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: 0927904
Sex: F
Age: 43
State:

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

Lab Data:

Allergies: None

Symptoms: Small red, raised area at site of injection. Warm to touch

Other Meds: Unithroid

Current Illness: None

ID: 0927905
Sex: F
Age: 41
State: IN

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

Lab Data:

Allergies: None

Symptoms: I have developed a swollen/painful lymph node under my Lt armpit area.

Other Meds: Birth control, Zoloft, Vit D, Prilosec

Current Illness: None

ID: 0927906
Sex: F
Age: 55
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 Health Authority 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: 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 Health Authority, 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: 0927907
Sex: F
Age: 37
State: FL

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: CODEINE - HIVES

Symptoms: 2 days after vaccination client noticed lesions on right buttock. Diagnosed with Shingles 1/7/21. Rx Acyclovir by Internal Medicine MD.

Other Meds: TYLENOL PRN AND TRAZADONE HS

Current Illness: NONE

ID: 0927909
Sex: F
Age: 38
State: MI

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

Lab Data:

Allergies: no known drug allergies

Symptoms: patient developed hives on heck, erythema/redness all up arms and neck, itchy on arms and feels warm behind ears. patient reports she has had many allergies (non-drug) in the past and has received allergy shots. patient received Famotidine and Prednisone in ED and discharged home

Other Meds: None

Current Illness:

ID: 0927910
Sex: F
Age: 36
State: TX

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

Lab Data:

Allergies:

Symptoms: Fever, chills, body aches and pain at the injection. Treatment is Tylenol. Patient will continue to monitor

Other Meds:

Current Illness:

ID: 0927911
Sex: M
Age: 37
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 program 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 clinic, Medical Staff and the office 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 AFMRA Risk Management, the NCR Market Healthcare Resolution Specialist and program, 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. Note: this patient was one of two who declined a second dose.

Other Meds:

Current Illness:

ID: 0927912
Sex: F
Age: 43
State: PA

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

Lab Data: N/A

Allergies: Codeine and Acetaminophen

Symptoms: Sore arm for 36hrs, followed by pain in right armpit 2-4 days post injection. 7 days after injection, developed an itchy rash at the injection site that continues to grow in size and is now 4" x 3" in diameter.

Other Meds: B12 and B vitamin complex, Iron supplements

Current Illness: N/A

ID: 0927913
Sex: F
Age: 48
State: MI

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

Lab Data: None

Allergies: Penicillin

Symptoms: 3pm, day after vaccine, general malaise, fatigue, body aches, no fever. Slept for 2.5 hours and woke up feeling better. Went to bed early and feel fine.

Other Meds: Synthyroid, .75 mcg Pristiq, 50mg Supplements: Iron, Vitamin D3

Current Illness: Head cold 1-2 weeks prior

ID: 0927914
Sex: F
Age: 40
State: CT

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

Lab Data: Rapid COVID PCR; Negative

Allergies: None

Symptoms: 12 hours from vaccine #2, I started with rigors, myalgias/arthralgias, severe headache, temperature 100-101, nasal congestion, and profound fatigue. Symptoms resolved after 36 hours with Tylenol/Advil and supportive care. Sent for COVID Rapid PCR which was negative; missed 1 day of work.

Other Meds: Estradiol patch

Current Illness: None

ID: 0927915
Sex: F
Age: 42
State: ME

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

Lab Data:

Allergies:

Symptoms: elevated Blood Pressure 154/104, Heart Rate 57; arm numbness/tingling, arm cold to touch

Other Meds:

Current Illness:

ID: 0927916
Sex: M
Age: 40
State: AZ

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

Lab Data:

Allergies:

Symptoms: Body aches, chills, headaches, refused MD follow up at time of report

Other Meds:

Current Illness:

ID: 0927917
Sex: M
Age: 37
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 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 contacts 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 Agency 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. Note; this was one of the two patients who chose not to get revaccinated until the scheduled second dose

Other Meds:

Current Illness:

ID: 0927919
Sex: F
Age: 45
State:

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

Lab Data: 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 contacts 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 Agency 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.

Allergies:

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 0927920
Sex: F
Age: 33
State: IL

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

Lab Data:

Allergies:

Symptoms: Began feeling light headed the evening of the vaccine, overnight developed shaking chills, fever of 104 with headache. Took ibuprofen which brought temperature down to 99. Still (on day 2) having some sweats & nausea.

Other Meds:

Current Illness:

ID: 0927921
Sex: M
Age: 36
State: NC

Vax Date: 12/22/2020
Onset Date: 01/08/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: 2 MDs looked at burning vesicular rash. Didn?t officially see doctor because I work at doctor?s office.

Allergies: N/a

Symptoms: Shingles left flank, mild case so far

Other Meds: N/a

Current Illness: Na

ID: 0927922
Sex: F
Age: 22
State: WV

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

Lab Data: none

Allergies: Nickel

Symptoms: Developed a very sore arm about 36 hours post injection. About 48 hours post injection developed swelling; redness; itching and pain at injection site. Acetaminophen used but ineffective.

Other Meds: Trisprint Tech; Sertraline;

Current Illness: None

ID: 0927923
Sex: M
Age: 24
State: NY

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

Lab Data:

Allergies: None

Symptoms: Awoke at 7:30am with increased injection site soreness in upper L arm and a headache with fatigue, symptoms resolved after I took a single dose of naproxen sodium 220 mg at 2pm and currently feel no side effects

Other Meds: None

Current Illness: None

ID: 0927924
Sex: F
Age: 49
State: CA

Vax Date: 12/30/2020
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: None

Allergies: Allergy to dust mites

Symptoms: Vertigo, diapharesis, nausea

Other Meds: Zyrtec, Flonase, Azestaline, MVI, vitamin C, Vit D, Albuterol prn, Tylenol. Herbal Tea Moringa & Ginger.

Current Illness: Sinus infection 2-3 weeks prior

ID: 0927925
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: Left side numbness and tingling on same side vaccine administered. Mild swelling to arm and hand.

Other Meds: Allegra Tylenol

Current Illness: None

ID: 0927926
Sex: M
Age: 26
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. 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: Medical Staff and the Staff 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 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: 0927927
Sex: F
Age: 43
State: WV

Vax Date: 01/06/2020
Onset Date: 01/07/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data: N/A

Allergies: N/A

Symptoms: 1/7/2021 Woke up at about 6am with sore arm, muscle/joint pain, low grade fever 100.4. treated with ibuprofren and tylenol 1/8/2021 Took more ibuprofren at 4am, 'feel just fine'. *I think that severity of the symptoms, which i was expecting, the 2nd dose was more 'hard hitting' then the first; More side affects with muscle and joint pain.

Other Meds: N/A

Current Illness: N/A

ID: 0927928
Sex: F
Age: 45
State: PA

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

Lab Data: None

Allergies: latex

Symptoms: Initially had localized redness, tenderness and swelling at injection site. This resolved and came back 7 days later, although with less pain and increased warmth to the injection site.

Other Meds: Plaquenil, lamictal, Wellbutrin, pristiq, vitamin D, mega red, magnesium, zinc, esomeprazole, vitamin b12, multivitamin, calcium, biotin

Current Illness: none

ID: 0927929
Sex: F
Age: 47
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 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 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 Market 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. Note: this is one of the two patients who will defer a repeat dose and proceed to 2nd dose at 28 days

Other Meds:

Current Illness:

ID: 0927930
Sex: F
Age: 57
State: VT

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

Lab Data: None

Allergies: PCN, Compazine

Symptoms: Fever of 102 degrees F. or higher (temp was 102 degrees 2 hours after taking ibuprofen), shaking chills, headache, nausea, severe generalized body aches.

Other Meds: Allegra

Current Illness: None

ID: 0927931
Sex: F
Age: 62
State: IN

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: Biaxin, small pox vaccine

Symptoms: Swollen lymph nodes in left ancillary and into the left breast.

Other Meds: Allegra 180mg, levothyroxine 0.075mg,estradiol 1mg,aspirin 81mg,calcium w/vitamin D bid

Current Illness:

ID: 0927933
Sex: F
Age: 51
State: TX

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

Lab Data: none

Allergies: naproxen, sulfa

Symptoms: patient "did not feel right"

Other Meds: none

Current Illness: none

ID: 0927934
Sex: F
Age: 47
State: MI

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

Lab Data: No

Allergies: None

Symptoms: Developed fever, chills that evening, achiness, headache, arm pain through 1/7/21 evening. Was to the point of being unable to function and leave couch which is unusual for her.

Other Meds: None

Current Illness: No. Tested positive for COVID in November

ID: 0927935
Sex: M
Age: 41
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: Agency, Medical Staff and Others 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 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 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: 0927950
Sex: F
Age:
State: NY

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

Lab Data:

Allergies:

Symptoms: she received PNEUMOVAX 23 "every year"; No additional adverse events reported; This spontaneous report was received from a pharmacist and refers to a female patient of an unknown age. No information regarding the patient's medical history, concurrent conditions or concomitant medications was provided. Since unknown dates, the patient was vaccinated with doses of pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) injection , every year (dose, route of administration, anatomical localization, lot # and expiration date were unknown) for prophylaxis. No additional adverse events reported. This is one of two case reports from the same reporter.; Sender's Comments: US-009507513-2012USA005988:

Other Meds:

Current Illness:

ID: 0927951
Sex: M
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: V ARlV AX was administered to his 19 year old son today 1/5/2020 at 12: 15 PM via intramuscular route; No additional AE; This spontaneous report was received from a physician reporting for his son and refers to a 19-year-old male patient. His concurrent conditions included allergy to diary products. His concomitant therapies and previous drug reactions were unknown. On 05-JAN-2021 at 12:15, the patient was vaccinated with varicella virus vaccine live (oka/merck) (VARIVAX) via intramuscular route (strength, dose, lot # and expiration date were not provided) as a booster of varicella virus vaccine live (oka/merck) (VARIVAX) based on titer levels. The vaccine was administered in an inappropriate route as it should have been administered subcutaneously. There was no treatment given for the event. There were no additional adverse events (AE) reported. No further information was provided. The outcome of the event was not reported.

Other Meds:

Current Illness: Food allergy

ID: 0927952
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: patient got a sinus infection; Initial information was received on 05-Jan-2021 regarding an unsolicited valid non-serious case from a consumer/non-health care professional (patient) via social media. This case involves a patient of unknown age who got a sinus infection (sinusitis), while patient received vaccine INFLUENZA VACCINE. Medical history, past medical treatment(s), vaccination(s), concomitant medications and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number, expiration date not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, (latency: unknown) it was reported that patient got a flu shot 7 years ago, never been so sick in patients life. Had not got a flu shot since and had not been that sick since. Use to never get sick in the fall or spring until the stupid shot, now ever year around the fall and spring patient got a sinus infection (sinusitis). No laboratory data was provided. It was not reported if the patient received a corrective treatment. At the time of report, the outcome of event was unknown. Information on lot number was requested for this case.

Other Meds:

Current Illness:

ID: 0927953
Sex: M
Age: 16
State: MI

Vax Date: 12/22/2020
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: FLUBLOK had been administered to 11 pediatric patients (with no adverse event); Initial information was received on 04-Jan-2021 regarding an unsolicited valid non-serious case from an other health professional. This case involves a 16 years old male patient for whom it was reported that Flublok had been administered to 11 pediatric patients (with no adverse event) (Product administered to patient of inappropriate age), while he received vaccine influenza quadrivalent recombinant vaccine (Flublok QIV). Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medication was not reported. On 22-Dec-2020, the patient received a dose of suspect influenza quadrivalent recombinant vaccine at a dose of 0.5 mL once via intramuscular route (lot number: UJ509AA, expiry date: 05-Oct-2020) as prophylactic vaccination in the right deltoid. On an unknown date (latency unknown) after taking the suspect, it was reported that Flublok had been administered to 11 pediatric patients (with no adverse event) (Product administered to patient of inappropriate age) (intensity: not applicable). No laboratory test was reported. Action taken was reported as not applicable. Corrective treatment was not reported. Outcome was reported as not applicable for the event. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holders compliance with the requirements set out in Directive 2001-83-EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. No further information was reported.

Other Meds:

Current Illness:

ID: 0927958
Sex: F
Age: 50
State: CT

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

Lab Data:

Allergies: Bees, spiders, strawberries

Symptoms: dizziness at first that lasted half hour along with heart rate increase, and slight headache. an hour after injection, body aches, lethargic, a stronger headache, injection sight (left arm) was very sore. Later, aprox 3-4 hours, as symptoms subsided (headache, body aches, lethargic, heart rate returned to normal a few hours after injection), a new symptoms arise with numbness in my left leg from the knee down to my foot ,injection sight and arm soreness, and the back of my throat felt "funny" and dry it lasted aprox an hour (fyi: drank plenty of water throughout these symptoms). I took my normal medication. Went to sleep. Woke up and numbness was gone. Injection sight is still a bit sore but not as intense. I am feeling well today with little or no symptoms at all.

Other Meds: Lexapro, Rosuvastatin, Alprazolam, Losartan, Trazodone, and pro air(prn)

Current Illness: n/a

ID: 0927959
Sex: F
Age: 62
State: FL

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: Nobe

Allergies: No known allergies

Symptoms: Itching, redness, Swelling, warmth, discomfort in left arm that started 7 days after vaccine was given. Much better now but still with smaller area of sight redness and slight itching

Other Meds: Vitamin B12, multivitamin centrum silver, coQ10

Current Illness: None

ID: 0927960
Sex: F
Age: 30
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 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 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 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: 0927961
Sex: M
Age: 58
State: OH

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: n/a

Allergies:

Symptoms: Localized reaction to injection site with swelling, redness, and tightness at site.

Other Meds: Levothyroxine

Current Illness: n/a

ID: 0927963
Sex: M
Age: 28
State: CT

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

Lab Data: None.

Allergies: None.

Symptoms: Erythema, itchiness and warmth around the injection site. No pain. Slight induration.

Other Meds: Vitamin C daily, vitamin D weekly

Current Illness: Mild asthma

ID: 0927964
Sex: F
Age: 54
State: WI

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

Lab Data: I was prescribed Antibiotics after an Urgent Care visit.

Allergies: NKA

Symptoms: Had my 1st Moderna COVID-19 vaccine at 0745, on 12/30/20. On 1/6/20 at approximately 0400 while taking a showering I noticed a hematoma on Left Deltoid area. During the day of 1/6/20, my Left Deltoid area became increasingly red, swollen & painful. On Thursday, 1/7/20, the Left Deltoid area continued to increase in redness, warmth & swelling. I had the area of Left Deltoid marked with a skin marker at work on 1/7/20, during the day the redness & swelling increased beyond the skin marker. After work on 1/7/20, I went to an Urgent Care, I was diagnosed with Cellulitis and prescribed antibiotics. I also was unable to go work on Friday, 1/8/20, related to pain.

Other Meds: Gabapentin; Vit D; Vit C

Current Illness: None

ID: 0927965
Sex: F
Age: 50
State: MI

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

Lab Data:

Allergies: none

Symptoms: Insomnia for 3 nights following

Other Meds: none

Current Illness: none

ID: 0927966
Sex: F
Age: 38
State: GA

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

Lab Data:

Allergies: Augmentin

Symptoms: Woke up in am day after shot with sever body aches, headache and nausea. That lasted for 24 hours. Injection site was swollen right after it was administered and red and warm to the touch for 5 days.

Other Meds: Tri-sprintec (birth control) Xyzal

Current Illness: None

ID: 0927967
Sex: F
Age: 43
State: WV

Vax Date: 01/06/2020
Onset Date: 01/07/2020
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: 1/5/2021 received vaccination 1/6/2021 woke up at 6am with sore arm, muscle/joint pain, low grade fever of 100.4 . Treated with Tylenol and Ibuprofren. *I expected the second dose to be more 'hard hitting' then the first. The muscle / joint paint was a 6/10. 1/7 woke up at 4am and took Ibuprofren 1/8/ 'today i feel great'

Other Meds: N/A

Current Illness: N/A

ID: 0927968
Sex: F
Age: 60
State: NY

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

Lab Data:

Allergies: None

Symptoms: None stated.

Other Meds: Ropinirol, Omeprozole, Vitamin D

Current Illness: None

ID: 0927969
Sex: F
Age: 44
State: WI

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

Lab Data: COVID test 1/5/21 Influenza test 1/5/21 COVID test 1/8/21

Allergies: Na

Symptoms: Symptoms started 1/1/21 Pm. Headache, ear ache, chills, fever. COVID and influenza swabbed 1/5/21 both negative. Symptoms continued ear infection 1/6/21, nausea and chest pain. 1/7/21 vomiting and diarrhea started. Going in for COVID swab this am. And seeing a provider.

Other Meds: Vitamin D, Aspirin 81 mg, bupropion, metoprolol, escitalopram

Current Illness: Na

ID: 0927970
Sex: F
Age: 60
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 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: Agencies 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: 0927971
Sex: M
Age: 32
State: MT

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Cold Flashes Migraine

Other Meds:

Current Illness:

ID: 0927972
Sex: F
Age: 47
State: KY

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data:

Allergies: PCN

Symptoms: On the 8th day after the vaccine I soreness in the R deltoid, arm felt warm and when I looked there was a large red area with some raised redness. My arm was also itching. Day 9 the area was larger, but had the same itching, warmth, redness and raised area, also had some hives on top of upper R shoulder. Day 10 the area was slightly smaller, still itching and tender. Taking 25mg Benadryl twice daily for the itching. This is day 10 as I turn this in.

Other Meds: HCTZ, Celexa, Zinc, MVI, Oral Contraceptive

Current Illness:

ID: 0927973
Sex: M
Age: 36
State: OH

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

Lab Data:

Allergies:

Symptoms: 5 minutes after receiving the Moderna COVID vaccine, patient reported numbness/tingling on the inside of his mouth and tongue. No changes in vitals. Patient given Benadryl 50 mg once. 20 minutes later, patient reported no symptoms. Monitored for an additional hour, no symptoms.

Other Meds: none

Current Illness:

ID: 0927974
Sex: F
Age: 46
State: IL

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

Lab Data:

Allergies:

Symptoms: On day 9 developed redness, itching, swelling, hardness, heat & pain at injection site

Other Meds:

Current Illness:

ID: 0927975
Sex: F
Age: 31
State: IA

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/08/2021
Hospital:

Lab Data: N/A

Allergies: Penicillin

Symptoms: Initially began with sore arm one day after vaccination (12/30), The next Wednesday (1/6), the vaccinated arm was sore, and later in the day developed small red areas near the vaccination area. The next morning the entire vaccination area was red, hot to the touch, swollen, and aching, and the redness had developed into an 11x7 cm area. The area continued to expand and later developed hives on chest, hips, legs in addition to joint pain (hips, left arm shoulder to wrist) and severe chills. Sought treatment and receive Keflex for cellulitis, since treatment the redness has improved but the area has continued to expand.

Other Meds: Levothyroxine - 100 mcg daily

Current Illness: Recent recovery from a cold

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm