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: 0927851
Sex: M
Age: 67
State: TX

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Sore arm where Vacine was injected the next morning

Other Meds: Bystolic

Current Illness: None

ID: 0927852
Sex: F
Age: 39
State: NJ

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: Augmentin

Symptoms: About 3 minutes after I received the vaccine I became flushed for just a few moments and had a strange taste in my mouth. I could feel a tingle in my mouth at the same time. I became panicked of course but the flushing quickly subsided. The mouth sensation lasted a bit longer but there was no airway compromise at all.

Other Meds: D?TERRA LLV vitamins Vitamin D3 Black seed cumin oil Turmeric Probiotic

Current Illness: None

ID: 0927853
Sex: F
Age: 59
State: NY

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: tetracycline/tramicyine

Symptoms: Around the injection site there is a raised red, painful, warm and itchy spot. It started on 01/07/21 last night it was a 2 " x 2" area. This morning it is 3" x 4".

Other Meds: amlodipine 2.5 mg daily ; atorvastatin 10 mg every other day; propranolol er 80 mg daily; duloxetine hcl dr 60 mg daily; vitamin d3

Current Illness: n/a

ID: 0927854
Sex: F
Age: 58
State: OH

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: Erythromycin, Bactrim - Rash

Symptoms: Had itching and tingling in left arm on 1/7/2021. That evening noticed red, raised, warm area about the size of a baseball at sight of injection. Treated with cortisone cream which seemed to improve somewhat.

Other Meds: Multivitamins, Vitamin D3, Gingko Biloba, Magnesium

Current Illness: None

ID: 0927855
Sex: F
Age: 32
State: NY

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: CHILLS, HEADACHE, BODY ACHE, SORE IN VACCINE AREA, NAUSEA, DIARRHEA,COUGH

Other Meds: IRON, VITAMIN C

Current Illness: N/A

ID: 0927856
Sex: F
Age: 61
State: NJ

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: none

Allergies: Sulfa drugs

Symptoms: At approximately 3:30 pm the next day (27 hours later), I noticed significant tearing from both eyes, while outside walking. When I returned home, and checked in the mirror, I noticed significant puffiness around the eyes (though not to the point of closure or impaired vision), especially in the inner corners (L>R). I contacted my PCP at 4:45 pm and was instructed to go to the Urgent Care. I was seen there and evaluated, then was discharged without any treatment plan. I had no other symptoms and felt great, and even felt the puffiness had subsided a little bit by the time I left the clinic. Today, 1/8/2021, at 7:30 am awakening, the eyes are quite puffy again, and my nose actually appears a bit swollen on the sides near the eyes. I hear clicking sounds in my sinuses and have a small amount of sinus pressure. I applied ice packs to the eye lids in an effort to reduce swelling, which seems to help a little. Please note that I had botox in my forehead and around the outside corners of the eyes, and dermal filler under the eyes (12/7/2021), this being the first time for the filler.

Other Meds: Fluoxetine Nutrafol Cucurmin Milk Thistle vitamin d3

Current Illness:

ID: 0927857
Sex: M
Age: 33
State: MO

Vax Date: 12/18/2020
Onset Date: 12/26/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: Banana

Symptoms: Rapid swelling, redness, itching, and warmth developed in the exact location of the injection. Swelling was egg-shaped, approximately 3 cm x 4.5 cm. Subsided over the course of three days

Other Meds: Glucosamine - chondroitin

Current Illness: None

ID: 0927858
Sex: F
Age: 43
State: NC

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Benazapril

Symptoms: rash on chest and back - light red, mildly itchy

Other Meds: gabapentin, losartan, buspar, prozac, allegra, singulair

Current Illness:

ID: 0927859
Sex: F
Age: 39
State: NY

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Numbness and tingling on whole left side of body from head to toes on side vaccine was administered. Swelling to left arm/hand.

Other Meds: Allegra Tylenol Motrin

Current Illness: none

ID: 0927860
Sex: F
Age: 41
State: TX

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Symptoms - ? EE reports pain at injection immediately after injection. EE reports ?nickel size? knot on her arm almost immediately after, worsening to 2x2 size this morning (1/8). 1/7 morning: body aches, chills, feelings of unwell. Unsure of fever as she has been rotating Tylenol and motrin. EE reports she saw RN at campus this morning for inspection of injection site. Home remedies? - ice pack to injection site and rotating Tylenol (last dose 20:30 1/7) and motrin (last dose 23:00 1/8) Any improvement? ? mild improvement Recommendation? EE encouraged to continue to ice injection site and to rotate Tylenol and motrin. EE encouraged to continue to monitor symptoms and to call vaccine support with further questions and/or concerns. EE denied history of COVID-19 exposure without proper PPE and denied recent travel. EE educated to manange per Illness in the Workplace Policy. EE encouraged to fill out V-safe. EE verbalized back understanding and denied further questions at this time.

Other Meds:

Current Illness:

ID: 0927861
Sex: F
Age: 35
State: VT

Vax Date: 12/31/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: NA

Symptoms: Day 6 after receiving vaccine, slightly swollen and sore left axilla nodes. Day 8 starting to resolve

Other Meds: Valtrex

Current Illness: Shingles

ID: 0927862
Sex: F
Age: 41
State: OH

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: allergies to nickel, metal, dust

Symptoms: Pt received vaccine at 0733 and developed itchiness, swelling and hives on face and neck. 25mg of Benadryl given at 0800. Vitals signs within defined limits sating well on RA. Pt observed for an additional 15 minutes with no other side effects noted.

Other Meds:

Current Illness:

ID: 0927864
Sex: F
Age: 47
State: MI

Vax Date: 12/30/2020
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None.

Allergies: none

Symptoms: Moderna COVID-19 Vaccine: Yesterday, 1 week post injection - bright red rash at injection site, warm to touch, feels like a hard bump at the site, whole upper arm hurts (my arm hurt for a few days after the injection, then was OK) I called my PCP's office. They stated to monitor, use Tylenol, warm compress. Seek medical visit if it gets worse. Today: I still have a rash, warm to touch, my arm doesn't hurt as bad. My mom thinks it might be spreading. She works in my PCP's office and they recommended reporting it here and monitoring.

Other Meds: Flonase Tylenol

Current Illness: none

ID: 0927865
Sex: F
Age: 66
State: TX

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Sore arm, the arm where injection was dosed

Other Meds: None

Current Illness: None

ID: 0927866
Sex: M
Age: 37
State: ME

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: COVID test

Allergies: Hydrocodone

Symptoms: The day (Dec. 24th) after Covid vaccine patient had bad headache, felt very sluggish and nauseated x3d. 4th d, patient's eyes started turning red and burning as well as a rash on face.

Other Meds: none

Current Illness: None

ID: 0927867
Sex: M
Age: 61
State: NJ

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: NA

Allergies: NA

Symptoms: Moderna 10 PM, started to shiver, head ache freezing, fever, went to sleep, had night mares, took Tylenol, sleep till 3:30 PM, went back to sleep at 6Pm and woke up 6am.

Other Meds: Carvedilol 25mg , Amlodipine besylate 5 mg, Atorvastatin 10mg, Esomeprazole 40 mg, Losartan potassium 100 mg,

Current Illness: NA

ID: 0927868
Sex: F
Age: 44
State: OH

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: latex

Symptoms: 15 post vaccination started to complain of her lips tingling. It progressed to itchy eyes and started getting a little itchy all over. Her lips went from feeling itchy to feeling waxy. Gave benadryl at 5;15 pm. Patient started felling less itchy and lips were feeling a little better at 5:30. continues to monitor patient until 5:45pm patient stated she was feeling better and felt comfortable going home. Patient left clinic at 5:50pm. Called and checked on patient at 7:00pm and she stated all symptoms were gone that she was just tired from the benadryl

Other Meds: On antibiotics for UTI started taking on 01/04/2021. Gave benadryl while on clinic for symptoms of allergic reaction

Current Illness: UTI, COVID 19

ID: 0927869
Sex: F
Age: 45
State: FL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Mangos

Symptoms: Patient states that she was vaccinated on 1/4/2021. She is stating that she is in pain and went to get a MRI a few days ago. The doctors told her that she has fluid in the joints from post vaccination. The doctor also mentioned to her that she needs to see an orthopedic surgeon to remove the liquid.

Other Meds:

Current Illness:

ID: 0927870
Sex: F
Age: 36
State: VA

Vax Date: 12/29/2020
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Nickel and cobalt (showed on allergy testing September 2020)

Symptoms: On day 6 my arm begin to be sore again just like when I received the vaccine. It was sore for about 3 days. It was also red, warm, and swollen. On day 7 I noticed a rash on my arm at the injection site. It began to spread down my arm. There has also been itching too. I am now on steroids on day 2 of the pack. Rash has began lighten some and swelling and warmth has resolved still itching.

Other Meds: Adapalene Gel for face Spirlactone for acne Eucrisa for eczema

Current Illness:

ID: 0927871
Sex: F
Age: 28
State: MN

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: About 12 hours after the shot, I had significant chills, body aches, fever, severe nausea that induced vomiting (unable to keep down water). 12 hours then after these symptoms is when things began to slowly subside. Just ended up missing work for two days.

Other Meds: Zoloft 25 mg and Nexplanon subdermal contraceptive

Current Illness: None

ID: 0927872
Sex: F
Age: 35
State: TX

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Ceclor

Symptoms: Sore arm, headache, neck ache, nausea

Other Meds: Mirena IUD, sertraline

Current Illness: None

ID: 0927873
Sex: F
Age: 74
State: FL

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

Lab Data: None

Allergies: Sulfur drugs

Symptoms: Mild swelling in throat , treated with med similar to bennidrill

Other Meds: Multi vitamin Calcium D3 Saffron

Current Illness: None

ID: 0927874
Sex: F
Age: 36
State: NY

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: ED visit and antibiotics started

Allergies: nitrofurantoin

Symptoms: Patient developed erythema about a week post injection at the site, 1.5 X 2.5 inches. She was instructed to seek medical intervention in the ED

Other Meds:

Current Illness:

ID: 0927875
Sex: M
Age: 63
State: ME

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: none noted

Symptoms: increase temperature 99.6-103, elevated Blood Pressure 196/128, Heart Rate 115, mild light headedness, no shortness of breath, alert and oriented

Other Meds: None

Current Illness:

ID: 0927876
Sex: F
Age: 78
State: NH

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: N/A

Allergies: codeine

Symptoms: Injection site : Itching, large pink blotching area, hot to touch, nausea

Other Meds: BREO ELLIPTA, incruse ellipta, albuterol hsa

Current Illness: N/A

ID: 0927877
Sex: F
Age: 57
State: CA

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Compozine Bananas Eggplant

Symptoms: My arm started itching and there was a red mark on my arm

Other Meds: Gabapentin Benzonatate Omeprazole

Current Illness: None

ID: 0927879
Sex: F
Age: 53
State: PR

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None.

Allergies: No. Have had prior dermatitis related to regular use of latex gloves. Have nasal allergies and allergies to UV light gel nail polish and acrylic nails.

Symptoms: On Day #8 after vaccination (1st dose) of Moderna Covid-19, developed a 3 cm sore red welt hot to the touch and minor pain in the area of vaccine inoculation. I have applied 1% hydro cortisone cream and took benadryl 25mg and night and today on the morning. Area is less red and swollen but still hot to the touch. I still have fluocinonide cream that used on my nails. and fingers after an allergic episode to UV light gel nail polish and recently applied to the area to see if it helps.

Other Meds: Progesterone 400mg, Vit C, Vit B12, Caltrate, simvastatin 20mg, Cardesartan 8mg, zyrtec, Biot? hormone replacement therapy started December 14, 2020

Current Illness: None.

ID: 0927880
Sex: F
Age: 42
State: MI

Vax Date: 12/27/2020
Onset Date: 12/27/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: None Observation by nurse for 10 minutes

Allergies: Food intolerances: walnuts, chickpeas, seasonal allergies

Symptoms: Lightheaded and full sensation in throat 20 minutes after shot

Other Meds: Xyzal

Current Illness: None

ID: 0927881
Sex: M
Age: 64
State: FL

Vax Date: 12/29/2020
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: doctor checked inner ear and blood pressure, all ok.

Allergies: no

Symptoms: vertigo

Other Meds: diabetes meds

Current Illness: diabetes 2

ID: 0927882
Sex: M
Age: 26
State: CA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills, fever, hives

Other Meds:

Current Illness:

ID: 0927883
Sex: M
Age: 41
State: MI

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Bilateral rash and itchiness in palms and fingers. lasted 15-20min. Resolved with 10mg Cetirizine.

Other Meds: none

Current Illness: none

ID: 0927884
Sex: F
Age: 49
State: OH

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: CBC, BMP, BNP, Xray, EKG

Allergies: IVP dye, Robitussin

Symptoms: At approximately 945pm-I developed a very rapid heart rate while sitting on the couch at home. I tried to break this by bearing down, and also coughing. None of this helped. I had my husband call 911. Squad arrived-at that time my heart rate was 222 bpm. I was taken by ambulance to hospital in which i was given 6 of adenosine by IV which converted me.

Other Meds: Atenolol 50mg

Current Illness: n/a

ID: 0927885
Sex: M
Age: 61
State: AZ

Vax Date: 01/04/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: left eye itchy on 1/4, left eye swollen on Wednesday and red, resolved on own, no treatment.

Other Meds:

Current Illness:

ID: 0927886
Sex: F
Age: 65
State: OH

Vax Date: 12/29/2020
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: none

Allergies: Latex

Symptoms: 6 days post vaccine, arm felt a little itchy by the next day area was red, erythematous, slightly warm

Other Meds: Atorvastin Ca 40 mg QD, Asprin 81 mg QD, Vitamin D3 25mcg QD, Multi vitamin QD

Current Illness: None

ID: 0927887
Sex: F
Age: 55
State: NE

Vax Date: 12/31/2020
Onset Date: 01/03/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: ASA, Cymbalta, Ultra, Sulfurs, Codeine, Penicillin; latex contact

Symptoms: usual right arm soreness, then settled in right wrist area tingling, pain, weakness, and itchy type feeling in wrist

Other Meds: Jaurdiance, Metformin, Protonix, Plavix, Mobic, Vit D3 5k, CoQ10, probiotics 25m, Losartin, Singular, Xyzal

Current Illness: None

ID: 0927888
Sex: F
Age: 52
State: MD

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: allergic to Flaygyll, lisinopril, losartan, Augmentin, tetracycline

Symptoms: Following day (Wed) my right eye was irritated and became itchy later on. Had Dr look at it and she started me on hot compresses with orders to start eye drops with antihistamine if this did not help. Did hot compresses felt a bit better on Thurs. Fri eyes were worse, started Eye drops. Saturday ears were itchy and sore with drainage--thought infected. Sunday both eyes were red, itchy oozing,, ears still oozing and sore--went to Urgent care. They said no ear infection and started me on Eye drops with steroids but could not get them until Monday around 5pm. Corners of mouth started cracking open as well. Monday started steroid drops. Wednesday eyes were much worse and felt like glass in them. called Dr. She said to stop steroid drops and go back to antihistamine drops and start Claritin. Started immediately and I started putting Ivarest in my ears. Eyes have stopped oozing but are still red. Ears are clearing up and not as sore. Mouth is starting to clear up

Other Meds: Furosemide, Levothyroxine 200mcg 1x per day, Chlorthalidone 25mg, 1x per day Hydrocodone-7.5-325mg (1-2 per day as needed) typically I take 1/2 twice a day probiotic

Current Illness: sniffles day before but thought it was from sinus

ID: 0927889
Sex: F
Age: 42
State: KY

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: none

Allergies: Tree nut allergy

Symptoms: The evening of the vaccination I had a knot under the skin, was sore for several days but went away. 7 days after vaccine the injection site started itching really bad and the knot under my skin started getting larger. Day 9 around 8pm I noticed a large pink spot with a lighter center at the injection site 7 cm X 8 cm round/oval, slightly raised, swollen, itchy, and slightly warmer than surrounding skin. I took diphenhydramine 50 mg. I first notified my manager and reported the event to employee health nurse. The employee health nurse asked me to report the reaction to this website and contact PCP if symptoms got worse. Day 10 morning swelling and discolorization improving.

Other Meds: levothyroxine sodium 75mcg daily, bupropion HCL XL 300mg daily, phentermine 37.5 mg daily, vitamin D2 50,000 units 1.25 mg weekly

Current Illness: low vitamin D level

ID: 0927890
Sex: M
Age: 37
State: DC

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Statement of Incident: A partially used vial of Moderna was returned to the refrigerator instead of being discarded on 30 Dec 2020. On 4 Jan 2021, the partially used vial was used to vaccinate at least six patients. On 5 Jan 2021, the Immunizations Team was discussing wasted vaccines and was reminded of the 6 hour expiration timeframe once a vial is punctured. One of the members realized that they used the above mentioned open vial on 4 Jan 2021 well beyond the 6 hour timeframe. In addition, once a vial is punctured and brought to room temperature, placing the vial back into the refrigerator will invalidate the vial and make it unusable. Mission Impact: A minimum of six patients received invalidated vaccine. Consultation with agency concurred the doses given from this vial should be considered invalid and recommend that all patients who received vaccine from this vial be revaccinated. Corrective Action Required/Taken: The Chief, Medical Staff and the Commander were notified to report the patient safety error. The team identified ten patients who did or possible did receive the invalid vaccine. After consulting with Risk Management, the Healthcare Resolution Specialist and agency, all ten patients were contacted, received full disclosures, and were recommended to receive repeat Dose 1 as soon as possible. Eight patients were revaccinated on 6 Jan 2021. Two declined revaccination and plan to get Dose 2 as previously scheduled. A Concise Incident Analysis (mini- Root Cause Analysis) is being conducted to determine root causes and ensure effective process improvements are implemented.

Other Meds:

Current Illness:

ID: 0927891
Sex: F
Age: 58
State: FL

Vax Date: 12/12/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: Covid positive

Allergies:

Symptoms: Positive covid result on 1 -7-2021

Other Meds: Magnesium

Current Illness:

ID: 0927892
Sex: F
Age: 36
State: NY

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None yet.

Allergies: None known to any medication, food, or other products.

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: Wellbutrin 150mg QD, Zoloft 50mg QD, Klonopin 0.5mg TID, Omeprazole 20mg QD, Bariatric multivitamin.

Current Illness: None.

ID: 0927893
Sex: F
Age: 45
State: GA

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: n/a

Allergies: floxen antibiotics

Symptoms: red bumpy rash around the injection site--hot to touch and itches. Where the needle went in is white

Other Meds: wellbutrin lo lo estrin adderall

Current Illness: n/a

ID: 0927894
Sex: F
Age: 58
State: NY

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Severe itching, hotness & red at injection site - this symptom started on Day 8 following vaccine (it is now Day 9).

Other Meds: Estradiol, Calcium, Vit C, Glucosamine

Current Illness: None

ID: 0927895
Sex: F
Age: 33
State: TN

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: ER visit on 12/30/2020. EKG completed with cardiac monitoring. No other testing done.

Allergies: TB skin test

Symptoms: Within 5 min of vaccine developed LEFT chest & neck rash / hives. Within 10 min entire neck / chest rash / hives with palpitations, tachycardia, flushing, & itching occurred. Took Benadryl 25 mg with no improvement. Monitored in ER for 2 hrs with additional dose of Benadryl 25 mg given. Rebound rash occurred about 24 hrs after injection, but no further rash / hives. Left supraclavicular lymph node swelling noted 3 days after vaccine administered. Saw PCP 01/08/2021 with persistent lymph node swelling. Starting Medrol dose pak to see if improvement occurs.

Other Meds: Lo loestrin Fe

Current Illness: No

ID: 0927896
Sex: F
Age: 44
State: PA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: No known laboratory or diagnostic tests during the initial ER visit.

Allergies: Shell Fish

Symptoms: Initially the recipient felt tightness in her throat, which she relates is similar to past episodes of anaphylaxis .

Other Meds: Unknown

Current Illness: No known illnesses at the time of vaccination

ID: 0927898
Sex: F
Age: 27
State: KY

Vax Date: 12/31/2020
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None.

Allergies: No

Symptoms: Injection site was painful, red, hot, and swollen after vaccination until 1/5/20, resolved and then all symptoms returned 1/7/20.

Other Meds: Progestin only birth control, Pre-natal vitamins

Current Illness: No

ID: 0927899
Sex: F
Age: 54
State: FL

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Regalan, Zonisamide, Plevto, Depatale, Tegaderm pate (upper arm and chest)

Symptoms: I experienced after taking a shower a rash, was red, blotchy down my torso and down to both of my legs which lasted a couple of hours. I talked to my HCP gave me a metrodose pack was also put on an anti histamine medication. I take quick warm showers. I called my oncologist who is recommending to see an allergist specialist and have an appointment next Tuesday. On 12-9-2020 had a swap to her nose. Yesterday after taking a hot shower, I still continue with rash on my body.

Other Meds: Xyzal PRN 5mg, Insulin pump with novalog, Spirinolactone 25mg, Ramapril 10mg, Simvastatin 40mg, Metoprolol 15mg, Levothyroxine 15mcg, Keppra 500mg, Troncandi, Vitamin D 2 1.5mg

Current Illness: Had right shoulder surgery on 12-09-2020.

ID: 0927900
Sex: F
Age: 36
State: IA

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: N/A

Allergies: Sulfa/nauseous

Symptoms: 1 week after receiving the vaccine, I developed a rash around the injection site that was warm to the tough, and was itchy. It?s been 2 days since that started and now the rash is the size of my hand.

Other Meds: Escitalopram 20mg daily, vitamin d 5000 units daily, buspirone 15mg bid, multivitamin

Current Illness: N/A

ID: 0927901
Sex: M
Age: 31
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Statement of Incident: A partially used vial of Moderna was returned to the refrigerator instead of being discarded on 30 Dec 2020. On 4 Jan 2021, the partially used vial was used to vaccinate at least six patients. On 5 Jan 2021, the Immunizations Team was discussing wasted vaccines and was reminded of the 6 hour expiration timeframe once a vial is punctured. One of the members realized that they used the above mentioned open vial on 4 Jan 2021 well beyond the 6 hour timeframe. In addition, once a vial is punctured and brought to room temperature, placing the vial back into the refrigerator will invalidate the vial and make it unusable. Mission Impact: A minimum of six patients received invalidated vaccine. Consultation with MILVAX concurred the doses given from this vial should be considered invalid and recommend that all patients who received vaccine from this vial be revaccinated. Corrective Action Required/Taken: The Joint Base Medical Staff and the Medical Squadron Commander were notified to report the patient safety error. The team identified ten patients who did or possible did receive the invalid vaccine. After consulting with Risk Management, the Resolution Specialist and MILVAX, all ten patients were contacted, received full disclosures, and were recommended to receive repeat Dose 1 as soon as possible. Eight patients were revaccinated on 6 Jan 2021. Two declined revaccination and plan to get Dose 2 as previously scheduled. A Concise Incident Analysis (mini- Root Cause Analysis) is being conducted to determine root causes and ensure effective process improvements are implemented.

Other Meds:

Current Illness:

ID: 0927902
Sex: M
Age: 33
State: TX

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: none

Allergies: unknown

Symptoms: tingling around eyes that resolved after 20 minutes

Other Meds: none

Current Illness: none

ID: 0927903
Sex: M
Age: 31
State: MI

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Started with nausea, next day had joint pain, fatigue and nausea with diarrhea and fever of 101F. Day 3 had muscle pain, fatigue and severe diarrhea and fever of 100 F with acetaminophen started around the clock. Day 4 had migraine and nausea and diarrhea and fever of 100F. Day 5 has diarrhea throughout night approx every 30 minutes and extreme fatigue and headache. Symptoms have not yet subsided. One day 5 post vaccine.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm