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

ID: 1551885
Sex: F
Age: 45
State: KS

Vax Date: 12/28/2020
Onset Date: 01/06/2021
Rec V Date: 08/13/2021
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: Mild illness; Tested positive for COVID; This spontaneous case was reported by a nurse and describes the occurrence of ILLNESS (Mild illness) in a 45-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025J20A-2A) for COVID-19 vaccination. No Medical History information was reported. On 28-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Jan-2021, the patient experienced ILLNESS (Mild illness). At the time of the report, ILLNESS (Mild illness) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. She tested positive for COVID on 1/6/2021 via nasal swab PCR. Concomitant medications were not reported. Treatment information were not provided.

Other Meds:

Current Illness:

ID: 1551886
Sex: F
Age: 52
State: CA

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 08/13/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: little burning on arm; little soreness on arm; Very red hot square at the injection site; very red hot square at the injection site; This spontaneous case was reported by an other health care professional and describes the occurrence of BURNING SENSATION (little burning on arm), PAIN IN EXTREMITY (little soreness on arm), VACCINATION SITE WARMTH (Very red hot square at the injection site) and VACCINATION SITE ERYTHEMA (very red hot square at the injection site) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011J20A) for COVID-19 vaccination. Concurrent medical conditions included Complex regional pain syndrome. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In January 2021, the patient experienced BURNING SENSATION (little burning on arm), PAIN IN EXTREMITY (little soreness on arm), VACCINATION SITE WARMTH (Very red hot square at the injection site) and VACCINATION SITE ERYTHEMA (very red hot square at the injection site). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, BURNING SENSATION (little burning on arm) and PAIN IN EXTREMITY (little soreness on arm) outcome was unknown and VACCINATION SITE WARMTH (Very red hot square at the injection site) and VACCINATION SITE ERYTHEMA (very red hot square at the injection site) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant product was reported. Treatment drug include Tylenol before bed the same day of the injection for the symptoms and took compounded cream with Ketamine for her knee.

Other Meds:

Current Illness: Complex regional pain syndrome

ID: 1551887
Sex: F
Age: 51
State: OR

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 08/13/2021
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: had systemic flu-like symptoms with no fever; arm began to swell 10 days after the vaccine; swelling covered my arm and was one inch from elbow; she noticed a ?red circle that grew bigger during the night; felt crappy for a day; arm hurt for "like a week after the injection"; arm was very painful; This spontaneous case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of PERIPHERAL SWELLING (arm began to swell 10 days after the vaccine; swelling covered my arm and was one inch from elbow), MALAISE (felt crappy for a day), INFLUENZA LIKE ILLNESS (had systemic flu-like symptoms with no fever), PAIN IN EXTREMITY (arm hurt for "like a week after the injection"; arm was very painful) and RASH ERYTHEMATOUS (she noticed a ?red circle that grew bigger during the night) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025J20-2A) for COVID-19 vaccination. No Medical History information was reported. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Jan-2021, the patient experienced PAIN IN EXTREMITY (arm hurt for "like a week after the injection"; arm was very painful). On 15-Jan-2021, the patient experienced MALAISE (felt crappy for a day). On 24-Jan-2021, the patient experienced PERIPHERAL SWELLING (arm began to swell 10 days after the vaccine; swelling covered my arm and was one inch from elbow) and RASH ERYTHEMATOUS (she noticed a ?red circle that grew bigger during the night). On 27-Jan-2021, the patient experienced INFLUENZA LIKE ILLNESS (had systemic flu-like symptoms with no fever). On 15-Jan-2021, MALAISE (felt crappy for a day) had resolved. On 28-Jan-2021, INFLUENZA LIKE ILLNESS (had systemic flu-like symptoms with no fever) had resolved. At the time of the report, PERIPHERAL SWELLING (arm began to swell 10 days after the vaccine; swelling covered my arm and was one inch from elbow) and RASH ERYTHEMATOUS (she noticed a ?red circle that grew bigger during the night) was resolving and PAIN IN EXTREMITY (arm hurt for "like a week after the injection"; arm was very painful) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. On 25JAN2021, the patient sought medical advise from her HCP about the a ?red circle that grew bigger during the night." She reported that her doctor instructed her to elevate her arm with ice and take ibuprofen. The caller stated that the 27JAN2021 and 28JAN2021 were the worst days. On 28JAN2021, the patient emailed her doctor and was prescribed antibiotics. The patient reported that she did not take them; she used a steroid cream instead and the next day her arm started to feel better. The patient also reports taking diphenhydramine.

Other Meds:

Current Illness:

ID: 1551888
Sex: F
Age: 20
State: NY

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 08/13/2021
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: developed hives; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (developed hives) in a 20-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Feb-2021, the patient experienced URTICARIA (developed hives). At the time of the report, URTICARIA (developed hives) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.

Other Meds:

Current Illness:

ID: 1551889
Sex: F
Age: 73
State:

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 08/13/2021
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: it was hot; it was very itchy; rash at the injection site that was quite large about 3 to 5 inches; it was red; it was swollen; typical soreness; This spontaneous case was reported by a physician and describes the occurrence of VACCINATION SITE WARMTH (it was hot), VACCINATION SITE PRURITUS (it was very itchy), MYALGIA (typical soreness), VACCINATION SITE RASH (rash at the injection site that was quite large about 3 to 5 inches) and VACCINATION SITE ERYTHEMA (it was red) in a 73-year-old female patient who received COVID-19 VACCINE MRNA (MRNA 1273) (MODERNA COVID-19 VACCINE) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Food allergy. Concomitant products included ESTRADIOL for HRT. On 08-Jan-2021, the patient received first dose of COVID-19 VACCINE MRNA (MRNA 1273) (MODERNA COVID-19 VACCINE) (Intramuscular) dosage was changed to 1 dosage form at an unspecified frequency. On an unknown date, the patient received first dose of COVID-19 VACCINE MRNA (MRNA 1273) (MODERNA COVID-19 VACCINE) (Intramuscular) 1 dosage form at an unspecified frequency. On 08-Jan-2021, after starting COVID-19 VACCINE MRNA (MRNA 1273) (MODERNA COVID-19 VACCINE), the patient experienced MYALGIA (typical soreness). On 15-Jan-2021, the patient experienced VACCINATION SITE WARMTH (it was hot), VACCINATION SITE PRURITUS (it was very itchy), VACCINATION SITE RASH (rash at the injection site that was quite large about 3 to 5 inches), VACCINATION SITE ERYTHEMA (it was red) and VACCINATION SITE SWELLING (it was swollen). On 31-Jan-2021, VACCINATION SITE WARMTH (it was hot) had resolved. At the time of the report, VACCINATION SITE PRURITUS (it was very itchy), MYALGIA (typical soreness), VACCINATION SITE RASH (rash at the injection site that was quite large about 3 to 5 inches), VACCINATION SITE ERYTHEMA (it was red) and VACCINATION SITE SWELLING (it was swollen) outcome was unknown. con meds: Progesterone, 1mg, oral route, HRT-indication Patient have medication allergy, Ibuprofen allergy, Augmentin allergy, but not allergic to other penicillin's. Most recent FOLLOW-UP information incorporated above includes: On 23-Jun-2021: Follow up received: Please confirm NNI

Other Meds: ESTRADIOL

Current Illness: Food allergy

ID: 1551890
Sex: F
Age: 22
State: NY

Vax Date: 01/12/2021
Onset Date:
Rec V Date: 08/13/2021
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: Swollen lymph node on the left side that the vaccine was administered; Inflamed; swelling at the injection site; This spontaneous case was reported by a consumer and describes the occurrence of LYMPHADENOPATHY (Swollen lymph node on the left side that the vaccine was administered), VACCINATION SITE INFLAMMATION (Inflamed) and VACCINATION SITE SWELLING (swelling at the injection site) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20-2A) for COVID-19 vaccination. No Medical History information was reported. On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) at an unspecified dose. On an unknown date, the patient experienced LYMPHADENOPATHY (Swollen lymph node on the left side that the vaccine was administered), VACCINATION SITE INFLAMMATION (Inflamed) and VACCINATION SITE SWELLING (swelling at the injection site). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) at a dose of UNK dosage form and LORATADINE (CLARITIN [LORATADINE]) at a dose of UNK dosage form. At the time of the report, LYMPHADENOPATHY (Swollen lymph node on the left side that the vaccine was administered) and VACCINATION SITE SWELLING (swelling at the injection site) outcome was unknown and VACCINATION SITE INFLAMMATION (Inflamed) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No relevant concomitant medications were provided. According to the patient, the swelling at the injection site was still about the same, but had gone down a bit, at the time of reporting.

Other Meds:

Current Illness:

ID: 1551891
Sex: F
Age:
State: CA

Vax Date: 01/27/2021
Onset Date:
Rec V Date: 08/13/2021
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: Dizziness; Lightheadedness; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (Dizziness) and DIZZINESS (Lightheadedness) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027L20A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included CANAGLIFLOZIN (INVOKANA [CANAGLIFLOZIN]), GABAPENTIN, LEVOTHYROXINE SODIUM (LEVOXYL), FOLIC ACID and KCL for an unknown indication. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DIZZINESS (Dizziness) and DIZZINESS (Lightheadedness). At the time of the report, DIZZINESS (Dizziness) and DIZZINESS (Lightheadedness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No treatment information was reported.

Other Meds: INVOKANA [CANAGLIFLOZIN]; GABAPENTIN; LEVOXYL; FOLIC ACID; KCL

Current Illness:

ID: 1551892
Sex: F
Age: 32
State: PA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 08/13/2021
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: lymph nodes of the side of the injection site swollen; lymph nodes of the side of the injection site swollen painful; headache; chills; soreness of the arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (soreness of the arm), HEADACHE (headache), CHILLS (chills), VACCINATION SITE SWELLING (lymph nodes of the side of the injection site swollen) and LYMPH NODE PAIN (lymph nodes of the side of the injection site swollen painful) in a 32-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013L20A) for COVID-19 vaccination. No Medical History information was reported. On 21-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jan-2021, the patient experienced VACCINATION SITE PAIN (soreness of the arm). On 23-Jan-2021, the patient experienced HEADACHE (headache) and CHILLS (chills). On 25-Jan-2021, the patient experienced VACCINATION SITE SWELLING (lymph nodes of the side of the injection site swollen) and LYMPH NODE PAIN (lymph nodes of the side of the injection site swollen painful). On 22-Jan-2021, VACCINATION SITE PAIN (soreness of the arm) had resolved. On 23-Jan-2021, HEADACHE (headache) and CHILLS (chills) had resolved. On 28-Jan-2021, VACCINATION SITE SWELLING (lymph nodes of the side of the injection site swollen) and LYMPH NODE PAIN (lymph nodes of the side of the injection site swollen painful) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No corrective treatment was provided.

Other Meds:

Current Illness:

ID: 1551893
Sex: F
Age: 38
State: IL

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 08/13/2021
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: her cheeks swollen; 1 circle on each of her cheeks; tingling sensation; numbness; redness; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING FACE (her cheeks swollen), RASH VESICULAR (1 circle on each of her cheeks), PARAESTHESIA (tingling sensation), HYPOAESTHESIA (numbness) and ERYTHEMA (redness) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013L20A) for COVID-19 vaccination. No Medical History information was reported. On 25-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Jan-2021, the patient experienced SWELLING FACE (her cheeks swollen), RASH VESICULAR (1 circle on each of her cheeks), PARAESTHESIA (tingling sensation), HYPOAESTHESIA (numbness) and ERYTHEMA (redness). At the time of the report, SWELLING FACE (her cheeks swollen), RASH VESICULAR (1 circle on each of her cheeks), PARAESTHESIA (tingling sensation), HYPOAESTHESIA (numbness) and ERYTHEMA (redness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were provided as allergy medication No Treatment information provided

Other Meds:

Current Illness:

ID: 1551894
Sex: F
Age: 70
State: TX

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 08/13/2021
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: On 01-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Feb-2021, the patient experienced DIARRHOEA (Diarrhea) and ABDOMINAL PAIN (Severe colon pain). On 03-Feb-2021, DIARRHOEA (Diarrhea) had resolved. At the time of the report, ABDOMINAL PAIN (Severe colon pain) outcome was unknown. Not Provided Patient's concomitant drugs included heart medications, thyroid medications and cholesterol medications. No corrective treatment was provided.

Other Meds:

Current Illness: Blood cholesterol abnormal; Heart disorder; Thyroid disorder NOS

ID: 1551895
Sex: F
Age: 62
State: TX

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 08/13/2021
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: Itching at injection site; Redness at injection site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itching at injection site) and VACCINATION SITE ERYTHEMA (Redness at injection site) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included No adverse event (No recorded medical history). On 21-Jan-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Jan-2021, the patient experienced VACCINATION SITE ERYTHEMA (Redness at injection site). On 29-Jan-2021, the patient experienced VACCINATION SITE PRURITUS (Itching at injection site). At the time of the report, VACCINATION SITE PRURITUS (Itching at injection site) and VACCINATION SITE ERYTHEMA (Redness at injection site) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. On 22-Jan-2021, the patient experienced redness at the injection site that ended on 26-Jan-2021. On 29-Jan-2021, the patient reported that the injection site redness has came back. Concomitant product use was not provided by the reporter. Treatment information was not provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1551896
Sex: F
Age: 85
State: WA

Vax Date: 01/17/2021
Onset Date: 01/17/2021
Rec V Date: 08/13/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Vaccination site pain; TIGHT; injection site was red; itchy rash; red spot; shingles; eczema; psoriasis; itching; FEELS LIKE SHE IS LOSING HER MIND; sensitivity in her arm; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PAIN IN EXTREMITY (sensitivity in her arm), RASH PRURITIC (itchy rash), RASH MACULAR (red spot), HERPES ZOSTER (shingles) and ECZEMA (eczema) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for Vaccination: Shingles. On 17-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Jan-2021, the patient experienced PAIN IN EXTREMITY (sensitivity in her arm), HERPES ZOSTER (shingles), ECZEMA (eczema), PSORIASIS (psoriasis), PRURITUS (itching) and NERVOUS SYSTEM DISORDER (FEELS LIKE SHE IS LOSING HER MIND). On 26-Jan-2021, the patient experienced RASH PRURITIC (itchy rash), RASH MACULAR (red spot), VACCINATION SITE INDURATION (TIGHT) and INJECTION SITE ERYTHEMA (injection site was red). On an unknown date, the patient experienced VACCINATION SITE PAIN (Vaccination site pain). At the time of the report, PAIN IN EXTREMITY (sensitivity in her arm), RASH PRURITIC (itchy rash), RASH MACULAR (red spot), VACCINATION SITE INDURATION (TIGHT) and INJECTION SITE ERYTHEMA (injection site was red) was resolving and HERPES ZOSTER (shingles), ECZEMA (eczema), PSORIASIS (psoriasis), PRURITUS (itching), NERVOUS SYSTEM DISORDER (FEELS LIKE SHE IS LOSING HER MIND) and VACCINATION SITE PAIN (Vaccination site pain) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No corrective treatment was provided. Most recent FOLLOW-UP information incorporated above includes: On 19-May-2021: Added events

Other Meds:

Current Illness:

ID: 1551897
Sex: F
Age:
State: CT

Vax Date: 01/21/2021
Onset Date:
Rec V Date: 08/13/2021
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: got a very strong reaction; had fever of 101?F; chills; body aches; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (got a very strong reaction), PYREXIA (had fever of 101?F), CHILLS (chills) and MYALGIA (body aches) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028L20A) for COVID-19 vaccination. The patient's past medical history included COVID-19 in December 2020. On 21-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (got a very strong reaction), PYREXIA (had fever of 101?F), CHILLS (chills) and MYALGIA (body aches). At the time of the report, VACCINATION COMPLICATION (got a very strong reaction), PYREXIA (had fever of 101?F), CHILLS (chills) and MYALGIA (body aches) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101 (High) 101?F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No corrective treatment was provided. Most recent FOLLOW-UP information incorporated above includes: On 16-Apr-2021: Updated events outcome.

Other Meds:

Current Illness:

ID: 1551898
Sex: F
Age: 82
State: TN

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 08/13/2021
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:

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

Symptoms: Lethargic; Transitory loss of taste; Nausea; Stomach cramping; Fatigue; Didn't feel good; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN UPPER (Stomach cramping), LETHARGY (Lethargic), AGEUSIA (Transitory loss of taste), FEELING ABNORMAL (Didn't feel good) and NAUSEA (Nausea) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 043L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Glaucoma and Allergy (The patient was taking dizol as allergy pill.). Concomitant products included ATENOLOL, AMLODIPINE, LATANOPROST, CALCIUM and COLECALCIFEROL (VIT D [COLECALCIFEROL]) for an unknown indication. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jan-2021, the patient experienced FEELING ABNORMAL (Didn't feel good) and FATIGUE (Fatigue). On 27-Jan-2021, the patient experienced ABDOMINAL PAIN UPPER (Stomach cramping). On 28-Jan-2021, the patient experienced LETHARGY (Lethargic), AGEUSIA (Transitory loss of taste) and NAUSEA (Nausea). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at a dose of UNK dosage form. On 28-Jan-2021, ABDOMINAL PAIN UPPER (Stomach cramping) and AGEUSIA (Transitory loss of taste) had resolved. At the time of the report, LETHARGY (Lethargic) and NAUSEA (Nausea) had not resolved and FEELING ABNORMAL (Didn't feel good) and FATIGUE (Fatigue) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Additional concomitant medications included eye drops for glaucoma (unspecified) and Dizol as allergy pill. Most recent FOLLOW-UP information incorporated above includes: On 17-Apr-2021: Non-significant follow-up information received (consumer denied follow-up as she is doing fine).

Other Meds: ATENOLOL; AMLODIPINE; LATANOPROST; CALCIUM; VIT D [COLECALCIFEROL]

Current Illness: Allergy (The patient was taking dizol as allergy pill.); Glaucoma

ID: 1551899
Sex: F
Age: 76
State: AL

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 08/13/2021
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: Fever; Pain in the stomach; Burning head; Weakness; Felt very hot; Discomfort in the stomach; Not feeling hungry; Very weak; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever), ABDOMINAL PAIN UPPER (Pain in the stomach), BURNING SENSATION (Burning head), ASTHENIA (Weakness) and FEELING HOT (Felt very hot) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Jan-2021, the patient experienced PYREXIA (Fever), ABDOMINAL PAIN UPPER (Pain in the stomach), BURNING SENSATION (Burning head), ASTHENIA (Weakness), FEELING HOT (Felt very hot), ABDOMINAL DISCOMFORT (Discomfort in the stomach), ABDOMINAL DISTENSION (Not feeling hungry) and ASTHENIA (Very weak). The patient was treated with PARACETAMOL (ADVIL 6 PLUS) at an unspecified dose and frequency. On 25-Jan-2021, PYREXIA (Fever), ABDOMINAL PAIN UPPER (Pain in the stomach), BURNING SENSATION (Burning head), FEELING HOT (Felt very hot), ABDOMINAL DISCOMFORT (Discomfort in the stomach) and ABDOMINAL DISTENSION (Not feeling hungry) had resolved. At the time of the report, ASTHENIA (Weakness) and ASTHENIA (Very weak) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds:

Current Illness:

ID: 1551900
Sex: F
Age: 53
State: OR

Vax Date: 01/16/2021
Onset Date: 01/25/2021
Rec V Date: 08/13/2021
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: Irritation; Itchy; Rash; Red rash on left arm; This spontaneous case was reported by a consumer and describes the occurrence of SKIN IRRITATION (Irritation), PRURITUS (Itchy), RASH (Rash) and INJECTION SITE ERYTHEMA (Red rash on left arm) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 025J20-2A and 041l20a) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Many cold medicines---Heart race or pass out. Immediate reaction), Drug allergy (Vicodin ----Nausea and throwing up. Needed to take anti nausea med), Drug allergy (Oxycodone---Nausea and throwing up. Needed to take anti nausea med) and Drug allergy (Anesthesia- Nausea and throwing up. Needed to take anti nausea med). Concomitant products included IBUPROFEN and PARACETAMOL (TYLENOL) for Back pain, MULTIVITAMIN & MINERAL and VIT D [VITAMIN D NOS] for an unknown indication. On 16-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 2 dosage form. On 25-Jan-2021, the patient experienced SKIN IRRITATION (Irritation), PRURITUS (Itchy), RASH (Rash) and INJECTION SITE ERYTHEMA (Red rash on left arm). The patient was treated with CORTISONE at an unspecified dose and frequency. On 16-Feb-2021, SKIN IRRITATION (Irritation), PRURITUS (Itchy), RASH (Rash) and INJECTION SITE ERYTHEMA (Red rash on left arm) had resolved. . Most recent FOLLOW-UP information incorporated above includes: On 23-Jun-2021: Follow-up received on 23 JUNE 2021, vaccine hypersensitivity form was added(date of second dose and outcome of event was added).

Other Meds: MULTIVITAMIN & MINERAL; VIT D [VITAMIN D NOS]; IBUPROFEN; TYLENOL

Current Illness:

ID: 1551901
Sex: M
Age: 51
State: IL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 08/13/2021
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: Bad headache; Nausea; Left arm swollen at the injection site; A spontaneous report was received from a consumer concerning a 51-years-old patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced events bad headache, nausea, left arm swollen at the injection site, symptoms increased besides the tylenol he took. The patient's medical history was not provided. No relevant concomitant medications were reported. On 27 Jan 2021, prior to the onset of the events the patient received their first of two planned doses of mRNA-1273 (lot/batch: not provided.) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 27 Jan 2021, the patient experienced the event(s) bad headache, nausea, left arm swollen at the injection site. On 28 Jan 2021, the patient experienced the event(s) symptoms increased besides the tylenol he took. Treatment details included Tylenol since 27Jan2021. Action taken with mRNA-1273 in response to the events was not reported. The outcome of event(s), bad headache, nausea, left arm swollen at the injection site, symptoms increased besides the tylenol he took was unknown.

Other Meds:

Current Illness:

ID: 1551902
Sex: M
Age:
State: NC

Vax Date: 01/21/2021
Onset Date:
Rec V Date: 08/13/2021
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: phlegm in his throat; This spontaneous case was reported by an other and describes the occurrence of PRODUCTIVE COUGH (phlegm in his throat) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 21-Jan-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCTIVE COUGH (phlegm in his throat). At the time of the report, PRODUCTIVE COUGH (phlegm in his throat) had resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 16-Apr-2021: Changed the outcome to resolved as patient is fine.

Other Meds:

Current Illness:

ID: 1551903
Sex: F
Age: 78
State: FL

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 08/13/2021
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: Entire arm became red; hot to the touch; Low grade fever; Aches; Fever; Chills; Whole arm turned black and blue; This spontaneous case was reported by a consumer and describes the occurrence of CONTUSION (Whole arm turned black and blue), PAIN (Aches), ERYTHEMA (Entire arm became red), FEELING HOT (hot to the touch) and PYREXIA (Fever) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood pressure. On 20-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Jan-2021, the patient experienced CONTUSION (Whole arm turned black and blue). On 21-Jan-2021, the patient experienced PAIN (Aches), PYREXIA (Fever) and CHILLS (Chills). On 28-Jan-2021, the patient experienced ERYTHEMA (Entire arm became red), FEELING HOT (hot to the touch) and PYREXIA (Low grade fever). On 21-Jan-2021, CONTUSION (Whole arm turned black and blue) outcome was unknown, PAIN (Aches), PYREXIA (Fever) and CHILLS (Chills) had resolved. At the time of the report, ERYTHEMA (Entire arm became red) and FEELING HOT (hot to the touch) had not resolved and PYREXIA (Low grade fever) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided.

Other Meds:

Current Illness: Blood pressure.

ID: 1551904
Sex: F
Age: 39
State: MI

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: had a rash, started down the middle her chest, spread to left side of her stomach, spread a little bit on right arm, spread down all over her legs; diarrhea; felt anxious; chills; sweating; body aches; felt like her body was prickly; A spontaneous report was received from a consumer concerning a 39-years-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced events chills, sweating / hyperhidrosis, body aches /pain, felt like her body was prickly, had a rash, started down the middle her chest, spread to left side of her stomach, spread a little bit on right arm, spread down all over her legs / rash, diarrhea, felt anxious/anxiety. The patient's medical history include allergies, include mold, dust and dogs. Concomitant medications reported were cetirizine hydrochloride, mometasone furoate, vitamins nos, fish oil, for drug use for unknown indication. On 03 Feb 2021, prior to the onset of the events the patient received their second of two planned doses of mRNA-1273 (lot/batch: 029L20A) (unknown route) in the left arm for prophylaxis of COVID-19 infection. On 03 Feb 2021, the patient experienced the event(s) chills, sweating, body aches, felt like her body was prickly. On 4 Feb 2021, the patient experienced the event(s) had a rash, started down the middle her chest, spread to left side of her stomach, spread a little bit on right arm, spread down all over her legs, diarrhea, felt anxious. Treatment details included acetaminophen. The patient received both scheduled doses of mRNA-1273 prior to the event(s); therefore, action taken with the drug in response to the event(s) is not applicable The outcome of event(s), chills, sweating, body aches, felt like her body was prickly, had a rash, started down the middle her chest, spread to left side of her stomach, spread a little bit on right arm, spread down all over her legs, diarrhea, felt anxious was unknown.

Other Meds: ZYRTEC ALLERGY; FLONASE [MOMETASONE FUROATE]; VITAMINS NOS; FISH OIL

Current Illness: Allergy (Allergies include mold, dust and dogs.)

ID: 1551905
Sex: F
Age: 65
State: CA

Vax Date: 01/25/2021
Onset Date: 01/27/2021
Rec V Date: 08/13/2021
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:

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

Symptoms: headache.; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (headache.) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 042L20A) for COVID-19 vaccination. No Medical History information was reported. On 25-Jan-2021 at 8:30 AM, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Jan-2021, the patient experienced HEADACHE (headache.). At the time of the report, HEADACHE (headache.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. The concomitant product is not provided. Treatment is not provided.

Other Meds:

Current Illness:

ID: 1551906
Sex: F
Age: 64
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 08/13/2021
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: Redness; Small Rash; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE ERYTHEMA (Redness) and VACCINATION SITE RASH (Small Rash) in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included No adverse event. On 04-Jan-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Jan-2021, the patient experienced VACCINATION SITE ERYTHEMA (Redness) and VACCINATION SITE RASH (Small Rash). On 09-Jan-2021, VACCINATION SITE ERYTHEMA (Redness) and VACCINATION SITE RASH (Small Rash) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. ICE used as treatment therapy.

Other Meds:

Current Illness:

ID: 1551907
Sex: M
Age: 75
State: FL

Vax Date: 01/04/2021
Onset Date: 01/29/2021
Rec V Date: 08/13/2021
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: Soreness; Chills; Tiredness; Temperature of 98 degress; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Soreness), CHILLS (Chills), FATIGUE (Tiredness) and PYREXIA (Temperature of 98 degress) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 04-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 29-Jan-2021, the patient experienced PAIN (Soreness), CHILLS (Chills), FATIGUE (Tiredness) and PYREXIA (Temperature of 98 degress). At the time of the report, PAIN (Soreness), CHILLS (Chills) and FATIGUE (Tiredness) outcome was unknown and PYREXIA (Temperature of 98 degress) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In January 2021, Body temperature: 98 (Inconclusive) 98 Degrees. No Concomitant medications were provided No Treatment information provided

Other Meds:

Current Illness:

ID: 1551908
Sex: F
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 08/13/2021
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: Sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore arm). At the time of the report, PAIN IN EXTREMITY (Sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were provided No Treatment information provided

Other Meds:

Current Illness:

ID: 1551909
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/13/2021
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: Hypersensitive reaction; Rash in her face and body; This spontaneous case was reported by a physician and describes the occurrence of HYPERSENSITIVITY (Hypersensitive reaction) and RASH (Rash in her face and body) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced HYPERSENSITIVITY (Hypersensitive reaction) and RASH (Rash in her face and body). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) at an unspecified dose and frequency. At the time of the report, HYPERSENSITIVITY (Hypersensitive reaction) and RASH (Rash in her face and body) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medications were provided

Other Meds:

Current Illness:

ID: 1551910
Sex: F
Age:
State: WI

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 08/13/2021
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: Felt warm; Felt like heart was going really fast; This spontaneous case was reported by a consumer and describes the occurrence of FEELING HOT (Felt warm) and PALPITATIONS (Felt like heart was going really fast) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Jan-2021, the patient experienced FEELING HOT (Felt warm) and PALPITATIONS (Felt like heart was going really fast). At the time of the report, FEELING HOT (Felt warm) and PALPITATIONS (Felt like heart was going really fast) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were provided No Treatment information provided

Other Meds:

Current Illness:

ID: 1551911
Sex: F
Age:
State:

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 08/13/2021
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: Did not sleep very well overnight; Achy; Headache; Nausea; Fatigue; Chills; Soreness at injection site; Flu-like symptoms; This spontaneous case was reported by an other health care professional and describes the occurrence of INFLUENZA LIKE ILLNESS (Flu-like symptoms), MIDDLE INSOMNIA (Did not sleep very well overnight), PAIN (Achy), HEADACHE (Headache) and NAUSEA (Nausea) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011J20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included No adverse event. On 03-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Feb-2021, the patient experienced INFLUENZA LIKE ILLNESS (Flu-like symptoms), PAIN (Achy), HEADACHE (Headache), NAUSEA (Nausea), FATIGUE (Fatigue), CHILLS (Chills) and VACCINATION SITE PAIN (Soreness at injection site). On 05-Feb-2021, the patient experienced MIDDLE INSOMNIA (Did not sleep very well overnight). At the time of the report, INFLUENZA LIKE ILLNESS (Flu-like symptoms), MIDDLE INSOMNIA (Did not sleep very well overnight), PAIN (Achy), NAUSEA (Nausea), FATIGUE (Fatigue) and CHILLS (Chills) outcome was unknown and HEADACHE (Headache) and VACCINATION SITE PAIN (Soreness at injection site) had not resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant product use was reported. No treatment details were provided.

Other Meds:

Current Illness:

ID: 1551912
Sex: M
Age: 55
State: NJ

Vax Date: 01/19/2021
Onset Date:
Rec V Date: 08/13/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Right arm sensitive to the touch; Injection site is hot to the touch; Fever; hard 1.5 inch diameter around the injection site; redness in right arm; Pain in right arm; Right arm swollen; slight pain on the left arm after the vaccination; This spontaneous case was reported by a consumer and describes the occurrence of HYPERAESTHESIA (Right arm sensitive to the touch), VACCINATION SITE WARMTH (Injection site is hot to the touch), PYREXIA (Fever), VACCINATION SITE INDURATION (hard 1.5 inch diameter around the injection site) and VACCINATION SITE ERYTHEMA (redness in right arm) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced HYPERAESTHESIA (Right arm sensitive to the touch), VACCINATION SITE WARMTH (Injection site is hot to the touch), PYREXIA (Fever), VACCINATION SITE INDURATION (hard 1.5 inch diameter around the injection site), VACCINATION SITE ERYTHEMA (redness in right arm), VACCINATION SITE PAIN (Pain in right arm), INJECTION SITE SWELLING (Right arm swollen) and INJECTION SITE PAIN (slight pain on the left arm after the vaccination). At the time of the report, HYPERAESTHESIA (Right arm sensitive to the touch), VACCINATION SITE WARMTH (Injection site is hot to the touch), PYREXIA (Fever), VACCINATION SITE INDURATION (hard 1.5 inch diameter around the injection site), VACCINATION SITE ERYTHEMA (redness in right arm), VACCINATION SITE PAIN (Pain in right arm), INJECTION SITE SWELLING (Right arm swollen) and INJECTION SITE PAIN (slight pain on the left arm after the vaccination) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication information was provided. No treatment medication were provided. This case was linked to MOD-2021-079539, MOD-2021-079539. Most recent FOLLOW-UP information incorporated above includes: On 16-Apr-2021: Live follow up received on 16-Apr-2021: Event related information added. On 11-Jul-2021: Updated event outcome from unknown to recovered resolved

Other Meds:

Current Illness:

ID: 1551913
Sex: F
Age: 56
State: NC

Vax Date: 01/14/2021
Onset Date: 01/20/2021
Rec V Date: 08/13/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: throat numb; throat tingly; mouth numb; mouth tingly; arm very warm to touch; arm swollen up; arm very red; This spontaneous case was reported by an other health care professional and describes the occurrence of PHARYNGEAL HYPOAESTHESIA (throat numb), OROPHARYNGEAL DISCOMFORT (throat tingly), HYPOAESTHESIA ORAL (mouth numb), STOMATITIS (mouth tingly) and VACCINATION SITE WARMTH (arm very warm to touch) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025J20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included HCTZ, OMEPRAZOLE (PROTONIX [OMEPRAZOLE]) and ESTRADIOL (VIVELLE [ESTRADIOL]) for an unknown indication. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Jan-2021, the patient experienced PHARYNGEAL HYPOAESTHESIA (throat numb), OROPHARYNGEAL DISCOMFORT (throat tingly), HYPOAESTHESIA ORAL (mouth numb), STOMATITIS (mouth tingly), VACCINATION SITE WARMTH (arm very warm to touch), VACCINATION SITE SWELLING (arm swollen up) and VACCINATION SITE ERYTHEMA (arm very red). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) ongoing from 20-Jan-2021 at a dose of 1 dosage form and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) from 20-Jan-2021 to 22-Jan-2021 for Numbness, at a dose of 25 mg. On 24-Jan-2021, PHARYNGEAL HYPOAESTHESIA (throat numb), OROPHARYNGEAL DISCOMFORT (throat tingly), HYPOAESTHESIA ORAL (mouth numb), STOMATITIS (mouth tingly), VACCINATION SITE WARMTH (arm very warm to touch), VACCINATION SITE SWELLING (arm swollen up) and VACCINATION SITE ERYTHEMA (arm very red) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. On 20 Jan 2021, the patient reported her arm started to swell and she has numbness and tingling in her mouth, neck and throat. On 24 Jan 2021 she recovered from the events of swelling, numbness and tingling in her mouth, neck and throat . This case was linked to MOD-2021-237552. Most recent FOLLOW-UP information incorporated above includes: On 25-Jun-2021: Follow-up information received on 25 JUN 2021, updated patient demography and concomitant medications.

Other Meds: HCTZ; PROTONIX [OMEPRAZOLE]; VIVELLE [ESTRADIOL]

Current Illness:

ID: 1551914
Sex: M
Age: 90
State: TX

Vax Date: 01/22/2021
Onset Date:
Rec V Date: 08/13/2021
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: weakness; lightheadness/dizziness; Headache; fatigue; pain in arm; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (weakness), DIZZINESS (lightheadness/dizziness), HEADACHE (Headache), FATIGUE (fatigue) and VACCINATION SITE PAIN (pain in arm) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included TIA (It was a slight blood clot that disappeared after 30 minutes and he was released from the hospital after two days of observation.) on 06-Dec-2020 and Clot blood. Concurrent medical conditions included Migraine headache, Blood pressure and Cholesterol. Concomitant products included ATORVASTATIN CALCIUM (LIPITOR) for Cholesterol, METOPROLOL for Hypertension, RIVAROXABAN (XARELTO) and CLOPIDOGREL BISULFATE (PLAVIX) for Thrombus. On 22-Jan-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced ASTHENIA (weakness), DIZZINESS (lightheadness/dizziness), HEADACHE (Headache), FATIGUE (fatigue) and VACCINATION SITE PAIN (pain in arm). At the time of the report, ASTHENIA (weakness), DIZZINESS (lightheadness/dizziness), HEADACHE (Headache), FATIGUE (fatigue) and VACCINATION SITE PAIN (pain in arm) had resolved. Treatment information were not provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 24-Jun-2021: TCR form includes Outcome of the events as resolved.

Other Meds: METOPROLOL; XARELTO; PLAVIX; LIPITOR

Current Illness: Blood pressure; Cholesterol; Migraine headache

ID: 1551915
Sex: M
Age: 71
State: FL

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 08/13/2021
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: Wrist became inflammed and in pain, dr said flare of carpal tunnel now in both wrists, but worse on left arm; Joint pain in arm and shoulder-left side; Injection site soreness; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of CARPAL TUNNEL SYNDROME (Wrist became inflammed and in pain, dr said flare of carpal tunnel now in both wrists, but worse on left arm), INJECTION SITE PAIN (Injection site soreness) and ARTHRALGIA (joint pain in arm and shoulder-left side) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029K20A) for COVID-19 vaccination. The patient's past medical history included No adverse event. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jan-2021, the patient experienced INJECTION SITE PAIN (Injection site soreness). On an unknown date, the patient experienced CARPAL TUNNEL SYNDROME (Wrist became inflammed and in pain, dr said flare of carpal tunnel now in both wrists, but worse on left arm) and ARTHRALGIA (joint pain in arm and shoulder-left side). At the time of the report, CARPAL TUNNEL SYNDROME (Wrist became inflammed and in pain, dr said flare of carpal tunnel now in both wrists, but worse on left arm), INJECTION SITE PAIN (Injection site soreness) and ARTHRALGIA (joint pain in arm and shoulder-left side) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product used included blood thinner. The week following vaccination, the patient wrists became inflamed and in pain. Their doctor said it was flare up of carpal tunnel, which is now in both wrists, but worse in the left arm. Treatment for the events included ice. No prescription medications were provided. The patient has recovered with no problems. Most recent FOLLOW-UP information incorporated above includes: On 05-May-2021: Follow-up information was received and processed the same time as initial report. Follow-up information from the patient indicated they recovered.

Other Meds:

Current Illness:

ID: 1551916
Sex: M
Age: 51
State: TX

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 08/13/2021
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: Swelling in arm; Redness; Fever; Injection site is hurting really bad; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Swelling in arm), ERYTHEMA (Redness), PYREXIA (Fever) and VACCINATION SITE PAIN (Injection site is hurting really bad) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012m20a) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included ALPRAZOLAM (XANAX) and ENOXAPARIN SODIUM (CLEXANE) for an unknown indication. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Feb-2021, the patient experienced VACCINATION SITE PAIN (Injection site is hurting really bad). On an unknown date, the patient experienced PERIPHERAL SWELLING (Swelling in arm), ERYTHEMA (Redness) and PYREXIA (Fever). At the time of the report, PERIPHERAL SWELLING (Swelling in arm), ERYTHEMA (Redness), PYREXIA (Fever) and VACCINATION SITE PAIN (Injection site is hurting really bad) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. The patient post receiving their first dose of vaccine stated their left arm at injection site was hurting really bad. On 20-Apr-2021, the patient reported that they experienced swelling in arm, redness and fever post receiving the first dose of vaccine. Reportedly, the patient took the second dose on 04-Mar-2021. No treatment information was provided. Most recent FOLLOW-UP information incorporated above includes: On 20-Apr-2021: Follow-up was received on 20-Apr-2021 and added additional events experienced after first dose. Updated the Action taken. Included second dose date in I-narrative supplement.

Other Meds: XANAX; CLEXANE

Current Illness:

ID: 1551917
Sex: F
Age: 56
State: TX

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 08/13/2021
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: Feeling chills all day; This spontaneous case was reported by an other and describes the occurrence of CHILLS (Feeling chills all day) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041L20A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jan-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage form. On 30-Jan-2021, the patient experienced CHILLS (Feeling chills all day). At the time of the report, CHILLS (Feeling chills all day) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds:

Current Illness:

ID: 1551918
Sex: F
Age: 86
State: MI

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 08/13/2021
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: Itchy at the point of injection; Slight rash at the point of injection; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itchy at the point of injection) and VACCINATION SITE RASH (Slight rash at the point of injection) in an 86-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 206L20A) for COVID-19 vaccination. No medical history was provided by reporter. No concomitant medication reported. On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Jan-2021, the patient experienced VACCINATION SITE PRURITUS (Itchy at the point of injection) and VACCINATION SITE RASH (Slight rash at the point of injection). On 27-Jan-2021, VACCINATION SITE RASH (Slight rash at the point of injection) had resolved. At the time of the report, VACCINATION SITE PRURITUS (Itchy at the point of injection) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant product use was reported. No treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 24-Jun-2021: Additional information added on 24JUN2021 contains non significant information. Patient had concerns about the form and how to provide more information if needed.

Other Meds:

Current Illness:

ID: 1551919
Sex: F
Age:
State:

Vax Date: 01/14/2021
Onset Date: 01/26/2021
Rec V Date: 08/13/2021
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: Erythema, Pruritus

Symptoms: 2 raised bumps on her arm at the injection site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (2 raised bumps on her arm at the injection site) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 14-Jan-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Jan-2021, the patient experienced VACCINATION SITE SWELLING (2 raised bumps on her arm at the injection site). At the time of the report, VACCINATION SITE SWELLING (2 raised bumps on her arm at the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No relevant concomitant medications were reported. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1551920
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/13/2021
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: Reaction to the shot; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE REACTION (Reaction to the shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE REACTION (Reaction to the shot). At the time of the report, VACCINATION SITE REACTION (Reaction to the shot) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1551921
Sex: M
Age: 23
State: NJ

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 08/13/2021
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: Low blood pressure; Swelling on lymph nodes; Fever; Sore arm; Chills; Fast heart beating; This spontaneous case was reported by a consumer and describes the occurrence of HYPOTENSION (Low blood pressure), LYMPHADENOPATHY (Swelling on lymph nodes), PYREXIA (Fever), VACCINATION SITE PAIN (Sore arm) and CHILLS (Chills) in a 23-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Jan-2021, the patient experienced HYPOTENSION (Low blood pressure), LYMPHADENOPATHY (Swelling on lymph nodes), PYREXIA (Fever), VACCINATION SITE PAIN (Sore arm), CHILLS (Chills) and TACHYCARDIA (Fast heart beating). At the time of the report, HYPOTENSION (Low blood pressure), LYMPHADENOPATHY (Swelling on lymph nodes), PYREXIA (Fever), VACCINATION SITE PAIN (Sore arm), CHILLS (Chills) and TACHYCARDIA (Fast heart beating) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In October 2019, COVID-19: Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. No treatment medications were provided.

Other Meds:

Current Illness:

ID: 1551922
Sex: F
Age: 72
State: TX

Vax Date: 01/23/2021
Onset Date: 01/25/2021
Rec V Date: 08/13/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: On 23-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Jan-2021, the patient experienced TENDERNESS (Tenderness), CHILLS (Chills) and LYMPHADENOPATHY (Lymph nodes swelling under the right arm). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] 25-Jan-2021 for Adverse event, at a dose of 500 milligram once a day. At the time of the report, TENDERNESS (Tenderness) and CHILLS (Chills) outcome was unknown and LYMPHADENOPATHY (Lymph nodes swelling under the right arm) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were provided.

Other Meds:

Current Illness:

ID: 1551923
Sex: F
Age: 66
State: CA

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 08/13/2021
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: I got COVID symptoms; Back Ache; Dizzy; Stomach Ache; sore arm; muscle aches; chills; head ache for 2 days; This spontaneous case was reported by a consumer and describes the occurrence of SUSPECTED COVID-19 (I got COVID symptoms), BACK PAIN (Back Ache), DIZZINESS (Dizzy), ABDOMINAL PAIN UPPER (Stomach Ache) and PAIN IN EXTREMITY (sore arm) in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 042L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Jan-2021 at 2:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Jan-2021, the patient experienced SUSPECTED COVID-19 (I got COVID symptoms), BACK PAIN (Back Ache), DIZZINESS (Dizzy), ABDOMINAL PAIN UPPER (Stomach Ache), PAIN IN EXTREMITY (sore arm), MYALGIA (muscle aches), CHILLS (chills) and HEADACHE (head ache for 2 days). On 28-Jan-2021, SUSPECTED COVID-19 (I got COVID symptoms), BACK PAIN (Back Ache), DIZZINESS (Dizzy), ABDOMINAL PAIN UPPER (Stomach Ache), PAIN IN EXTREMITY (sore arm), MYALGIA (muscle aches), CHILLS (chills) and HEADACHE (head ache for 2 days) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were provided No treatment medications were provided

Other Meds:

Current Illness:

ID: 1551924
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/13/2021
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:

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

Symptoms: skin reaction; This spontaneous case was reported by a consumer and describes the occurrence of SKIN REACTION (skin reaction) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included No adverse event (No medical history provided). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage form. On an unknown date, the patient experienced SKIN REACTION (skin reaction). At the time of the report, SKIN REACTION (skin reaction) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment information was provided

Other Meds:

Current Illness:

ID: 1551925
Sex: F
Age:
State: GA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 08/13/2021
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: really tired; stomach issue; really bad cramps; diarrhea; alot of body ache; low grade fever; chills; Freezing; hardly work; cold; This spontaneous case was reported by a consumer and describes the occurrence of FREEZING PHENOMENON (Freezing), GAIT DISTURBANCE (hardly work), FEELING COLD (cold), ABDOMINAL PAIN UPPER (stomach issue) and MUSCLE SPASMS (really bad cramps) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012M20A) for an unknown indication. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product MELATONIN for an unknown indication. Concomitant products included ENALAPRILAT (VASOTEC [ENALAPRILAT]), HYDROCHLOROTHIAZIDE, FAMOTIDINE, APIXABAN (ELIQUIS) and METOPROLOL for an unknown indication. On 26-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient started MELATONIN (unknown route) at an unspecified dose. On 26-Jan-2021, the patient experienced FREEZING PHENOMENON (Freezing), GAIT DISTURBANCE (hardly work), FEELING COLD (cold), MYALGIA (alot of body ache), PYREXIA (low grade fever) and CHILLS (chills). On 31-Jan-2021, the patient experienced ABDOMINAL PAIN UPPER (stomach issue), MUSCLE SPASMS (really bad cramps) and DIARRHOEA (diarrhea). On an unknown date, the patient experienced FATIGUE (really tired). At the time of the report, FREEZING PHENOMENON (Freezing), GAIT DISTURBANCE (hardly work), FEELING COLD (cold), ABDOMINAL PAIN UPPER (stomach issue), MUSCLE SPASMS (really bad cramps), DIARRHOEA (diarrhea), MYALGIA (alot of body ache), PYREXIA (low grade fever), CHILLS (chills) and FATIGUE (really tired) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Other concomitant medications include Vitamin C and Vitamin D. Treatment medications were not provided.

Other Meds: VASOTEC [ENALAPRILAT]; HYDROCHLOROTHIAZIDE; FAMOTIDINE; ELIQUIS; METOPROLOL

Current Illness:

ID: 1551926
Sex: F
Age: 51
State: CA

Vax Date: 01/15/2021
Onset Date: 01/26/2021
Rec V Date: 08/13/2021
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: swelling of a lymph node in my armpit; hard swollen area about 2 inches below the injection site.; This spontaneous case was reported by a consumer and describes the occurrence of LYMPHADENOPATHY (swelling of a lymph node in my armpit) and VACCINATION SITE SWELLING (hard swollen area about 2 inches below the injection site.) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 042L20A) for COVID-19 vaccination. Concomitant products included PARACETAMOL (TYLENOL) and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for an unknown indication. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Jan-2021, the patient experienced LYMPHADENOPATHY (swelling of a lymph node in my armpit) and VACCINATION SITE SWELLING (hard swollen area about 2 inches below the injection site.). At the time of the report, LYMPHADENOPATHY (swelling of a lymph node in my armpit) and VACCINATION SITE SWELLING (hard swollen area about 2 inches below the injection site.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medications were not provided.

Other Meds: TYLENOL; BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]

Current Illness:

ID: 1551927
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/13/2021
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: Tested positive for COVID-19; A Spontaneous report was received from a consumer concerning an unknown-year-old, male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced covid-19. The patient's medical history, was not provided .The Concomitant medications were not reported . On an unknown day , prior to the onset of the events, the patient received their first dose of two planned doses of mRNA-1273 (Lot number: Batch number not provided) intramuscularly in an unknown location for prophylaxis of COVID-19 infection. On an unknown day, patient developed covid-19 positive. No further information was reported. The treatment information was not reported. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event covid-19 was considered as unknown.

Other Meds:

Current Illness:

ID: 1551928
Sex: F
Age: 77
State: AL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 08/13/2021
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: injection site pain and sore arm; This spontaneous case was reported by a consumer and describes the occurrence of INJECTION SITE PAIN (injection site pain and sore arm) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037620A and 011J20A) for COVID-19 vaccination. The patient's past medical history included No adverse event. On 05-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Jan-2021, the patient experienced INJECTION SITE PAIN (injection site pain and sore arm). At the time of the report, INJECTION SITE PAIN (injection site pain and sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. This case was linked to MOD21-021617 (E2B Linked Report).; Sender's Comments: MOD21-021617:Crosslink

Other Meds:

Current Illness:

ID: 1551929
Sex: F
Age: 70
State: NC

Vax Date: 01/14/2021
Onset Date: 01/26/2021
Rec V Date: 08/13/2021
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: Cold chill; This spontaneous case was reported by a patient and describes the occurrence of CHILLS (Cold chill) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 6039K209) for COVID-19 vaccination. The patient's past medical history included Bronchitis. Concurrent medical conditions included Allergy (Allergic to grass and mold.). On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Jan-2021, the patient experienced CHILLS (Cold chill). At the time of the report, CHILLS (Cold chill) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds:

Current Illness:

ID: 1551930
Sex: F
Age: 73
State: NY

Vax Date: 01/17/2021
Onset Date: 01/19/2021
Rec V Date: 08/13/2021
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: Red Rash Near the Injection Site; Hot Rash Near the Injection Site; Fever; Nausea; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of RASH ERYTHEMATOUS (Red Rash Near the Injection Site), VACCINATION SITE WARMTH (Hot Rash Near the Injection Site), PYREXIA (Fever), NAUSEA (Nausea) and FATIGUE (Fatigue) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20-2A) for COVID-19 vaccination. No Medical History information was reported. On 17-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Jan-2021, the patient experienced PYREXIA (Fever), NAUSEA (Nausea) and FATIGUE (Fatigue). On 24-Jan-2021, the patient experienced RASH ERYTHEMATOUS (Red Rash Near the Injection Site) and VACCINATION SITE WARMTH (Hot Rash Near the Injection Site). On 23-Jan-2021, PYREXIA (Fever), NAUSEA (Nausea) and FATIGUE (Fatigue) had resolved. On 28-Jan-2021, RASH ERYTHEMATOUS (Red Rash Near the Injection Site) and VACCINATION SITE WARMTH (Hot Rash Near the Injection Site) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant products use was not provided by the reporter. Patient reported taking Antihistamines, to try and help alleviate the symptoms.

Other Meds:

Current Illness:

ID: 1551931
Sex: F
Age:
State:

Vax Date: 01/18/2021
Onset Date: 01/20/2021
Rec V Date: 08/13/2021
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: severe itching at the site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (severe itching at the site) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Jan-2021, the patient experienced VACCINATION SITE PRURITUS (severe itching at the site). At the time of the report, VACCINATION SITE PRURITUS (severe itching at the site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1551932
Sex: F
Age: 75
State: OK

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 08/13/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Erythema; heart rate > 100 beats per minute; Shortness of breath; Itchy Rash; rash came back at the injection site and ran to the back of the arm., went up to her cheek; Baseball Size Red Hive at injection site, Ran to the back of the arm, Cheek and was itchy; little pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (little pain), RASH PRURITIC (Itchy Rash), RASH (rash came back at the injection site and ran to the back of the arm., went up to her cheek), INJECTION SITE URTICARIA (Baseball Size Red Hive at injection site, Ran to the back of the arm, Cheek and was itchy) and DYSPNOEA (Shortness of breath) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027L20A and 030B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Breast cancer in 2014, Radiation therapy (was treated with radiation for breast cancer) in 2014 and Surgery (had surgery for her breast cancer) in 2014. Concurrent medical conditions included Asthma (she has some asthma issues.), Food allergy (Crab), Penicillin allergy, Drug allergy (Anesthesics) and Drug allergy (versed). Concomitant products included FLUOXETINE HYDROCHLORIDE (PROZAC) for Depression. On 12-Jan-2021 at 2:20 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Apr-2021 at 10:30 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Jan-2021, the patient experienced PAIN (little pain). On 24-Jan-2021, the patient experienced RASH PRURITIC (Itchy Rash) and RASH (rash came back at the injection site and ran to the back of the arm., went up to her cheek). 24-Jan-2021, the patient experienced INJECTION SITE URTICARIA (Baseball Size Red Hive at injection site, Ran to the back of the arm, Cheek and was itchy). On 26-Jan-2021, the patient experienced DYSPNOEA (Shortness of breath). On an unknown date, the patient experienced ERYTHEMA (Erythema) and HEART RATE INCREASED (heart rate > 100 beats per minute). The patient was treated with HYDROCORTISONE (HYDROCORTIZON [HYDROCORTISONE]) (topical) from 18-Jan-2021 to 23-Jan-2021 for Welts, at a dose of 2.5 percent every four hours; HYDROCORTISONE SODIUM SUCCINATE (CORTIZON) (topical) on 26-Jan-2021 at an unspecified dose and frequency; METHYLPREDNISOLONE (MEDROL [METHYLPREDNISOLONE] PAK) on 26-Jan-2021 at an unspecified dose and frequency and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) on 26-Jan-2021 at an unspecified dose and frequency. At the time of the report, PAIN (little pain), RASH PRURITIC (Itchy Rash), RASH (rash came back at the injection site and ran to the back of the arm., went up to her cheek), INJECTION SITE URTICARIA (Baseball Size Red Hive at injection site, Ran to the back of the arm, Cheek and was itchy), DYSPNOEA (Shortness of breath), ERYTHEMA (Erythema) and HEART RATE INCREASED (heart rate > 100 beats per minute) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Depression is caused by death of son at age 41. 03-FEB-2021 armpit lump lasted until end of February and rash going down inner thighs and back. Red welt gone on 23-JAN-2021 and returned larger below injection site elbow, front and back of arm on 24-JAN-2021. Most recent FOLLOW-UP information incorporated above includes: On 23-Jun-2021: General tab-Reporter details added, Patient Tab- Medical history added, Product tab- Concomitant medication and treatment medication, Event Tab- Dates added

Other Meds: PROZAC.

Current Illness: Asthma (she has some asthma issues.); Drug allergy (versed); Drug allergy (Anesthesics); Food allergy (Crab); Penicillin allergy.

ID: 1551933
Sex: F
Age: 84
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 08/13/2021
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: even when try to lay down the arm ,i can not because of the pain, jumpmed on mysleep because I leaned on it; arm is pinkish,; her left arm very swollen; can not move left arm; it is so sore/ it hurts only when moving the arm; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (her left arm very swollen), MOBILITY DECREASED (can not move left arm), PAIN IN EXTREMITY (it is so sore/ it hurts only when moving the arm), LIMB DISCOMFORT (even when try to lay down the arm ,i can not because of the pain, jumpmed on mysleep because I leaned on it) and VACCINATION SITE ERYTHEMA (arm is pinkish,) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030M20A) for COVID-19 vaccination. The patient's past medical history included Cancer (had cancer some years ago, and her doctor told her, not to have vaccines in that arm.). On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Feb-2021, the patient experienced PERIPHERAL SWELLING (her left arm very swollen), MOBILITY DECREASED (can not move left arm), PAIN IN EXTREMITY (it is so sore/ it hurts only when moving the arm) and VACCINATION SITE ERYTHEMA (arm is pinkish,). On 05-Feb-2021, the patient experienced LIMB DISCOMFORT (even when try to lay down the arm ,i can not because of the pain, jumpmed on mysleep because I leaned on it). The patient was treated with PARACETAMOL (TYLENOL) on 04-Feb-2021 for Adverse event following immunisation, at an unspecified dose and frequency. At the time of the report, PERIPHERAL SWELLING (her left arm very swollen), MOBILITY DECREASED (can not move left arm), PAIN IN EXTREMITY (it is so sore/ it hurts only when moving the arm), LIMB DISCOMFORT (even when try to lay down the arm ,i can not because of the pain, jumpmed on mysleep because I leaned on it) and VACCINATION SITE ERYTHEMA (arm is pinkish,) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications taken regularly included sleeping pill at night, iron pill and infusions every 3 weeks for the anemia Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1551934
Sex: F
Age: 65
State: IL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 08/13/2021
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: Tingly on her face; Could not eat.; Every part of her body hurt; Chills; Headache; Nauseous; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 05-Feb-2021 and was forwarded to Moderna on 05-Feb-2021. This spontaneous case was reported by a consumer and describes the occurrence of PARAESTHESIA (Tingly on her face), EATING DISORDER (Could not eat.), PAIN (Every part of her body hurt), CHILLS (Chills) and HEADACHE (Headache) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 03-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Feb-2021, the patient experienced PARAESTHESIA (Tingly on her face), EATING DISORDER (Could not eat.), PAIN (Every part of her body hurt), CHILLS (Chills), HEADACHE (Headache) and NAUSEA (Nauseous). On 03-Feb-2021, PARAESTHESIA (Tingly on her face) had resolved. On 05-Feb-2021, EATING DISORDER (Could not eat.), PAIN (Every part of her body hurt), CHILLS (Chills) and NAUSEA (Nauseous) had resolved. At the time of the report, HEADACHE (Headache) had not resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. Treatment details included Tylenol and Motrin.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm