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: 1049605
Sex: F
Age: 32
State: HI

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Tenderness on the injection site left arm, Right hip pain, Right elbow pain, Headache and fatigue

Other Meds:

Current Illness:

ID: 1049606
Sex: F
Age: 62
State: PR

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 02/23/2021
Hospital:

Lab Data: None.

Allergies: Septra.

Symptoms: Body aches, low blood pressure, tingling sensation in hands, symptoms lasted for a week.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 1049607
Sex: F
Age: 61
State: KS

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: She was referred to her PCP for specifics.

Allergies: Ultram

Symptoms: The patient reports that the day following her 2nd vaccination she developed a fever (lasting 48 hrs) up to 101.1F, headache, abdominal cramps, nausea, diarrhea and numerous sores in her mouth.

Other Meds: Metformin, Effexor, Singulair, Tenoretic

Current Illness: Strep throat (dx'd shortly after receiving 1st dose on 1/20/2021). Diagnosed with internal shingles on 2/22/2021.

ID: 1049631
Sex: U
Age: 10
State: TX

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: no additional AE reported; Vaqta involved in temperature excursion on 01/01/2021. Vaccine had been administered to 33 patients; This spontaneous report was received from a medical assistant and refers to a 10-year-old patient of unknown gender. The patient's pertinent medical history, drug reactions and concomitant therapies were not provided. On 05-JAN-2021, the patient was vaccinated with an improperly stored hepatitis A vaccine, inactivated (VAQTA) lot # T013204 has been verified to be a valid lot number, with expiration date reported as 03-DEC-2021 (strength, exact dose, dose #, anatomical location and route of administration were not reported) as prophylaxis. Administered dose of vaccine experienced a temperature excursion of 47.01 degrees Fahrenheit for 1 minute and 30 seconds on 01-JAN-2021. Digital data logger was involved. There was no previous excursion noted. There was no additional adverse event reported. This is one of 33 reports from the same reporter (original case # 2102USA004059). combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: T013204; expirationdate: 03-DEC-2021; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability; Sender's Comments: US-009507513-2102USA004059:

Other Meds: VAQTA SYRINGE

Current Illness:

ID: 1049632
Sex: U
Age: 67
State: TX

Vax Date: 04/13/2009
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: shingles; Information has been received from a lawyer regarding a case in litigation and refers to a currently 79-year-old patient (pt) of unknown gender. The patient's pertinent medical history, concurrent conditions and concomitant medications were not provided. On or about 13-APR-2009, pt was vaccinated with zoster vaccine live (ZOSTAVAX) for the long-term prevention of shingles and zoster-related conditions (strength, dose, route of administration, anatomical location, lot # and expiration date were not reported). Subsequently, on an unknown date, pt had shingles (herpes zoster) and received treatment for this injury. At reporting time, the outcome of herpes zoster was unknown and this event was considered to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1049633
Sex: U
Age: 57
State: AZ

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Test Date: 20210121; Test Name: Body temperature; Result Unstructured Data: (Test Result:101,Unit:degree F,Normal Low:,Normal High:)

Allergies:

Symptoms: i have a 101 fever; This case was reported by a consumer via call center representative and described the occurrence of fever in a 57-year-old patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (1st dose received on an unknown date). On 20th January 2021, the patient received the 2nd dose of Shingrix. On 21st January 2021, 1 days after receiving Shingrix, the patient experienced fever. On an unknown date, the outcome of the fever was unknown. It was unknown if the reporter considered the fever to be related to Shingrix. Additional details were provided as follows: The case was reported by the patient. The patient got the 2nd shot last night from the day of reporting. They took temperature and it was normal. The patient got the shot and now at the time of reporting had a 101 degree Fahrenheit fever. The patient did not have this kind of a reaction to the 1st shot. The patient how long could expect the side effects to last.

Other Meds:

Current Illness:

ID: 1049634
Sex: F
Age: 68
State: CA

Vax Date: 12/04/2020
Onset Date: 12/04/2020
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: minor throat swelling; This case was reported by a consumer via call center representative and described the occurrence of throat swelling in a 68-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of injection site swelling (1st dose received on end of September 2020, refer link case US2021014406). On 4th December 2020, the patient received the 2nd dose of Shingrix (intramuscular). On 4th December 2020, less than a day after receiving Shingrix, the patient experienced throat swelling. The patient was treated with ibuprofen (Advil). On 5th December 2020, the outcome of the throat swelling was recovered/resolved. It was unknown if the reporter considered the throat swelling to be related to Shingrix. Additional details were provided as follow: Caller was the patient and reported a reaction when taking 2nd dose of the Shingrix vaccine. The patient received 2nd dose of Shingrix vaccine on 4th December 2020 in the morning and reported a minor throat swelling during the night after she received her 2nd Shingrix vaccine. The reporter asked was this a side effect of Shingrix and took an Advil tablet for the swelling. The swelling was completely resolved in an hour after taking the Advil tablet. The reporter did not consent to follow-up. The reporter does not give permission to contact HCP.; Sender's Comments: US-GLAXOSMITHKLINE-US2021014406:same reporter

Other Meds:

Current Illness:

ID: 1049635
Sex: F
Age: 77
State: NM

Vax Date: 10/13/2020
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Came down with shingles / shingles episode is not totally over; rash is receding ut there are still some eruptions; This case was reported by a consumer via call center representative and described the occurrence of shingles in a 77-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 13th October 2020, the patient received the 1st dose of Shingrix (intramuscular). On an unknown date, 3 weeks after receiving Shingrix, the patient experienced shingles and rash. On an unknown date, the outcome of the shingles was not recovered/not resolved and the outcome of the rash was recovering/resolving. It was unknown if the reporter considered the shingles and rash to be related to Shingrix. Additional details were reported as follows: The patient received Shingrix in an unspecified arm. Three weeks later she came down with shingles. The patient stated she did not necessary think Shingrix caused the shingles outbreak, she said it was probably just a coincidence. She stated that the pharmacist did not give her any literature therefore she did not have the lot number or expiration date of the vaccine. The shingles episode was not totally over She said the rash was receding but there were still some eruptions. Consented to follow up.

Other Meds:

Current Illness:

ID: 1049636
Sex: M
Age: 93
State: NC

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Very harsh dysrhythmia; Parkinson's symptoms got worse with joint contractions, stiffening, and confusion; Napping more; Blood pressure has been haywire, sometimes going high and sometimes low; A spontaneous report was received from a consumer, who was also the daughter of a 93-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a very harsh dysrhythmia (arrhythmia), Parkinson's symptoms got worse with joint contractions, stiffening, and confusion (Parkinson's disease); he has been napping more than before (somnolence), and blood pressure has been haywire, sometimes going high and sometimes low (hypertension, hypotension). Medical history, as provided by the reporter, included COVID in July 2020 from which he fully recovered, slight dysrhythmia, Parkinson's (tremors only), and slightly elevated blood pressure. The reported stated the patient's baseline health had been pretty good and he was usually mobile, active, cognitive, and had speech. Concomitant medications included carbidopa monohydrate (+) levodopa, losartan, beta blocker (unspecified), and liquid morphine. On 20 Jan 2021, one day prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (lot number: 028L20A) intramuscularly in his right (dominant) arm for prophylaxis of COVID-19 infection. On 21 Jan 2021, around 2 pm, the patient had "a very harsh" dysrhythmia and his Parkinson's symptoms worsened with joint contractions, stiffening, and confusion. He had also been napping more than before. Since getting the vaccine, his blood pressure "has been haywire", sometimes going high and sometimes low. Treatment information was not provided. The action taken with mRNA-1273 in response to the events was unknown. The outcome of the events, a very harsh dysrhythmia, Parkinson's symptoms got worse with joint contractions, stiffening, and confusion; napping more than before, and blood pressure has been haywire, sometimes going high and sometimes low, were considered not recovered/not resolved at the time of this report.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: CARBIDOPA + LEVODOPA; LOSARTAN; BETA BLOCKING AGENTS; MORPHINE

Current Illness: Blood pressure increased (slightly); Dysrhythmias (slight); Parkinson's disease (tremors only)

ID: 1049637
Sex: M
Age: 65
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: miembro viril esta muerto-virile member is dead; bad taste in mouth; loss of taste; legs are very weak especially in the knees, sometimes not able to stand in his feet; pain in the arm; A spontaneous report was received from a consumer who was also a 65-year-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a little pain in the arm, bad taste in the mouth, loss of taste, legs are very weak, specially in the knees, not able to stand on his feet, and "miembro viril esta muerto" meaning "his virile member is dead" or having erectile dysfunction. The patient's medical history included a hernia intervention on 20 Jan 2021, HIV positive, and has headaches. Products known to have been used by the patient included a multivitamin and HIV medicines. Patient states that he received "injections for headaches in his brain, " however no medications are specified. Patient has no known allergies. On 25 Jan 2021, prior to the onset of the events, the patient received one of two planned doses of mRNA-1273 (Lot number: 042L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 25 Jan 2021, one day after the mRNA-1273 vaccine was given, the patient noted that he had a little pain in the arm but nothing to worry. On 28 Jan 2021, the patient stated that he started to have a bad taste in the mouth, loss of taste, legs are very weak, specially in the knees, not able to stand on his feet, and erectile dysfunction. Treatment information was not provided. Action taken with mRNA-1273 was not reported. The outcome of the events, little pain in the arm, bad taste in the mouth, loss of taste, legs are very weak, specially in the knees, not able to stand on his feet, and having erectile dysfunction is unknown.; Reporter's Comments: Based on the current available information, the absence of an other etiologies and temporal association between the use of the product and the start date of the reported event, a causal relationship cannot be excluded. Vaccination site pain is consistent with the known safety profile of the vaccine

Other Meds: MULTIVITAMIN [VITAMINS NOS]; HIV Medicines

Current Illness: Headache NOS; HIV positive

ID: 1049638
Sex: F
Age: 46
State: AZ

Vax Date: 01/13/2021
Onset Date: 01/15/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Test Date: 20210124; Test Name: oxygen saturation; Result Unstructured Data: oxygen levels were going down; Test Date: 20210117; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: positive

Allergies:

Symptoms: Pneumonia; Loss of taste; Loss of smell; stared into space for hours; Covid Positive Test; Felt Spacy; Cough; A spontaneous report was received from a consumer concerning a 46 year-old female patient who experienced Covid-19 positive test [COVID-19], felt spacy [dizziness], stared into space for hours [staring], and pneumonia. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 13 Jan 2021, approximately five days prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. On 15 Jan 2021, the patient started experiencing symptoms of coughing. On 17 Jan 2021, the patient tested positive for Covid-19. The patient reported she felt spacy and stared into space for hours. On 19 Jan 2021, the patient experienced symptoms of loss of taste and smell. On 24 Jan 2021, the patient's oxygen levels were going down. Treatment for the event of Covid-19 included azithromycin, prednisone, albuterol, and cough medicine. On 28 Jan 2021, the patient tested positive for pneumonia. Treatment for the event of pneumonia included levofloxacin. Action taken with mRNA-1273 in response to the events was unknown. The event of pneumonia was considered resolved on an unknown date. The outcome of the event of Covid-19 was unknown. The events, felt spacy and stared into space for hours, were considered resolved on an unknown date.; Reporter's Comments: Based on the concurrent Covid-19 infection, the events are assessed as unlikely related to mRNA-1273.

Other Meds:

Current Illness:

ID: 1049639
Sex: F
Age:
State: NM

Vax Date: 01/26/2021
Onset Date: 02/05/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: swelling on the left side of my face; Bell's palsy/ left side can not function properly. I have little eye, mouth and forehead movement; This is a spontaneous report from a contactable consumer (patient). A 40-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EL8982), via an unspecified route of administration (at the age of 40-years-old) on 26Jan2021 10:15 at a single dose in Left arm for COVID-19 immunization. Medical history was not applicable (N/A). The patient was not Pregnant at the time of vaccination. The patient's concomitant medications were not reported. The patient experienced swelling on the left side of my face and Bell's palsy/ left side can not function properly. I have little eye, mouth and forehead movement on 05Feb2021 10:30. The patient reported, "I have swelling on the left side of my face as well as Bell's palsy. My left side cannot function properly. I have little eye, mouth and forehead movement." The events resulted in Doctor or other healthcare professional office/clinic visit, Disability or permanent damage. The outcome of the events was not recovered. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No other medications received within 2 weeks of vaccination. Therapeutic measures were taken as a result of the events which included anti-viral medication and a steroid. The events were assessed as serious (Seriousness criteria-Disabling/Incapacitating). Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19.

Other Meds:

Current Illness:

ID: 1049640
Sex: F
Age:
State: AR

Vax Date: 02/06/2021
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: diarrhea and it was just all bright red fresh blood/bright red blood with diarrhea; bright red blood coming from her anal area; feel heaviness, she just feels that heaviness.; she lost weight; This is a spontaneous report from a contactable consumer (patient). A 81-year old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE lot number EM9809) (at the age of 81-years-old), via an unspecified route of administration on 06Feb2021 between 12:30 and 1PM as a single dose for covid-19 immunization. The facility where COVID-19 vaccine was a doctor's office and administered anatomically located on the right arm. The patient medical history included: She has been diagnosed years ago 10 years ago, which was since she smoked with COPD and she is on breathing medication, but she has not had it due to getting in a donut hole with insurance and she cannot afford it, her hands also won't let her use it, She hasn't had it for 2 months. Arthritis. She has had no other vaccines on the same day or in the past 4 weeks, she had the flu shot back in Oct2020. Family Medical History: Her dad had heart problems and cancer. Her brother had cancer. Her mother had heart conditions. Concomitant medications included: Acetaminophen and Naproxen sodium. She was taking a lot of acetaminophen and Naproxen sodium for arthritis pain, but she has not had any since Friday night 05Feb2021. She did not want to take anything before the shot. She hasn't been weighed in a while, she lost weight. On 06Feb2021, at 8 o clock on the night, she experienced bright red blood coming from her anal area; then, she had diarrhea and it was just all bright red fresh blood, it was fresh new blood not dark at all. Today she is still having bright red blood with diarrhea; the blood seems like it is decreasing, it's being colored by diarrhea. She felt maybe in so many years is like when you have a period at times and feel heaviness, she just feels that heaviness. Caller reports that she does have a standing appointment with her provider tomorrow. The clinical outcome of the events bloody diarrhea and anal bleeding was not recovered, heaviness and weight decreased was unknown. She is scheduled for the second dose on 10Feb2021.

Other Meds: ACETAMINOPHEN; NAPROXEN SODIUM

Current Illness:

ID: 1049642
Sex: F
Age:
State: SC

Vax Date: 12/30/2015
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: face was really red like an allergy; blood pressure went up to 170; face was really red like an allergy and neck was very red; Initial information regarding an unsolicited valid non-serious case was received from a consumer/non-health care professional. (Reference number- 00457128) and transmitted to Sanofi on 02-Feb-2021 This case involves a 68 year old female patient who had face was really red like an allergy (hypersensitivity), while she received INFLUENZA USP TRIVAL A-B HIGH DOSE SUBVIRION VACCINE [FLUZONE HIGH DOSE]. Medical history, medical treatment(s), past vaccination(s) concomitant medication and family history were not provided. On 30-Dec-2015, the patient received a dose of suspect INFLUENZA USP TRIVAL A-B HIGH DOSE SUBVIRION VACCINE (lot UI517AA and expiry date: 23-Jun-2016) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient developed face was really red like an allergy (hypersensitivity) with their symptoms face was really red like an allergy and neck was very red (erythema) and blood pressure went up to 170 (hypertension) (unknown latency) following the administration of INFLUENZA USP TRIVAL A-B HIGH DOSE SUBVIRION VACCINE. Laboratory data was not provided. Patient was given 4 shots of steroids and her symptoms resolved after a few days. Patient also had to take Benadryl and went to a dermatologist because the redness on her face would not go away. At the time of reporting, the patient was not recovered from erythema and recovered from rest of the events.

Other Meds:

Current Illness:

ID: 1049643
Sex: F
Age: 18
State: PA

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: rash at the injection site; 18 year old female patient inadvertently administered Pentacel instead of Menactra; 18 year old female patient inadvertently administered dose of Pentacel; Initial information received on 11-Feb-2021 regarding an unsolicited valid non-serious case received from a nurse in the United States. This case involves a 18 years old female patient who inadvertently administered dose of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] instead of MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE [MENACTRA] (wrong product administered and product administered to patient of inappropriate age) and patient who experienced rash at the injection site (vaccination site rash), while she received vaccine DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL]. Medical history, medical treatment, concomitant medication, vaccination and family history were not provided. On 08-Feb-2021, the patient received a 0.5 ml dose of suspect DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (lot UJ337AAA and expiry date: 05-Jul-2021) via an intramuscular route in the left deltoid for prophylactic vaccination. It was a case of actual medication error due to wrong product administered and product administered to patient of inappropriate age (latency on same). On 10-Feb-2021, the patient developed a non-serious rash at the injection site (vaccination site rash) two days following the administration of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE. Details of laboratory data not reported. The patient was treated with MEDROXYPROGESTERONE ACETATE (DEPO-PROVERA). At the time of reporting, the patient had not recovered from the vaccination site rash (also reported that rash does not go away in a few days). Reporter relationship: health care professional (HCP), Product used: used still using product: no This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's 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.

Other Meds:

Current Illness:

ID: 1049644
Sex: F
Age: 68
State: OH

Vax Date: 02/12/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: No

Allergies: Colgate toothpaste with the bubbles. Lip swelling and rash around mouth. Went to urgent care after 3 days as my symptoms had worsen. Given prednisone injection and tablets to take for 7 days. This was 4 or 5 years ago. Can still use Colgate but not that variety.

Symptoms: Noticed redness at injection site and and just below injection site around 2 am Tuesday, February 23, 2021. It's not painful to the touch and does not itch. Some areas look like "welts".

Other Meds: Hydrochlorothiazide 12.5 mg 1 Every Monday, Wednesday, Friday (Did not take until after vaccination) Atorvastatin 10mg 1 at bedtime

Current Illness: No

ID: 1049645
Sex: F
Age: 76
State: TN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: NONE

Allergies: Argon gas

Symptoms: PATIENT PRESENTS TO COVID SITE FOR COVID VACCINATION. PATIENT'S PFIZER FORM INDICATES A FIRST DOSE NEEDED AND NO DOSE PREVIOUSLY GIVEN. PATIENT IS ADMINISTERED ONE PFIZER VACCINE LOT # EL9269 EXP 5/21 IN R DELTOID. UPON ENTRY INTO TENNIIS, IT IS DISCOVERED THAT THE PATIENT HAD IN FACT RECEIVED A FIRST DOSE OF MODERNA VACCINE LOT# 011J20A ON 1/11/21.

Other Meds: unknown

Current Illness: unknown

ID: 1049646
Sex: F
Age: 49
State: FL

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

Lab Data: none

Allergies: mushrooms, doxycillin, Zoloft, Nexium

Symptoms: redness and swelling at injection site, hematoma in lower abdomen, hematoma in right forearm

Other Meds: Zofran ODT 4mg; Bentyl 10mg; clonazepam .5 mg; Humolog 75/25; Duoneb; Singulair 10 mg; Protonics 40 mg; Prozac 20 mg; Atorvastatin

Current Illness: none

ID: 1049647
Sex: F
Age: 37
State: CO

Vax Date: 01/19/2021
Onset Date: 02/15/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: no

Allergies: no

Symptoms: On 2/15 I begin to have chill, body aches, headache, fatigue and breast pains which continued into the next day. I was again prescribed the same 7 day antibiotic and disagnosed again with Mastitis but this time the symptoms lasted a little longer and after about day 5 I began to feel myself again. A mammogram and an ultrasound has been ordered to see why I developed the Mastitis so frequently but is not scheduled for another few weeks out from today.

Other Meds: Singular, Flovent Inhaler, Nexplanon BC Implant, doxclimine

Current Illness: nothing besides the AE to the 1st vaccine

Date Died: 02/20/2021

ID: 1049648
Sex: M
Age: 87
State: WA

Vax Date: 02/02/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: unknown

Symptoms: I was notified on 2/22/21 that this patient passed away over the weekend. I do not know the details, nor can I confirm anything beyond what I was told. I believe the death occurred on 2/20/21 due to a massive stroke.

Other Meds: unknown

Current Illness: unknown

ID: 1049649
Sex: M
Age: 65
State: NE

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: During observation, patient stated he was lightheaded. Denied any other symptoms. No SOB, no oral or facial swelling, no rash or swelling. Vitals stable- BP 100/62, pulse 62, RR 12. Ate breakfast but had not had lunch. Patient was observed for 30 minutes and given water. Symptoms resolved by end of observation period.

Other Meds: None

Current Illness: None

ID: 1049650
Sex: F
Age: 37
State: NY

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Low grade temp. Body aches, head ache, and fatigue

Other Meds: Synthroid, Lexapro, Birth control

Current Illness: None

ID: 1049651
Sex: F
Age: 78
State: IN

Vax Date: 01/27/2021
Onset Date: 02/02/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: Iodine Codein, Tramadol, Percoset, Persantine, Tape, Cinnamon,

Symptoms: Started turning red on 2/2/21. Noticed when getting dressed. Red circle around injection site about size of half of orange. Later in day started itching a little. Next day size of half a grapefruit. Itching off and on. Didn't disappear until 2/7/21. Read online to use arm and apply cold. So i did this. every so often. N

Other Meds: Atenolol, Chlorthalid,, Losartan, Synthroid, Rosuvastin, Mometasone Furoate Spray, Arthritis Tylenol, Zyrtec, Centrum Silver, Bayer Regimen, Phytomega with Fish Oil, CoQ10, Preservision, Refresh Eye Drops, Pain-A-Trate Pain relieving topic

Current Illness: Tooth extraction on 1/2021

ID: 1049652
Sex: F
Age: 43
State: NY

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Labs sent on 2/23: Tryptase level, CBC, CMP, COVID antibody, CH50, C4, C3, cytokine 12 panel, C5B complement, C% complement, C6 complement, C7 complement, C8 complement, C9 complement

Allergies: none

Symptoms: pt initially noted palpitations and shortness of breath. After several minutes improved and then pt developed lip and tongue swelling

Other Meds: Biotin

Current Illness: none

ID: 1049653
Sex: M
Age: 35
State:

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pt felt a lump in sternum like he swallowed something and it was stuck.

Other Meds:

Current Illness:

ID: 1049654
Sex: F
Age: 66
State: NJ

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: SULFA , IODINE, SHELL FISH

Symptoms: Headache, felt like I was starting a bad cold , chills, low grade fever and every joint ached for 36 hours. Then it just went away.

Other Meds: RABEPRAZOLE SODIUM 20 MG

Current Illness: NONE

ID: 1049655
Sex: M
Age: 38
State: PA

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Severe and debilitating lower back pain that lasted roughly 3 hours. Use of a heating pad for an extended period of time assisted with recovery.

Other Meds: Famotidine and singular.

Current Illness: None

ID: 1049656
Sex: F
Age: 54
State: VA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: C/o feeling itchy on arms, neck, knee. No rash noted at injection site or on arms. Blotchy essential noted neck right clavicle area. Denies pain, SOB, dizziness, nausea. P76. Checked by EMT. EMT instruct ti take oral benadryl when she gets home. Client stated that perfums,perfume, lotions can set off itchy feeling when shesmells perfume.

Other Meds:

Current Illness:

ID: 1049657
Sex: F
Age: 59
State: WI

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Keeflex

Symptoms: Flu like symptoms 24 hours after shot. Fever, chills, sick to stomach, uncontrollable shaking!

Other Meds: Levothyroxine

Current Illness: None

ID: 1049658
Sex: F
Age: 77
State: VA

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: exam on 2-23-21 after symptoms resolved

Allergies: pneumonia vaccine, sulfa

Symptoms: bilateral lower leg edema started 24 hours after vaccine, associated with dizziness, leg spasm/tremors, unable to walk, resolved in 4 days. no prior history, no other new medications taken

Other Meds: amlodipine, vitamin D3, benazepril, carvedilol, hydrochlorothiazide, relafen, trazodone, Flonase

Current Illness: none

ID: 1049659
Sex: F
Age: 45
State: TX

Vax Date: 02/12/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: N/A

Allergies: Sulfa antibiotics

Symptoms: Moderna COVID-19 Vaccine EUA. Minor and expected tenderness the day after injection. Noticed 9 days after vaccination that the injection site is getting swollen and very itchy. Increasing redness. Taking OTC antihistamines and ibuprofen as needed. No need for additional intervention yet, but felt obligated to report and help provide information. Currently on injection day +10, increased redness, swelling, and itching.

Other Meds: Azathioprine, cetirizine, vitamins A and D

Current Illness: Nothing acute that I know of.

ID: 1049660
Sex: U
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Large (3 inch in diameter), red, hot, itchy, bump on left arm.

Other Meds:

Current Illness:

ID: 1049661
Sex: F
Age: 63
State: KS

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Reddness, swelling and warmth below injection site.

Other Meds:

Current Illness:

ID: 1049662
Sex: F
Age: 84
State: ID

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

Lab Data:

Allergies:

Symptoms: Hospice patient with multiple comorbidities. Within hours of injection became lethargic and unresponsive, she remained in this state for 3 days.

Other Meds:

Current Illness:

ID: 1049663
Sex: M
Age: 69
State: NE

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Client arrived to vaccine clinic with stomach ache. Denied fever or other symptoms and stated he thought he had food poisoning. Vaccine administered per client request. Client observed for 15 minutes and no other reaction noted. Patient left after 15 minutes. Later facility was told client returned to his apartment and called 911 to go the ER to be seen for stomach pain. Paramedics notified patient had received COVID-19 vaccine.

Other Meds: Unknown

Current Illness: Complaining of stomach ache and food poisoning when entered for vaccination. No fevers.

ID: 1049664
Sex: M
Age: 62
State: CO

Vax Date: 02/17/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: temp taken normal 97'C, pulse oximetry during event sat 91%, pulse 88,.

Allergies: none

Symptoms: severe chills. shivering at night for 2 hours. no fever, some aching and malaise. this was 4 days after shot. all previous days was fatigued alittle chilled and arm sore. taking alot of tylenol drinking alot of water. things did not get worse.

Other Meds: synthroid, coumadin, lasix, metaprolol. fish oil,

Current Illness: AFIB. was in hospital when offered first shot for AFIB.

ID: 1049665
Sex: F
Age: 81
State: CA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: Codene

Symptoms: Had body aches and low grade fever 99 +, took Tylenol 500mg, and fever broke. Next day just didn't feel well, tired and little nauseated. That lasted all day but next day felt fine.

Other Meds: Atorvastatin 20mg., Losartan/HCTZ 100-12.5 mg., Calcium Citrate, Acidophilus Probiotic, Aspirin 81mg.,Vitamin D3, Omeprazole, Aller-tec, Vitamin B-12, Co-Q-10

Current Illness: None

ID: 1049666
Sex: M
Age: 55
State: FL

Vax Date: 02/11/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: 01/28-- >136 Na level 02/16-- >130 Na level 02/17-- > 129 Na level

Allergies:

Symptoms: profound hyponatremia

Other Meds:

Current Illness:

ID: 1049667
Sex: M
Age: 24
State: KY

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: tylenol

Symptoms: 2nd dose of Moderna given to early. First dose given on 1/29/2021 and 2nd dose given 2/17/2021.

Other Meds: Unkown

Current Illness: none

ID: 1049668
Sex: F
Age: 71
State: OK

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None done.

Allergies: Codeine

Symptoms: Starting 16 hrs. Post vaccine; sniffles, fever 102 F. , mild bloody nose, arm pain, excruciating head ache and facial pain not relieved by #2 50mg Ultram every 4 to 5 hrs, lethargy, chapped lips and cold sore. February 23rd most symptoms gone except lethargy and cold sore.

Other Meds: Multi Vitamin, Vitamin C

Current Illness: None

ID: 1049669
Sex: M
Age: 75
State: MI

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: n/a

Allergies: NKA

Symptoms: fever

Other Meds: Theragran-M multivitamin tab 1 x day, Aspirin81 mg 1 x day, Tylenol cap 600 mg q 6 hr prn, Baclofen tab 5 mg 3 x day, cholecalciferol 50 mcg,atorvastatin calcium 40mg,

Current Illness: n/a

ID: 1049670
Sex: F
Age: 92
State: IL

Vax Date: 01/02/2021
Onset Date: 01/11/2021
Rec V Date: 02/23/2021
Hospital: Y

Lab Data:

Allergies: Codeine Ibuprofen Oxycontin

Symptoms: DX: Ileus Chief Complaint: Coffee-ground emesis, bowel obstruction Source of History: Patient History The patient is a 92 y.o. female with a past medical history notable for COPD, dementia, history of DVT, reflux, hypertension, hypothyroidism, recent small bowel obstruction. The patient presents for evaluation of Worsening issues of coffee-ground emesis once more. This is very similar patient's last hospitalization were patient required NG to and monitoring for blood loss. Patient continues to be confused and not a good source of history. Staff notes that patient started this 1 day prior at skilled care facility was sent into the ER. Patient's past medical history, past surgical history, social history, family history, medications allergies were reviewed. Patient shows no signs of any pain or discomfort

Other Meds: Current Outpatient Medications on File Prior to Encounter Medication Sig Dispense Refill ? acetaminophen (TYLENOL) 325 MG tablet Take 650 mg by mouth every 6 hours as needed for Pain ? albuterol (ACCUNEB) 0.63 MG/3ML nebulizer solution

Current Illness:

ID: 1049671
Sex: M
Age: 35
State: NY

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: None

Symptoms: Temp of 103 and 104, stabbing back pain. Cold bath for treatment

Other Meds: Bystolic,

Current Illness: Hypertension

ID: 1049672
Sex: F
Age: 65
State: OK

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: n/a

Allergies: n/a

Symptoms: 30 minutes after vaccination on left arm 2 inch round red spot, bigger than half dollar, hot and hard, sore

Other Meds: levothyroxine, hydroxychlorine

Current Illness: n/a

ID: 1049673
Sex: F
Age: 64
State: PA

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: NONE

Allergies: SHELLFISH, DILAUDID, PERCOCET

Symptoms: TUESDAY NIGHT, NIGHT OF INJECTION, ANXIOUSNESS. NEXT DAY IRRATIBILTIY, HIGH GLUCOSE READING IN AM , SORE SWOLLEN ARM (INJECTION SITE). LATE AFTERNOON DAY 2, SEVERE PAIN HANDS AND FEET, ESPECIALLY TOES AND FINGERS, VERY TIRED, AND INCREASE IN APPETITE AND JOINT PAIN. DAY 3 ALL DAY 2 EXCEPT GLUCOSE AM WAS BACK TO NORMAL, BUT ARM MORE SORE , SWOLLEN AND RED AND NOW HOT TO TOUCH. THESE SYMPTOMS CONTINUED UNTIL THE FOLLOWING SUNDAY. THE ARM CONTINUED TO BE SORE, RED AND SWOLLEN. TODAY, 2/23/2021, IS 3 WEEKS SINCE I WAS VACCNATED. MY ARM IS STILL SORE BUT I HAVE A LARGE SPOT ON MY UPPER ARM, INJECTION SITE, WHICH IS STILL SWOLLEN, RED AND HOT TO TOUCH BUT ALSO VERY ITCHY. CAN I HAVE SHOT #2?

Other Meds: METOPROLOL, LEVOTHYROXINE, XYPREXA, SOLIQUA, METFORMIN, GLIPIZIDE XL, GABAPENTIN, SUDAFED, MULTI VITAMIN, VIT B COMPLEX, VIT D

Current Illness: DIABETIC II, HTN, HYPOTHYROID, ALLERGIES, POST CA BREAST 2006,

ID: 1049674
Sex: M
Age: 68
State: FL

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Chills about 16 hours after vaccine.. lasted one hour sore arm 2 days . fatigue for 3 days , longer sleeping than usual.

Other Meds: Insulin, metformin, farxiga, welbutrin xl, lamotrogine, avorsytatin soligua

Current Illness: none

ID: 1049675
Sex: F
Age: 74
State: IA

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Hand xray on 2/23/2021

Allergies: Augmenting, and statins

Symptoms: Arthritic type flare in right hand with pain, swelling. Unable to grip due to stiffness and pain.

Other Meds: Insulin, asa81 mg, thyroid, metoprolol, Metformin, Tylenol, Ropinirole, famotidine, vagifem

Current Illness: None

ID: 1049676
Sex: F
Age: 63
State: IL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Eggs

Symptoms: Starting at 6 pm in 17 the. Feelings of electrical shocks in various places in my body every 15 to 20 minutes stopping at 5 pm the 18 the. A sensation like getting a shock from an exposed outlet but not on skin, it was inside my body. Enough of a shock to be startling. One time it would be in right upper arm then upper leg, lower leg, sides, etc...

Other Meds: Levothyroxine, previous, pepto bismol, melatonin

Current Illness:

ID: 1049677
Sex: F
Age: 27
State: CO

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Environmental: dust mites, cats Seasonal: corn pollen, juniper , Rocky Mountain cedar

Symptoms: 6 hours after receiving the vaccine I developed a sore arm & severe headache, later followed by chills, all over body aches, severe fatigue, nausea, diarrhea, and then a fever of 102.1 which lasted three days and did not break or go down with Tylenol. On the third day I had no symptoms at all other than slight fatigue.

Other Meds: None

Current Illness: None

ID: 1049678
Sex: F
Age: 63
State: OR

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: Amoxicillin

Symptoms: I was fine til about 2am when I was faint and light headed with flu-like symptoms, stuffy nose, body aches + terrible migraine headache. Was so sick that I was unable to find my migraine meds (prescribed by doctor). Have history of migraines but haven't had one in several month...I was dizzy and worried about thowing up and fainting. Note: usually never recieve the flu shot but not during 2020.

Other Meds: Nothing

Current Illness: none

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm