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
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1421798
Sex: M
Age: 52
State: NY

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/23/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421799
Sex: F
Age: 51
State: CA

Vax Date: 05/19/2021
Onset Date: 05/25/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: Pelvic and intra uterine sonogram to check that nothing else was wrong, came back normal.

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Have been in menopause for 2 years with no menstruation (with 2 years prior to that of erratic periods). Have had hormones checked and the low numbers also foot with menopause. And 10 days after my first dose of the Pfizer Covid Vaccine, I got my period. And it was very very heavy, heavier than any time in my life and made it hard to even leave the house for two days because of the constant need to deal with all of the blood. It lasted 7 days and then went away.

Other Meds: none

Current Illness: none

ID: 1421800
Sex: M
Age: 36
State: TX

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 06/23/2021
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: None

Allergies: None

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

Symptoms: Increased heart beat, potentially blood pressure but was not checked. Chest pain - tightness.

Other Meds: None

Current Illness: None

ID: 1421801
Sex: F
Age: 14
State: OR

Vax Date: 06/16/2021
Onset Date: 06/17/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: nl ekg, nl cxr, nl treponin and nt-pro- bnp CMP mild low K, increased ESR/CRP

Allergies: mold-yeast-dust (homeopathic product_

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 1 day after 2nd shot had fever, abdominal pain, chest pain, shortness of breath, tachycardia.. Was seen in ER. Fever. abdominal pain resolved in 2-3 days. Chest pain still present, and shortness of breath 5 days after

Other Meds: norgestimate-esthinyl estradiol

Current Illness: none

ID: 1421802
Sex: M
Age: 14
State: NY

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/23/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421803
Sex: M
Age: 24
State: NY

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

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421805
Sex: F
Age: 21
State: WA

Vax Date: 05/26/2021
Onset Date: 06/02/2021
Rec V Date: 06/23/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient reports approximately 1 week after receiving Moderna COVID vaccine she started to have tingling in her left arm down to her left hand. The tingling also went back up her arm to her neck causing muscle strain in the area and causing her to crack her neck. Patient's primary care provider told her this tingling is a result of the vaccine being given too low on the arm. Patient also reports she has gone to physical therapy as a result of this adverse event she associates with the Moderna vaccine.

Other Meds:

Current Illness:

ID: 1421806
Sex: M
Age: 46
State: TX

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

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

Lab Data: N/a

Allergies: Erythromycin

Symptom List: Pharyngeal swelling

Symptoms: Patient's second vaccine was taken from vial open on 6/21/21 at 4:45 pm. The vial was at room temperature. This has been reported to Moderna (Case #MOD21-115097) for further medical input.

Other Meds: Adderall XR, Fluticasone, Lipitor, Paxil

Current Illness: None

ID: 1421807
Sex: F
Age: 61
State: FL

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 06/23/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: severe diarrhea with shot 1 and high fever (104.2) with shot 2, no sense of taste/smell with shot 2

Other Meds:

Current Illness:

ID: 1421808
Sex: F
Age: 22
State:

Vax Date: 06/21/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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: Redness around injection site

Other Meds: Epuris

Current Illness:

ID: 1421809
Sex: U
Age: 63
State: NY

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421810
Sex: F
Age: 87
State: OR

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: I have had blood work, a urinalysis and an ultrasound. They found in my urine that there was a disfunction with my kidneys.

Allergies: I have sensitivity to codeine.

Symptom List: Rash, Urticaria

Symptoms: When COVID started, I did have all of the symptoms of the virus, but the tests came back negative. I know that I had some type of virus. Ever since I experienced this, I do stay constantly winded. If I stand up to fast, I will experience a bit a fuzziness. After receiving the vaccine, I found out a couple weeks after receiving my second dose, that I have stage 4 kidney problems. I have never had kidney problems before. My doctor called and told me that he wanted to set up an appointment of blood work and a urinalysis. I was very surprised about the call. I eat very healthy and I don't understand how this happened. The tests were telling him that my kidneys are not filtering like they should. I have another test coming up 7/5/2021. They are going to inject dye into a line to see what reaction occurs and to see if there is a blockage. After the ultrasound they couldn't find anything wrong. I asked if I should change my diet. I don't eat any junk food and I eat a lot of fruit and vegetables. I am just waiting for the follow-up appointment now.

Other Meds: Levothyroxine sodium; Simvastatin; Losartan; Januvia; Metoprolol succinate; Low-Dose Aspirin; Tylenol Extra Strength; Allegra; Multivitamin; Glucosamine; Cod Liver Oil; Nifedipine Extended Relief.

Current Illness: I did not have any other illnesses.

ID: 1421811
Sex: M
Age: 22
State: ID

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

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

Lab Data: N/A

Allergies: NKDA

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

Symptoms: Mistakenly administered Janssen 0.3 mg IM instead of Pfizer 0.3 mg IM. Patient declined to have full dose of Janssen administered and will return to clinic in 28 days to start Pfizer series.

Other Meds: N/A

Current Illness: N/A

ID: 1421812
Sex: F
Age: 69
State: GA

Vax Date: 05/25/2021
Onset Date: 06/01/2021
Rec V Date: 06/23/2021
Hospital: Y

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: Penicillin

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

Symptoms: I tested positive on 01/22/2021 and hospitalized on 01/27/2021. I was critically ill and spent time in the ICU. I was released to rehab on 02/15/2021 and released to home care on 03/08/2021. I had care until April 04/20/2021. I had still been having some weakness and I was on Oxygen at night. I was told I did not need it anymore. My lungs were clear in early May when I saw the Pulmonologist. I got the first dose of my vaccine one week later. I had flu like symptoms for 24 hours. After I got the second dose of the vaccine my legs seemed to be weaker, and I felt very unsteady on my feet. It started one week after the second dose. I felt like it was a setback. During that week I also started to have hair loss. My hair has been coming out in clumps. I have ordered a wig. It has been four weeks and I still have back pain and weakness. I am not sure if my symptoms are due to Covid-19 or if is the vaccine. I have improved a little.

Other Meds: Potassium; Diuretic; Pepcid; Vitamin C; Vitamin D; Zinc; Multivitamins

Current Illness:

ID: 1421813
Sex: F
Age: 44
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/23/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421814
Sex: F
Age: 54
State: FL

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Dose 1- sore arm Dose 2- chills. Couldn?t get warm that night. Chills on and off all the next day. Fever 101 degrees. Lethargy for 24 hours. Needed to lie down and sleep all day.

Other Meds: None

Current Illness: None

ID: 1421815
Sex: M
Age: 57
State: TN

Vax Date: 03/27/2021
Onset Date: 04/19/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: Ekg, blood tests

Allergies: None

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

Symptoms: About two weeks after vaccination I noticed my heart beat was irregular. The episodes we initially short, 3-5 minutes. After 4 weeks, the episodes lasted longer, up to 3 to 4 hours. On April 27th, I was taken by ambulance to the Emergency Room as I was in AFIB.

Other Meds: Lisinopril-htcz, lortidine, vitamin b12, vitamin d

Current Illness: None

ID: 1421816
Sex: U
Age: 57
State: NY

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421817
Sex: M
Age: 27
State: CA

Vax Date: 06/15/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Redness in a diameter of about 3 inches from the center of the vaccine shot.

Other Meds:

Current Illness:

ID: 1421818
Sex: F
Age: 66
State: ND

Vax Date: 01/26/2021
Onset Date: 04/05/2021
Rec V Date: 06/23/2021
Hospital: Y

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

Lab Data: unknown

Allergies: DIAGNOSTIC X-RAY MATERIALS ENALAPRIL MALEATE MEASLES, MUMPS & RUBELLA VAC NSAIDS ZOSTER VACCINE LIVE

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

Symptoms: Case was hospitalized. 2nd vaccine given 2/18/2021

Other Meds: unknown

Current Illness: unknown

Date Died: 04/19/2021

ID: 1421819
Sex: M
Age: 61
State: MA

Vax Date: 03/01/2021
Onset Date: 04/02/2021
Rec V Date: 06/23/2021
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: unknown- Pt was transported to Medical Center ER 4/19/2021

Allergies:

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

Symptoms: Pt was vaccinated on 3/31/2021. His long time partner reported that he started feeling a little off 2 days post vaccination, he thought he had indigestion. Over the next few weeks he began feeling worse especially with exertion. While at work on 4/19/2021 he told his friend that he hadn't been feeling well for 3 weeks. Shortly after reporting this he went into Cardiac arrest. He was transported to Medical Center, where he was pronounced dead. His partner reports he was healthy with the exception of hypertension. She reports he was thin, never smoked, didn't drink alcohol and rarely used marijuana. She reports only a visual autopsy was performed and pt was cremated.

Other Meds: Pt took a diuretic and another unknown medication for hypertension

Current Illness: None

ID: 1421820
Sex: F
Age: 43
State: OR

Vax Date: 04/05/2021
Onset Date: 04/20/2021
Rec V Date: 06/23/2021
Hospital: Y

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

Lab Data: Extensive. 06/02/2021 - PTT, PT/INR, CMP, CBC, Peripheral blood smear, Folate, Vit B12, Copper, TSH, Free T4, Coag panel, Hep C ab, LDH, HIV, COVID19 antigen, abdominal US limited 06/03/2021 - renal function, magnesium, CBC, type & screen, ABO/RH 06/04/2021 - renal function, magnesium, CBC 06/05/2021 - CBC, magnesium, renal function 06/12/2021 - CBC 06/14/2021 - Immature platelet fraction 06/15/2021 - Magnesium, CBC, CMP, Iron/Transferrin/Ferritin , Retic Profile, Bone Marrow Aspirate and Biopsy, CT bone marrow biopsy 06/16/2021 - Magnesium, BMP, CBC 06/23/2021 - H Pylori

Allergies: PCN

Symptom List: Unevaluable event

Symptoms: 04/20/2021 developed rash on body. Symptoms off and on. 05/31/2021 patient developed worsening rash 06/02/2021 patient evaluated. Admitted to hospital for ITP. 06/14/2021 patient re-admitted for ITP

Other Meds: Sertraline

Current Illness: Anxiety

ID: 1421821
Sex: F
Age: 23
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/23/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421822
Sex: F
Age: 70
State: NY

Vax Date: 06/05/2021
Onset Date: 06/21/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: Patient blood work came back normal. ECHO is scheduled to be completed. Kidney function came back normal. Patient will be monitored by cardiologist and put on a heart monitor if palpitations continue. Patient will also be tested for the presence of covid antibodies.

Allergies: NONE

Symptom List: Injection site pain, Pain

Symptoms: Patient received first dose on 5/15/2021 of the Pfizer Covid vaccine in the right arm. Patient experienced mild pain on the arm as well as lymph nodes on neck for few days after dose 1. The patient received dose 2 on 6/5/2021 in the right arm. Patient experienced pain on the left side under her arm as well as the same lymph node pain. On Monday 6/21/21 patient experienced heart palpitations around 2pm. On Tuesday 6/22/2021 patient experienced palpitations again around 2pm and spoke to oncologist and was advised to have VAERS report submitted.

Other Meds: Patient taking Zejula (Niraparib) 100mg once every night

Current Illness:

ID: 1421823
Sex: F
Age: 27
State: CT

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient presented to pharmacy for dose 2 in Moderna COVID19 vaccine series, dose was drawn up by the pharmacist, syringe appeared perfectly normal during dose draw up and correct dose was drawn up. pt requested to be vaccinated in the left arm, pharmacist went to administer vaccine, stuck needle into patients left deltoid and pushed the syringe plunger, the dose of vaccine ejected out of the syringe at the hub and did not get fully administered to the patient. most of the 0.5ml dose was not administered and instead sprayed onto the patients skin. in accordance with CDC guidelines for incorrect dose less than half dose given, patient was re-dosed in the alternate arm (right deltoid) with 0.5ml with a new syringe and needle

Other Meds:

Current Illness:

ID: 1421824
Sex: F
Age: 21
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/23/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421825
Sex: M
Age: 24
State: NY

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 06/23/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421826
Sex: F
Age: 21
State: ID

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

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

Lab Data:

Allergies: Augmentin, Intuniv

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The patient stated they were fine for the first 15 minutes after the injection, but as they were getting up to leave I could see her color was not good and I made her continue waiting . I got out an ice pack and put on the back of her neck and she leaned forward on another chair to try to get the blood to her head. She started breathing heavier and complaining of her stomach hurting and not feeling well. She was sweating and crying. We called 911 and laid her on the floor with a cushion under her head until they arrived. The patient continued to cry and complain of stomach pain and could not open her eyes. She also had no strength to stay upright. Her blood pressure was elevated at 163/100. The patient was taken by ambulance to the hospital.

Other Meds: unknown

Current Illness: Von willebrand disease

ID: 1421827
Sex: F
Age: 24
State: FL

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/23/2021
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: No lab tests and results

Allergies: Promethazine

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

Symptoms: Adverse event(s): rash at the injection site, bone and body ache Signs: redness at injection site, pain Time course: on-going

Other Meds: None

Current Illness: None

ID: 1421828
Sex: F
Age: 50
State: CA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Extreme body aches and fatigue; likely fever.

Other Meds: Levothyroxine for hypothyroidism

Current Illness: None

ID: 1421829
Sex: U
Age: 47
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421830
Sex: F
Age: 25
State: VA

Vax Date: 06/19/2021
Onset Date: 06/20/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies: Monocyline, doxycycline, bactrim, neosporin, codeine

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

Symptoms: Sore throat, cough, very tired

Other Meds: Lexapro Adderall

Current Illness: N/A

ID: 1421832
Sex: F
Age: 60
State: OR

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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:

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

Symptoms: MODERNA LEFT ARM GIVEN ON 06/21/21. PRESENTS TO URGENT CARE ON 06/23/2021 WITH BODY ACHES, CHILLS AND HEADACHES AND LYMPH NODE IN LEFT AXILLARY INFLAMMED.

Other Meds:

Current Illness: COVID POSITIVE 04/20/2021 X 18 DAYS

ID: 1421833
Sex: F
Age: 51
State: NY

Vax Date: 05/30/2021
Onset Date: 05/30/2021
Rec V Date: 06/23/2021
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:

Symptom List: Tremor

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421834
Sex: M
Age: 55
State: FL

Vax Date: 06/18/2021
Onset Date: 06/19/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: None

Allergies: Amoxicillin

Symptom List: Erythema, Pruritus

Symptoms: Diarrhea starting approximately 10 hours after administration and continuing up to time of this report. Treatment with OTC Loperamide provided only moderate relief for short periods of time.. Followed normal hydration recommendations to prevent dehydration. Nausea and stomach cramping started approximately 24 hours after administration and continue up to time of this report. Treatment of stomach cramping with Dicyclomine prescribed by GI for previous issues due to Crohn's Disease provided only moderate relief. Nausea untreated. Combination of symptoms led to anorexia and I am only able to tolerate small amounts of foods such as broth. GI doctor was contacted on 6/23/2021 and informed of symptoms with the objective of being prescribed stronger medications to control them. As of this report I have not received notification of any medications prescribed and awaiting me at pharmacy.

Other Meds: Pristiq, Xarelto, Levothyroxine, Remicade, Melatonin

Current Illness: N/A

ID: 1421835
Sex: M
Age: 16
State: NY

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/23/2021
Hospital:

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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421836
Sex: M
Age: 66
State: CO

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 06/23/2021
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: None.

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

Symptoms: Unsteady gait (poor balance) for the past four months. Ongoing, though improving.

Other Meds: None.

Current Illness: None.

ID: 1421837
Sex: M
Age: 67
State: CA

Vax Date: 02/23/2021
Onset Date: 02/27/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: Unable to identify cause of adverse events

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Dry mouth and lips developing blisters in my lips ,developing rush around my mouth also numbness on the tip of my tongue loss of taste.

Other Meds: Linzess

Current Illness: None

ID: 1421838
Sex: M
Age: 39
State: NY

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/23/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421839
Sex: M
Age: 15
State: WA

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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: N/A

Allergies: No

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

Symptoms: Patient, a 15-year-old white, non-Hispanic male received his first Pfizer vaccine on 6/23/21 at 3:10pm. After 13 minutes post-vaccination, patient passed out. Had a bit of wheezing, pale, cold, and clammy skin. Was conscious when pharmacist went out at 3:30pm. Called 911 for paramedics. Have patient drink cold water in the mean time and have legs elevated to help with blood flow. When paramedics came, vital signs were checked. O2 saturation is 98%, blood pressure is 96/60, and pulse is 88 bpm. Patient feels much better after 30-45 minutes, and was able to leave the store with mom without going to emergency room.

Other Meds: No

Current Illness: No

ID: 1421840
Sex: F
Age: 55
State: CA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: None

Allergies: Denied

Symptom List: Pain in extremity

Symptoms: Client reported chest pressure ("heavy chest") after receiving first dose of Pfizer COVID-19 vaccine. She did not take any medications and it resolved after two days. Vital signs were WNL and clinical team approved to administer 2nd dose. Client was educated on COVID-19 vaccine side-effects and encouraged to report side-effects on V-SAFE.

Other Meds: Zoloft.

Current Illness: Denied

ID: 1421841
Sex: U
Age: 27
State: NY

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1421843
Sex: F
Age: 58
State: WA

Vax Date: 06/23/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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: sulfa, amoxicillin

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

Symptoms: pt became faint immediately after injection, came to and had bp 103/60/60, elevated legs and provided water, pt waited 30 minutes and felt better. Left for home together with companion. Bp upon leaving was 103/59/60.

Other Meds: Unknown

Current Illness: unknown

ID: 1421844
Sex: F
Age: 56
State: FL

Vax Date: 06/22/2021
Onset Date: 06/23/2021
Rec V Date: 06/23/2021
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: None

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

Symptoms: Itchy, painful rash at and around injection site

Other Meds: None

Current Illness: None

ID: 1421845
Sex: F
Age: 61
State: IL

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 06/23/2021
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:

Symptom List: Vomiting

Symptoms: Vaccine was give 3 hours and 12 minutes after vial was punctured and left at room temperature. Per Janssen, there are no updates on stability beyond the 2 hours at room temperature. Patient has not reported any adverse events as a result of this event.

Other Meds:

Current Illness:

ID: 1421846
Sex: F
Age: 66
State: CA

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/23/2021
Hospital:

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

Lab Data: At the hospital kidney function was low compared to last year that was normal.

Allergies: Diclofenac

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Swelling of the legs and bloating of stomach, fluid retention

Other Meds: None

Current Illness: None

ID: 1421847
Sex: F
Age: 22
State: NY

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/23/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422011
Sex: F
Age: 71
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 06/23/2021
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: Trip to ER (patient is volunteer at hospital where vaccine was administered). EKG & vitals monitored for 2 hours.

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Tachycardia, elevated blood pressure

Other Meds: Lisinopril , Pravastatin, Plaquenil, 81 mg aspirin

Current Illness: No

ID: 1422012
Sex: F
Age: 29
State: FL

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 06/23/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1422013
Sex: M
Age: 66
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/23/2021
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:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am