VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

Date Died: 04/24/2021

ID: 1289756
Sex: F
Age: 86
State: PA

Vax Date: 04/05/2021
Onset Date: 04/24/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no known allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient passed away before receiving second dose, husband states not COVID related death.

Other Meds:

Current Illness:

ID: 1289757
Sex: F
Age: 50
State: IN

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Flu like symptoms Diaheria

Other Meds: None

Current Illness: None

ID: 1289758
Sex: F
Age: 23
State: TN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: patient has red blotchy spots on the left arm

Other Meds:

Current Illness:

ID: 1289759
Sex: M
Age: 26
State: GA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was given vaccine twice in the same arm at the same appointment. The patient was counseled on possible increased side effects. THere is no follow up.

Other Meds:

Current Illness:

ID: 1289760
Sex: M
Age: 26
State: GA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient was given vaccine twice in the same arm at the same appointment. The patient was counseled on possible increased side effects. THere is no follow up.

Other Meds:

Current Illness:

ID: 1289761
Sex: M
Age: 17
State: WI

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Amoxicillin

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Patient received vaccine under the approved age. No adverse events noted.

Other Meds:

Current Illness:

ID: 1289762
Sex: M
Age: 32
State: UT

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient experienced fever, body aches, and nausea followed by severe vomiting that laster for 2 hours.

Other Meds: xiidra, topamax

Current Illness:

ID: 1289763
Sex: M
Age: 48
State: CT

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Pharyngeal swelling

Symptoms: After 24 hours, slight headache and pressure. Resolved by next morning.

Other Meds: Propranolol 40mg x2/day

Current Illness: n/a

ID: 1289764
Sex: M
Age: 65
State: NY

Vax Date: 03/08/2021
Onset Date: 03/10/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Same day symptoms fever, myalgia, arthralgia, shortness of breath, leg swelling, transaminitis, hyponatremia. Found to have pericardial and pleural effusions. Proteinuria and hematuria on urine test. Kidney biopsy performed confirmed diagnosis of fibrillary glomerulonephritis. Diagnosed with serum sickness like reaction

Other Meds: Occasionally ibuprofen, levothyroxine, tildafil

Current Illness: None

ID: 1289765
Sex: F
Age: 69
State: CA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Tingling/pinching of left hand/thumb. No redness/swelling. Pt states feeling sleepy, appeared lethargic, shaking noted. Pt reports feeling weak but able to raise bilateral upper extremity forward. Diphenhydramine 25mg IM given in R arm. Pt alert and oriented. 911 called at 1345, EMS arrived 1350

Other Meds:

Current Illness:

ID: 1289766
Sex: F
Age: 18
State: NY

Vax Date: 04/16/2021
Onset Date: 05/01/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: pulmonary embolism

Other Meds: OCP

Current Illness: none

ID: 1289767
Sex: F
Age: 63
State: CA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Trazodone, sulfa, codeine, steriods

Symptom List: Rash, Urticaria

Symptoms: 1st dose, migraine, body aches especially hips, and neck, nauseous, temperature, malaise, Insomnia, agitated , lasted 4 days 2nd dose, migraine, body aches, lower back and neck has seized up, nauseous, malaise., insomnia, agitated. Continuing to have these side effects. Headaches are awful go from Migraine, to sinus, to tension like a vise grip is squeezing my temples to pain in the back of my neck. Brain fog, saying and doing stupid things, vertigo off and on. We are calling it covid brain. Its been 2 weeks since the 2nd vaccine. I have contacted my doctor and we are trying to figure something out. any of my friends are having long term side effects and they won't contact you.

Other Meds: lots you do not need to know

Current Illness: N/A

ID: 1289768
Sex: M
Age: 24
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Altered taste, loss of taste

Other Meds:

Current Illness:

ID: 1289769
Sex: M
Age: 47
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: ORIGINAL ON FILE AT FACILITY

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IM.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1289770
Sex: F
Age: 59
State: KS

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: History of Anaphylaxis to an Unknown Sulfonamide Antibiotic within the last 9 years.

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: After vaccination at 915 AM, patient developed isolated shortness of breath at 1730. The shortness of breath was progressive and not relieved by albuterol. Presented to a local ED at 1930 where she was given an unknown dose of steroid and was, by history, hypoxic enough that intubation was discussed. She was not intubated, but was transferred to hospital for allergy and cardiology assessment. This SOB was the only symptom that she developed. She was euvolemic on my exam today and does not appear to have had diuresis prior to my assessment. Her asthma is well controlled by history. She was placed on high flow o2 via NC and improved substantially overnight. She was on 3L of o2 at the time of my assessment (1215) today. There are several confounders to her case. She has a history of methamphetamine abuse and though she denies recent ingestion (last use was reportedly months ago) her UDS is positive at 0600 today.

Other Meds:

Current Illness: None

ID: 1289771
Sex: F
Age: 40
State: TX

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Na

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Chills, headache, muscle soreness (back & armpits), mild fever, soreness at injection site, metallic taste at back of throat, slight cough, itchiness in nasal cavity, occasional sneezing

Other Meds: Multivitamin, Vitamin D, Fish Oil omega 3, Vitamin C, Zinc, Magnesium, Plant based Interferon

Current Illness: Na

ID: 1289772
Sex: M
Age: 45
State: NY

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Peanuts.

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: General tiredness, injection site pain. Tiredness started roughly 6 hours after injection. Resolved with a nap. Injection site soreness remains 28 hours after shot. Tylenol is helping.

Other Meds: None

Current Illness: None

ID: 1289773
Sex: F
Age: 49
State: FL

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: codeine sensitive

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe migraine, low fever of 100.6, burning eyes, chills, extreme body pains and aches, throbbing of socket from recently removed tooth. Loss of appetite. Localized injection site pain. Took Tylenol every 4 hours for first 8 hours then switched to Tylenol PM. Lots of liquids and sleep. Ice pack on injection site

Other Meds: none

Current Illness: none

ID: 1289774
Sex: F
Age: 29
State: NC

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vertigo, tinnitus, dizziness, faint, fatigue, ache, swelling, anxiety, depression, irritation, unusual period, heart palpitations.

Other Meds: None

Current Illness: None

ID: 1289775
Sex: F
Age: 29
State: FL

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: None

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: On Monday April 26, 2021, about about 4 hours after the second dose of the Pfizer vaccine, itchiness was felt all over the body then a rash started to break out. The rash continued to spread and gradually get worse for two days until I went to see a doctor. They gave me a steroid injection and prescribed a Methylprednisolone pack. About 8 hours after the steroid injection the rash started to disappear but the itchy feeling still remains. My skin is still sensitive and flares up when slightly rubbed. mostly occurs on my arms, hands, chest, feet, inner and back thighs, face, neck, and ears

Other Meds: Allergy immunotherapy sublingual drops in the morning. Minocyclne 100MG 1 cap x 2 day.

Current Illness: Migraines

ID: 1289776
Sex: F
Age: 25
State: SC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: I had joint and muscle pain throughout my body, dizziness and weakness three days after my vaccine after giving blood that Saturday at 11 am. The pain was throughout my body so much that I couldn't do my normal functions. I also developed stomach pain a day after I gave whole blood. These symptoms lasted 5 days, after which I still had some muscle pains and weakness but not that I couldn't continue on in my normal activities. The muscle pain and weakness symptoms lasted another week before I felt more normal, although, the stomach pain went away after about 5 days. After my second dose on April 7th, 2021 with Pfizer lot number ER8727 in my left arm, I was tired and had a little bit of muscle pain right away but these symptoms only lasted 24 hours after my shot at 9am that Wednesday I received that dose.

Other Meds: Levothyroxine 88 mcg Azelaic Acid 15% gel Soolantra 1% Cream IUD: Kyleena

Current Illness: None

ID: 1289777
Sex: F
Age: 35
State: IA

Vax Date: 03/16/2021
Onset Date: 04/27/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Trileptal - rash

Symptom List: Unevaluable event

Symptoms: J&J COVID-19 Vaccine EUA J&J Dose 3/16/21 (1805018) COVID Positive 5/3/21 5/3/21: Presented to ED. 35-year-old female presents the ER with chief complaint of cough. Patient stated symptoms started 1 week ago. Fiancee has similar symptoms. Other associated symptoms include pleuritic chest discomfort, lightheaded upon standing, fever 102, chills, bilateral ear pain, headache, general malaise, bilateral leg pain, and fatigue. Cough is described as productive producing yellow green phlegm. No prior history of DVT or PE. No recent travels or surgeries. Patient is on Depo. She has no reports of unilateral leg pain or swelling. Patient is a diabetic type 2 with blood sugars running in the 170s 2 days ago. Normal is 100-200. She takes metformin and glipizide. She also has a history of anxiety, depression, bipolar, hypothyroidism. Discharged to home with albuterol, doxycycline, prednisone.

Other Meds: levothyroxine PO QD metformin PO QD

Current Illness:

ID: 1289778
Sex: F
Age: 22
State: FL

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: A few hours after my second dose of Pfizer I started feeling fatigued and slightly feverish I went to sleep after so I woke up vomiting with extreme nausea and eight above 100? fever and continue to be that way for about two days unable to keep down food or water or medication before going to the emergency room.

Other Meds: None

Current Illness: Lyme disease

ID: 1289779
Sex: F
Age: 67
State: PA

Vax Date: 12/30/2020
Onset Date: 01/05/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: ACETAzolamideShortness of breath / Dyspnea Pneumococcal 23-val Ps VaccineSwelling AdhesiveOther (document details in comments) FluoxetineOther (document details in comments) TriazolamOther (document details in comments)

Symptom List: Injection site pain, Pain

Symptoms: Headaches, chills

Other Meds: ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet b complex vitamins (B COMPLETE) tablet calcium carbonate/vitamin D3 (CALCIUM+D ORAL) codeine-guaifenesin (ROBITUSSIN-AC) 10-100 mg/5 mL liquid cycloSPORINE (RESTASIS) 0.05 % ophthalmic e

Current Illness:

ID: 1289780
Sex: M
Age: 66
State: NV

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Approximately 36 hours after I received the first Moderna vaccine, I developed a high fever 101.5, chills and body aches lasting about 4 days. I went to healthcare facility and had a negative influenza and Covid tests at that time. 2 days later, I started to have difficulty breathing. I had a routine doctor appt scheduled for 3/25. When I arrived, my O2 sats were 80% and I was sent to the ER. There I had another negative Covid test. I was diagnosed with bil PE's and had a 8 days stay in the hospital, 6 days in ICU. I was sent home on long term medications and oxygen.

Other Meds: Nexium 20mg QD; Gabapentin300mg QD; Singulair 10mg QD; Zyrtec 10mg QD prn; vitamin A 2400mcg QD, vitamin C 1000mg QD MVI QD; vitamin D3 2000IU QD

Current Illness: none

ID: 1289781
Sex: F
Age: 59
State: MN

Vax Date: 04/07/2021
Onset Date: 04/29/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Second Moderna vaccine given too early. First dose given on 4/7/21; 2nd dose given on 4/29/21, 22 days after first dose.

Other Meds:

Current Illness:

ID: 1289782
Sex: M
Age: 50
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: ORIGINAL ON FILE AT FACILITY

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IM.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1289783
Sex: M
Age: 71
State: OH

Vax Date: 04/07/2021
Onset Date: 04/29/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Developed COVID symptoms for a "few" days. Called his physician who referred him to the local hospital for suspected COVID. Tested positive for COVID at the hospital and blood clots in the lungs were discovered by CT scan. Patient was admitted to ICU for treatment. Details reported to VAERS by hospital and the Health District

Other Meds:

Current Illness:

ID: 1289784
Sex: F
Age: 70
State:

Vax Date: 04/03/2021
Onset Date: 04/05/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: sulfa, garlic, strawberriesnone

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: on 2nd (possibly 3rd) day after first shot I noticed a hard lump at the injection site. It was about 3/4 of an inch in diameter and tender to touch. No changes noticed until day 6 when it seemed a bit smaller. Finally gone on 8th day.

Other Meds: none

Current Illness: none

ID: 1289785
Sex: F
Age: 16
State: WI

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient was given vaccine under the approve age range. No adverse events noted.

Other Meds:

Current Illness:

ID: 1289787
Sex: F
Age: 48
State: AZ

Vax Date: 04/29/2021
Onset Date: 05/02/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: After the third day of my vaccine , I develop a small lump on my left size , i was feelin my skin because felt a weird painful feeling under my skin till i felt the lump .. has grow little bit more since that date. its painful to wear a seat belt when i am driving. My second dose was more painful that the first one and my left arm got swallowed a lot , got the chills and extreme fatigue. My fatigue has gone away but the lump still there, I do have a Dr, appoittment on May/12/21

Other Meds: I been taking bio- identicals hormones by cream.

Current Illness: None ? I have developed a small lump close to my bone neck and feels tender and painful 3 days after the vaccine, the second vaccine really make me fatigue and chills for 3-4 days after plus the lump on the side of my neck , feels like its the lymph node.

ID: 1289788
Sex: M
Age: 17
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: On this day I was assigned to give Covid vaccinations. Per procedure, the PT goes to the first tent where their age and status is verified then they are sent to have their vaccine administered. Once they arrived at the tent, I administer the vaccine. We have been told once they arrive at our section they have been verified and are clear for the vaccine. Due to this policy I did not check the age and status of the PT. Moving forward I will double age and status of all patients coming through my line. PT did not report any complications or AE from the vaccine. PT was 17 years of age

Other Meds:

Current Illness:

ID: 1289789
Sex: M
Age: 57
State: IL

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: During the two weeks after the first injection the Left shoulder continued with pain and increased in pain. during these same two weeks he noticed gradual and increasing arm weakness and numbness in the outer arm and forearm to the hand. The weakness is so severe that he could not bend the elbow to lift (flexion)the hand up, nor lift the shoulder forward or out.(no flexion or abduction). no new symptoms in the Right arm or either leg. there is severe atrophy of the proximal musculature of the left shoulder and upper arm.

Other Meds:

Current Illness: none

ID: 1289790
Sex: M
Age: 26
State: NY

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Patient did not cooperate with vaccine administration. Became very agitated and despite trying to clam him down, he would pull away during multiple attempts to inject. During one attempt, needle was introduced but patient withdrew the arm once he felt the needle. Two vaccine shots were wasted. Mother tried to hold him and fell backwards with the patient on top of some chairs and equipment. Patient also tried to kick the nurse and my person. We decided that there was more risk for everyone involved than the benefit of the vaccine.

Other Meds: Unknown

Current Illness: Mental retardation

ID: 1289791
Sex: M
Age: 19
State: TX

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Shortly after vaccination pt began experiencing blurred vision, loopiness, sweating, heavy breathing. BP: 128/60, P: 73, 98% room air.

Other Meds: Monolukast

Current Illness:

ID: 1289792
Sex: F
Age: 50
State: MD

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: April 10- shot administered at store; waited the obligatory 10 minutes. On the way home my upper arm got extremely hot, felt a bit foggy, major fatigue. April 11- vomiting, fatigue, congestion April 12- vomiting, fatigue, congestion April 13- vomiting, fatigue, congestion April 14- vomiting, fatigue, congestion, sore throat/ telehealth visit; dr. prescribes nausea meds April 15- fatigue, congestion April 16-fatigue, congestion, muscle pain April 17- congestion, muscle pain April 18- feeling 50% active. congestion April 19- feeling 70% active, still fatigue & congestion April 20- vomiting, fatigue, congestion April 21- vomiting, fatigue, congestion/ spoke w/ doctor, nausea meds refilled April 22- [didn?t record] April 23- 70% active, congestion April 24- 80% active, congestion April 25- 90% active, congestion April 26- vomiting, congestion April 27- 80% active, congestion April 28- 90% active, congestion April 29- 90% active, congestion April 30- vomiting, congestion, fatigue, chills/ went to hospital 7:30 pm- 4:15 am May 2- Admitted to Hospital Diagnosis 1. Dissection of vertebral artery & 2. Acute cholecystitis

Other Meds:

Current Illness:

ID: 1289793
Sex: F
Age: 59
State: FL

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Adverse Reaction Notes 59 y/o Haitian female with no past medical HX c/o "head heaviness" and dull neck pain 10/10 after receiving the 2nd dose of the vaccine. She reported that she had neck pain with the first dose but this time the pain is worse. She was assessed and monitored by NP, EMT, and paramedic. Initial BP - 204/110, 190/100, HR - 88, resp- 14, O2 sat 96% on RA. BP remained at 190/100 and she reported that she felt weak and dizzy. EMS called to take her to ED for eval and TX. Husband with pt and agreed with TX. She is awake, alert, oriented to person, place, time and situation, MAE. Pupils size 3mm, PERRL. Transported from site via stretcher by EMS personnel to go to ED.

Other Meds:

Current Illness:

ID: 1289794
Sex: F
Age: 73
State: IA

Vax Date: 04/08/2021
Onset Date: 04/22/2021
Rec V Date: 05/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: benzocaine - itching

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pfizer COVID-19 Vaccine EUA Pfizer Dose 1 3/18/21 (EN6207) Pfizer Dose 2 4/8/21 (EW0161) COVID Positive 4/23/21 4/22/21: Presnted to ED. The patient presents with Nausea and vomiting. A 73 year old female with a history of UTI and DM was brought to the ED today due to having nausea and vomiting for the past couple of days. She was administered Zofran by EMS; they checked her BS which was 171. The patient states she has been sick since the eighth of this month, and has had diarrhea, dysuria, and arm pain. She reports not taking her insulin since February due to her insurance no longer covering her. . The onset was 3 days ago. The course/duration of symptoms is constant. The character of symptoms is unknown. The degree at present is moderate. The exacerbating factor is none. The relieving factor is none. Risk factors consist of diabetes mellitus. Therapy today: emergency medical services. Associated symptoms: diarrhea. 4/30/21: A 73-year-old female, history of hypertension, diabetes mellitus type 2 with chronic kidney disease, adrenal insufficiency from renal cell carcinoma and adrenalectomy, and nonalcoholic steatohepatitis with portal hypertension, esophageal varices, has had nausea and vomiting for several days. She did receive her second COVID-19 vaccination on April 8, and has had ongoing symptoms since that time, much worse in the 3 days prior to admission. An initial COVID screen was negative, but rechecking the PCR COVID test was positive. Initially, she did not require any oxygen, but did require 2 L nasal cannula at night on the second night, at which time remdesivir and convalescent plasma were administered. She was also given dexamethasone, but had marked rise in her blood sugar to greater than 400. The dexamethasone was tapered and stopped. Glucose regulated with insulin. The patient initially had severe anorexia, poor oral intake, but this slowly improved. CT scan of the abdomen and pelvis has shown the small nodular liver consistent with cirrhosis and portal hypertension. There is some ascites and mild pleural effusions. The patient had been receiving some IV fluids, and we would discontinue the Lasix because of low blood pressure. There was no other obvious explanation for her poor oral intake or abdominal pain. The patient had IV access problems and eventually, despite the PICC line and midlines being attempted, we were unable to complete a successful IV to finish her CAP antibiotics or the remdesivir. The patient seemed to be doing better, oxygen is 98% on room air, blood pressure 98/63 and 116/60. We are holding the Lasix, potassium, and spironolactone. The glucose has been running at 213, 154, and 202. BUN at 35, creatinine 1.4. WBC 11,700 and hemoglobin 11.5. The patient was seen on the day of discharge at 1100 hours, doing quite well, and will be discharged home with her family. We have offered visiting nurses, but she feels that the family is there 24 hours a day. She does not need any visiting nurses. We have made some changes to her medications, and she will need to follow up with her primary doctor in the next week to see whether we need to restart Lasix, potassium, and spironolactone. DISCHARGE MEDICATIONS: Will be hydrocortisone 15 mg a.m., 5 mg evening, venlafaxine 37.5 daily, venlafaxine 150 mg at bedtime, rifaximin 550 mg b.i.d., Bactrim DS 1 daily, multivitamins daily, insulin glargine 35 units at bedtime, atorvastatin 20 mg daily, NovoLog 20 units before meals. Again, we are holding Lasix, potassium, and spironolactone.

Other Meds: atorvastatin 20 mg PO HS calcium-vitamin D 1 tab PO QD hydrocortisone 15 mg PO QD insulin glargine 35 units SQ QD insulin regular 15 units SQ AC levothyroxine 75 mg PO QD pantoprazole 40 mg PO QD rifaximin 550 mg PO BID venlafaxine 150 mg E

Current Illness:

ID: 1289796
Sex: F
Age: 54
State: NV

Vax Date: 03/24/2021
Onset Date: 04/17/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa, Naproxen, Z-pack- Azithromycin, latex

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: I experienced after my J&J vaccine, sciatica pain with sever low back pain and cramps. To this day I am still having the sciatica pain. I do not know if my symptoms are related to the vaccine.

Other Meds: Took her regular prescriptions at night (did not disclose them)

Current Illness:

ID: 1289797
Sex: F
Age: 33
State: PA

Vax Date: 12/31/2020
Onset Date: 04/04/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: New loss of taste or smell Congestion or running nose

Other Meds: prenatal vit no.124-iron-folic (PRENATAL VITAMIN) 27 mg iron- 800 mcg tablet

Current Illness:

ID: 1289798
Sex: F
Age: 32
State: CA

Vax Date: 04/25/2021
Onset Date: 04/29/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Pain in extremity

Symptoms: On 4th day - I started feeling dizzy and weak and it is still persistent. I continuously feel off balance . I also felt nausea on 29th April,2021 (4 days from the date of vaccination) but it has not been since then.

Other Meds: No

Current Illness: No

ID: 1289799
Sex: F
Age: 39
State: CO

Vax Date: 04/11/2021
Onset Date: 04/25/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Raised, red rash occured 2 weeks after 1st dose. Very itchy and sensitive to heat. Still ongoing.

Other Meds: Junel (birth control) and Zyrtec

Current Illness: none

ID: 1289800
Sex: F
Age: 17
State: WY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient, mom and pharmacist miscommunicated age. Need to know how to proceed with second dose

Other Meds:

Current Illness:

ID: 1289801
Sex: F
Age: 47
State: AK

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Difficulty breathing, Sweaty, Back/Abdominal pain 142/99; 100, 24, O2 sat99 Transferred to ER, released 4 hours later

Other Meds: N/A

Current Illness: N/A

ID: 1289802
Sex: F
Age: 47
State: CA

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: n/a

Symptom List: Vomiting

Symptoms: 9 hours of nausea / vomiting

Other Meds: plavix, baby aspirin, aimovig, biotin

Current Illness: n/a

ID: 1289803
Sex: M
Age: 16
State: OH

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient (16 yo) should have received Pfizer Biontech COVID-19 vaccine, but received Moderna COVID-19 vaccine instead.

Other Meds:

Current Illness:

ID: 1289804
Sex: M
Age: 53
State: WA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: amoxicillin

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: That evening - 04:30 pm, I started feeling body aches and pains and fatigue. The aches getting worse in the night. Felt feverish but didn't have a fever overnight. The next day the same - general aches and pains and fatigue. Early afternoon, I took Tylenol and at night time I had headache and I took Tylenol again that evening (about 11:00P). Next morning, just fatigue - no more aches. Site of vaccination was more sore than initially. I had a sort of sinus headache - left side of face and head. My wife noticed I had bags under my eyes - very odd bags under eyes. I took Sudafed. Inside of my left nostril was aching. Tuesday morning, the bags weren't there but I got bad acne on the same nostril - my left nostril. It was like - I was worried that the acne was cystic (very deep - through the nose). I haven't gotten acne in a long time. I had the sinus headache and acne which lasted two to three days. I tried nasal saline - on that Wednesday and Thursday. The acne lasted into the next week - subsided beginning on the 12th or 13th. The bagginess in eyes had been gone by end of the 5th. Headaches didn't persist after the 7th or 8th or so. Had trouble getting a doctor appt because they didn't know what doctor to send me to.

Other Meds: bupropion; Rosuvastatin; Allegra for allergies

Current Illness: no - just had seasonal allergies

ID: 1289805
Sex: M
Age: 68
State: MN

Vax Date: 04/08/2021
Onset Date: 04/30/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient developed nasal congestion, cough and fatigue 1 month after receiving COVID vaccine. Patient subsequently tested positive

Other Meds: Vitamin B12, D, K , B6 zinc Selenium Iodine

Current Illness: none

ID: 1289806
Sex: F
Age: 46
State: OR

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Not on File

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Patient presents with a potential reaction to the COVID19 vaccine. The patient reports a sensation of swelling around her L-sided face and neck with itching, but with no airway compromise. The patient has a history of facial swelling after a flu vaccine for which she was hospitalized. While the patient didn't have any clear sign of swelling on exam, 50mg of Benadryl IM was given as the patient had already taken OTC Zyrtec with no effect, and given her body habitus for improved absorption in a timely manner. AMR gave 50mg IM Benadryl given in R deltoid and tolerated well. With close monitoring and above intervention, symptoms resolved and patient was returned home with her partner as the driver.

Other Meds: Not reported

Current Illness:

ID: 1289808
Sex: F
Age: 34
State: TX

Vax Date: 04/26/2021
Onset Date: 05/01/2021
Rec V Date: 05/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Five days after receiving the second dose of the vaccine, my left hand went completely limp. I received X-rays of my hand and neck - no visible damage I received an oral steroid. 4 days later, I am slowly gaining use of my left hand

Other Meds: Nexplanon implant

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm