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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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

ID: 0966700
Sex: F
Age: 45
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: Injection site pain, muscle aches, chills

Other Meds:

Current Illness:

ID: 0966701
Sex: F
Age: 74
State: FL

Vax Date: 01/09/2021
Onset Date: 01/13/2021
Rec V Date: 01/22/2021
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, although I have had a sensitivity to sulfa and usually avoid medications with sulfa.

Symptom List: Anxiety, Dyspnoea

Symptoms: Red rash on face. At first, 1/13/21, I didn't think it was related to the vaccine. It spread and worsened over the next four days and then the injection site became red also that was when I related it to the vaccine, 1/18/21. I sent a picture to my doctor, a friend, who retired, and he said to take Benadryl and Pepcid AC, which I did for 3 days (1/18/21 - 1/10/21). I now have just a little roughness to my face and a very pale red mark by the injection site.

Other Meds: Rosuvastatin 5mg, Metoprolol ER 50 mg, Oxybutynin 5mg Calcium+D 600 mg, CoQ-10 100mg, Cranberry +C. Benefiber, Milk Thistle 250mg, Biotin 5,000 mcg, Folic Acid 800 mcg.

Current Illness: None

ID: 0966702
Sex: M
Age: 37
State: GA

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
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: Penecillin

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

Symptoms: After a night of being up with flu like symptoms, when I got out of bed at 7 am to start my day, I had a precipitous fall in body temperature. At this time, I also had profuse cold sweats, my limbs started getting cold, I could not see or hear and had ?stars? like I was about to pass out. My wife helped me downstairs and after some water and Tylenol, symptoms reversed themselves in about 15 minutes. My body temperature was not recognized by the thermometer and then registered 93.4

Other Meds: Tylenol

Current Illness: N/A

ID: 0966703
Sex: F
Age: 69
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, an PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966704
Sex: F
Age: 38
State: MA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: 10 mins after vaccine administration became very dizzy and 10 sec. loss of consciousness, then nauseated with dry heaving. VSS: 142/86-86 O2 sat 97%. Administered Ondansetron 4mg x 2 at 4:30pm, with some relief, Continued complaint of dizzy feeling nad nausea declined ED eval. Administered 500ml of NS, VS at 545pm: O2 sat 100% pulse 80 BP 153/99 discharged home with Zofran 4mg 2 4hours as needed

Other Meds: Amlodepine 2.5mg daily

Current Illness: No

ID: 0966705
Sex: U
Age: 78
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966706
Sex: F
Age: 67
State: FL

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/22/2021
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: Pyrexia, White blood cell count decreased

Symptoms: General malaise with burning sensation inside the body, no fever registered; inflammation of right arm and hand/wrist, migratory joints pains, muscle pain, stabbing pains sudden, neuralgic pain in the extremities. Pain was so severe that cause limitation for walking around the house. The last event on the 7th day was inflammation of the right foot and ankle with severe pain with no history of sprain or trauma.

Other Meds: Acetominophen 500 mg Zinc, Vitammin D

Current Illness: NONE

ID: 0966707
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/22/2021
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: Pharyngeal swelling

Symptoms: had 2nd covid vaccine Tuesday, then at 2:30 am woke from sleep with severe arm pain where she got the shot, then progressed to her left back, hip , shoulder, neck, headache, chills, took hot shower and got severely nauseated and dry heaving, and diarrhea and dizzy, then from the back of her neck to her arms she went numb and both hands started spasming, had trouble speaking

Other Meds:

Current Illness:

ID: 0966708
Sex: F
Age: 30
State: TX

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Around 4-5pm I did not feel well. About 6-7pm I started shivering and a fever of 102. I had muscle pain, just pain all over, I continued with a fever for two day. I took Tylenol for two days and called out of work. I had a migraine as well, I was hot/cold and sweating through my clothes. I seen my doctor, and she ran a Covid and flu test both came back negative.

Other Meds: Multi vitamin Vitamin D

Current Illness: Covid in August 2020

ID: 0966709
Sex: F
Age: 30
State: ND

Vax Date: 01/16/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
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: Sulfa drug

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Hives covering entire body for 3 days

Other Meds: Adult multi vitamin

Current Illness:

ID: 0966710
Sex: M
Age: 95
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, an PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966711
Sex: F
Age: 35
State: WA

Vax Date: 01/11/2021
Onset Date: 01/15/2021
Rec V Date: 01/22/2021
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: PENISILLEN.

Symptom List: Rash, Urticaria

Symptoms: when I got the vaccine it was puff for 4 days. On the 5th day I noticed that the injection site was red and plump. I also had a burning itch like a mosquito bite. It got to the size of a tennis ball. I tried to refrain from touching the area as well as scratching the area to not spread.

Other Meds: NONE

Current Illness: NONE

ID: 0966712
Sex: F
Age: 69
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: YELLOW #5, BEE STINGS

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

Symptoms: PT C/O L SCAPULA PAIN W/ FEELING OF SWOLLENESS AFTER RECEIVING MODERNA VACCINE. PT WAS BEING MONITORED FOR 30 MINS, D/T PAST ALLERGIC REACTION TO YELLO #4 AND BEE STINGS. AFTER 30 MINS PT'S R SHOULDER AREA SHOWED SWELLING TOWARDS NECK. 911 RESPONSE WAS INICIATED, VITALS WERE WNL. PT WAS TRANSPORTED TO THE HOSPITAL.

Other Meds: UNKNOWN

Current Illness: TREATED FOR LOW K RECENTLY

ID: 0966713
Sex: F
Age: 33
State: OR

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Seasonal allergies

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

Symptoms: Numbness and tingling sensation with tongue, lips, and around lip area.

Other Meds:

Current Illness:

ID: 0966714
Sex: F
Age: 43
State: NJ

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
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 that I know of

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

Symptoms: 20 minutes following vaccine I suddenly experienced tingling in mouth and throat, muscle twitches in hands, rapid heartbeat, and rash. I returned to vaccine clinic and was referred to ER. I was observed for several hours and symptoms resolved.

Other Meds: Multivitamin and probiotics

Current Illness: None

ID: 0966715
Sex: F
Age: 78
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966716
Sex: F
Age: 39
State: CA

Vax Date: 01/11/2021
Onset Date: 01/16/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: Redness/swelling, cellulitis of arm requiring antibiotics

Other Meds:

Current Illness:

ID: 0966717
Sex: F
Age: 78
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966718
Sex: F
Age: 80
State: LA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfur, Cortisone, Tylenol, Chocolate, Sweet Potatoes, Wheat, Cabbage, Oranges, Grape Fruit, Coconut,

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: lip swelling, left arm pain, hand pain/tightness

Other Meds: Eliquis 5 mg, Pantoprazole 40 mg, Aripiprazole 20 mg, Divalproex 500 mg, Atorvastatin 20 mg, Metoprololtartarte 25 mg , Benadryl as needed, Miralax as needed

Current Illness: None

ID: 0966719
Sex: F
Age: 40
State: WA

Vax Date: 12/31/2020
Onset Date: 01/10/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Keflex, cephalexin, sulfa drugs

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

Symptoms: Seems like shingles.

Other Meds: Wellbutrin, Adderall, propranolol, estradiol birth control, vitamin D3

Current Illness: None

ID: 0966720
Sex: F
Age: 40
State: NY

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: None

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

Symptoms: Within a few minutes I felt like my throat was getting tight, constricted, and maybe even the description would be inflamed. I was still able to breathe okay and swallow with only some restriction so I didnt say anything. I felt a little foggy and shaky as well for about another 2 hours and then was fine.

Other Meds: Multi-vitamins

Current Illness: None

ID: 0966721
Sex: F
Age: 76
State: WV

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Unevaluable event

Symptoms: After 5 min, patient experienced sharp left deltoid area to left neck with ?fuzzy headache?

Other Meds: Unknown

Current Illness: None

ID: 0966722
Sex: F
Age: 51
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: Injection site pain, headache. Resolved.

Other Meds:

Current Illness:

ID: 0966723
Sex: M
Age: 79
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: On January 21, 2021 at the Prospect COVID 19 Vaccine Clinic, an orthopedic PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator (a RN). The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the RN inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The RN then alerted the lead APRN, who escalated the situation to the operations manager. The operations manager then contacted the Chief Quality Officer. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a ?near miss? event and is being reported out of an abundance of caution

Other Meds:

Current Illness:

ID: 0966724
Sex: M
Age: 74
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, an PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966725
Sex: F
Age: 34
State: MO

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/22/2021
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: nkda

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

Symptoms: patient states severe swelling at injection site

Other Meds:

Current Illness:

ID: 0966726
Sex: F
Age: 66
State: CA

Vax Date: 01/15/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
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: nuts sulfa drugs cipro

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 4 days after vaccine reported - headache, diarrhea, itchy rash

Other Meds: BENZONATATE CAP,ORAL 100MG prn MONTELUKAST TAB 10MG TAKE ONE (1) TABLET BY MOUTH QD TO PREVENT ASTHMA ATTACKS CETIRIZINE TAB 10MG TAKE ONE (1) TABLET BY MOUTH EVERY DAY FOR SEASONAL

Current Illness: asthma hypothyroidism type II DM hyperlipidemia seasonal allergies

ID: 0966727
Sex: F
Age: 67
State: IL

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 2 1/2 to 3 inch area at injection site that is red firm and warm to touch , no fever or other problems

Other Meds: Hydrochlorothiazide, Amlodipine, Ibuprofen , multivitamins and airborne

Current Illness: none

ID: 0966728
Sex: F
Age: 12
State: WI

Vax Date: 01/05/2021
Onset Date: 01/08/2021
Rec V Date: 01/22/2021
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: NKDA

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

Symptoms: Patient presents today via virtual visit for rash. Virtual appointment has been arranged since we are in the middle of COVID-19 pandemic. Mother and patient were the historians. Patient had Gardasil, influenza, meningococcal MCV for PE, and Tdap vaccination on 1/5/2021. Patient went to the emergency room in on 1/10/2021 for a rash that developed on 1/8/2021. The rash developed on bilateral lower extremities. It started on the feet and has been ascending up the legs and is now located on the lower abdomen according to the ED notes. In the ED note the rash was painful and pruritic. According to the ED note the rash itself was very characteristic for Henoch Schoenlein purpura. Patient does not have any abdominal pain but she does have bilateral knee arthralgia. Patient had labs completed which showed mild leukocytosis. Her electrolytes and LFTs were within normal limits. Inflammatory markers including sed rate and CRP were both minimal. UA were worse without any evidence of UTI. There was no proteinuria. She has microscopic hematuria. In the ED she was mildly tachycardic. She received 1 L of IV fluids and her heart rate trend went back to normal. Patient then had follow-up appointment with her doctor on 1/11/2021. Patient had urine analysis completed in the doctor's office which showed trace ketones and trace leuks. Patient's CMP was within normal limits. Patient's CRP was minimal. Patient's sed rate was within normal limits at 15. Patient clinically looks well nontoxic. Mother reports that patient also had leg edema along with a rash which started to go down since the ED visit, however 3 days ago that the leg swelling came back. The rash has not worsened, but it has persisted. It continues to be painful and pruritic. They have not been doing any treatments. Patient denies fever, shortness of breath, dry cough, chills, shaking repeatedly with chills, muscle pain, headache, nausea, vomiting, diarrhea, sore throat, or new loss of taste or smell.

Other Meds: none

Current Illness: none

ID: 0966729
Sex: M
Age: 42
State: IL

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: sulfa (hives)

Symptom List: Nausea

Symptoms: Approximately 5 minutes after vaccination, while pt was in our waiting area in front of pharmacy, he started to feel light headed/dizzy. He stated he was tachycardic. I had pt sit down immediately. We called 911. I took his blood pressure which was considerably elevated (235/107). Pt had no other signs of an allergic rxn. Paramedics arrived and took pt to the nearest hospital.

Other Meds: none disclosed by the patient

Current Illness: none disclosed by the patient

ID: 0966730
Sex: F
Age: 48
State: MA

Vax Date: 01/11/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Injection site pain

Symptoms: arm pain day 1-2, day 2 fatigue and migraine, day 3-4 migraines and fatigue and joint pain, day 8 itching and swelling on arm around injection site and difficulty breathing, day 9 to present arm injection site swelling continues to grow in size on arm continues to be itchy and breathing is more difficult as day progresses. Right back of knee swelling and pain also beginning day 8, which gets worse as the day progresses.

Other Meds: Trokendi, levothyroxine, zomig, Fiornal,

Current Illness: none

ID: 0966731
Sex: M
Age: 81
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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 January 21, 2021 at the Clinic, an orthopedic PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted the Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966732
Sex: F
Age: 75
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966733
Sex: F
Age: 45
State: TX

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Patient reports flushing, lightheaded, dizzy, symptoms lasted about 3 minutes, she was seen and cleared by EMS. V/S; BP 152/87, HR 87, Spo2 100%

Other Meds:

Current Illness:

ID: 0966734
Sex: F
Age: 27
State: OR

Vax Date: 01/13/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: Aloe vera and most fruit or plant extracts.

Symptom List: Erythema, Pruritus

Symptoms: Severe headache began on 1/20/21 at 9 PM. I took Benadryl, Tramadol, and ibuprofen for relief and to sleep, asleep by 11 PM. Had a very restless sleep and woke up with severe sweating around 3 AM. Woke up at 9:30 AM with severe, pounding headache. Attempted to walk around at 10 AM, pounding headache was a 10/10 pain scale when upright. Nausea set in as soon as I was standing, ran to lay down to avoid vomiting. At 10:30 AM I sat up attempted to drink water and the vomiting began. Severe vomiting for about 30 minutes, then intermittent vomiting throughout the day until 6 PM. Headache did not let up all day, no response to medication (acetaminophen, ibuprofen, rizatriptan, magnesium). Headache subsided around 8 PM and I was able to sleep. No symptoms today 1/22/21.

Other Meds: Rx: Metoprolol Tartrate, Cromoyln solution, Spironolactone, low dose Naltrexone, Xulane patch, rizatriptan, sudafed. Over-the-counter: nasal decongestants, Alegra, Claritin, Xyrtec, benadryl, Flonase. Supplements: Vitamin D3, Iron, L-theani

Current Illness: none

ID: 0966735
Sex: F
Age: 55
State: CO

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: N/A

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

Symptoms: Pt developed diarrhea, nausea, vomiting, dizziness and diaphoresis, pallor

Other Meds: N/A

Current Illness:

ID: 0966736
Sex: F
Age: 74
State: AZ

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: PCN, Sulfa

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

Symptoms: Chills, muscle ache, headache.

Other Meds: Multivitamins, vit E, Krill oil, vit D

Current Illness: None

ID: 0966737
Sex: F
Age: 0
State: FL

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Clindamycin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Staff worker reported shortness of Breath/Labored breathing, lightheadedness/dizziness after approximately 7 minutes of receiving vaccine. Patient received Epipen injection and paramedics were called to transport her to hospital.

Other Meds: VItamin D; Levothyroxine

Current Illness:

ID: 0966738
Sex: M
Age: 67
State: TX

Vax Date: 01/07/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
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: None

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

Symptoms: On January 18, 2021, vaccine administration site started to itch, then by the next day, there was urticaria throughout the entire body. Patient took benadryl, with little effect. Went to outpatient clinic, was given cetirizine with better results.

Other Meds: Ezetimibe, Cetirizine, citalopram, lisinopril, Tadalafil, empagliflozin, metformin, testosterone.

Current Illness: Diabetes, HTN, depression, anxiety, fatigue.

ID: 0966739
Sex: M
Age: 81
State: AZ

Vax Date: 01/17/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: Penicillin

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

Symptoms: Wednesday morning he started to feel a lot of muscle soreness in the back of his neck and shoulders and could not put his head back to drink water. Wednesday evening put muscle rub on achy areas and took a couple of Aleve. Thursday morning was feeling better and Thursday evening a lot better. Friday just a slight tight feeling to remind him it is still there.

Other Meds: Amlodipine, Digoxin, Eliquis, Atenolol, Losartan, Requip, B12, Multiple Vitamin

Current Illness: gastritis from December 22nd, 2020 to December 28th 2020

ID: 0966740
Sex: F
Age: 53
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/22/2021
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: Pain in extremity

Symptoms: Headaches Sevier body aches tired runny nose

Other Meds:

Current Illness:

ID: 0966741
Sex: M
Age: 25
State: IN

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: Fever, vomiting, body ache,

Other Meds: None

Current Illness: None

ID: 0966742
Sex: F
Age: 90
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966744
Sex: F
Age: 27
State: CA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: c/o headache, pressure in her head, c/o pain in arm at injection. Physician assessed patient and d/c back to work in stable condition.

Other Meds:

Current Illness:

ID: 0966745
Sex: M
Age: 80
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966746
Sex: M
Age: 65
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of an abundance of caution.

Other Meds:

Current Illness:

ID: 0966747
Sex: F
Age: 43
State: AZ

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Numbness in lips, tongue, pallet, gums. and left side of face. Hives over body

Other Meds:

Current Illness:

ID: 0966748
Sex: M
Age: 60
State: SC

Vax Date: 01/01/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
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: Tequila, or any antibiotic in the quinolone group.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chills (freezing/shaking), headache, fever.

Other Meds: Zyrtec

Current Illness: None

ID: 0966749
Sex: F
Age: 50
State: AZ

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: ASA, nsaids, sulfa, statins

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

Symptoms: Moderate Site pain, generalized body ache, fatigue, chills, headaches

Other Meds: Metformin , metoprolol, livalo, plavix

Current Illness: None

ID: 0966750
Sex: M
Age: 79
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: On January 21, 2021 at the Clinic, a PA was administering vaccinations during the morning for a four-hour shift, 8 AM to noon. At the end of her shift, she handed off her vaccines to another vaccinator. The PA had three doses of vaccine drawn up at that time, in syringes, on her desk. When the nurse inspected the syringes, she found 0.4mL of vaccine had been drawn into those syringes rather than the required 0.3mL. The nurse then alerted the APRN, who escalated the situation to the manager. The manager then contacted Quality. The concern was that the PA had been vaccinating patients all morning with an inappropriate dose of vaccine, 0.4mL. After thorough internal investigation, we found that the PA drew up 38 vaccine doses and administered 35 of them. Additionally, based on vial usage for the day and total number of vaccines administered, we have concluded that it is highly unlikely that excess vaccine was administered. This was a near miss event and is being reported out of caution.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm