0917353
Sex: F
Age: 52
State: NE

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

Lab Data:

Allergies: anything that grows on tree fruits and nuts, shellfish,

Symptoms: Swelling at the site, Day one was about size of a 50 cent piece Day two- size of a baseball and was very itchy Day Three- size of a Softball and is very itchy and more than fills the palm of your hand

Other Meds: Lisinopril, synthroid, cymbalta, vitamin D, dycyclomine, gabapentine, amatryptoline,

Current Illness: I had Covid on ThanksgivingFibromyalgia

ID: 0917354
Sex: F
Age: 90
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: "Diabetic meds, thyroid meds, BP meds, Blood thinner"

Current Illness: None

ID: 0917355
Sex: M
Age: 67
State: CO

Vax Date: 11/09/2020
Onset Date: 11/11/2020
Rec V Date: 01/02/2021
Hospital:

Lab Data: EKG normal, Comprehensive Metabolic Panel blood test normal at Hospital emergency room on 11/20/2020 at 10:33 pm Went in for elevated bp. On 11/30/2020 at Hospital

Allergies: immune to PCN

Symptoms: Chest pain, stiff neck, muscle pain, High blood pressure, headache, nausea, chills, tiredness, exhaustion, dry cough, congestion, severe sinus infection. Lasting 5 weeks after the second Shingles vaccine. After the 1st dose I experienced tiredness, exhaustion, muscle pain, for 2 weeks.

Other Meds: Fish oil

Current Illness: None

ID: 0917356
Sex: M
Age: 95
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: "Blood thinner, heart pill"

Current Illness: None

ID: 0917357
Sex: F
Age: 52
State: MO

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

Lab Data: None

Allergies: No known allergies

Symptoms: Moderna COVID-19 Vaccine EUA Mild symptoms following injection: soreness at site, mild redness, malaise X 2 days January 1: growing redness and heat at site of injection

Other Meds: glucophage for polycystic ovaries not high blood sugar

Current Illness: None

ID: 0917358
Sex: F
Age: 21
State: OH

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

Lab Data:

Allergies: None

Symptoms: Started with arm pain, then lymph nodes in armpit were swollen and arm pain increased, could barely move arm because of pain, nausea and vomiting, chills and fever of 100.9, injection site the size of a baseball almost 48 hours after injection, super fatigued

Other Meds: Sertraline, lofarin-FE

Current Illness: None

ID: 0917359
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: Paint, Shingles vaccine, PCN, morphine

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: aspirin, namenda XR, sertaline, metoprolol, Crestor, lisinopril, Plavix

Current Illness: None

ID: 0917360
Sex: F
Age: 39
State: CA

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

Lab Data: none

Allergies: penicillin, ampicillin, pineapple food allergies

Symptoms: Within 45 min, patient had nausea, dizziness, and was given ondansetron and fluids with improvement

Other Meds: none

Current Illness: none

ID: 0917361
Sex: M
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: Xarelto 20mg daily, Myrbetriq 50mg daily, diltiazem 120mg BID, Citalopram 10mg daily, Simvastatin 20mg daily

Current Illness: None

ID: 0917362
Sex: F
Age: 65
State: TX

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

Lab Data:

Allergies:

Symptoms: Low grade fever 24 hours after immunization, also direct exposure to person with covid 19.

Other Meds:

Current Illness:

ID: 0917363
Sex: F
Age: 25
State: MT

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

Lab Data:

Allergies: N/A

Symptoms: Tenderness Swelling Redness All lasting 3 days after injection

Other Meds: Mini birth control pill Motrin

Current Illness: Mastitis starting Saturday prior

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm