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

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1604737
Sex: F
Age: 29
State: OH

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: maternal exposure during pregnancy; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of MATERNAL EXPOSURE DURING PREGNANCY (maternal exposure during pregnancy) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 011L20A and 028L20A) for COVID-19 vaccination. Concomitant products included PRENATAL VITAMINS [ASCORBIC ACID;BETACAROTENE;CALCIUM SULFATE;COLECALCIFEROL;CYANOCOBALAMIN;FERROUS FUMARATE;FOLIC ACID;NICOTINAMIDE;PYRIDOXINE HYDROCHLORIDE;RETINOL ACETATE;RIBOFLAVIN;THIAMINE MONONITRATE;TOCOPHERYL ACETATE;ZINC OXIDE] and ESOMEPRAZOLE SODIUM (NEXIUM [ESOMEPRAZOLE SODIUM]) for an unknown indication. On 04-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 04-Jan-2021, the patient experienced MATERNAL EXPOSURE DURING PREGNANCY (maternal exposure during pregnancy). On 04-Jan-2021, MATERNAL EXPOSURE DURING PREGNANCY (maternal exposure during pregnancy) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment details not provided.

Other Meds: PRENATAL VITAMINS [ASCORBIC ACID;BETACAROTENE;CALCIUM SULFATE;COLECALCIFEROL;CYANOCOBALAMIN;FERROUS ; NEXIUM [ESOMEPRAZOLE SODIUM]

Current Illness:

ID: 1604738
Sex: F
Age:
State:

Vax Date: 03/23/2021
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
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Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: This spontaneous case reported by a consumer, describes the occurrence of dizziness, malaise (doesn't feel good overall), urticaria, (neck broke-out and HCP said looked like hives), vaccine virus shedding (took one solid week to get the basic side effects to go away) and vaccine positive re-challenge (gotten basic side effects after getting the vaccine) in a female patient, of an unknown age, who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. The occurrence of additional events detailed below. No medical history reported. On Mar 23, 2021, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On an unknown date, patient experienced dizziness, malaise (doesn't feel good overall), urticaria, (neck broke-out and HCP said looked like hives), vaccine virus shedding (took one solid week to get the basic side effects to go away), vaccine positive re-challenge (gotten basic side effects after getting the vaccine), pain (didn't hurt anymore after 7 days) and rash on her neck. At the time of the report, dizziness, malaise (doesn't feel good overall), urticaria, (neck broke-out and HCP said looked like hives), vaccine virus shedding (took one solid week to get the basic side effects to go away), vaccine positive re-challenge (gotten basic side effects after getting the vaccine), pain (didn't hurt anymore after 7 days) and rash on her neck outcome: unknown. The action taken with mRNA-1273 (Moderna COVID-19 vaccine): unknown. Treatment: topical cream and medication. Reporter did not allow further contact.

Other Meds:

Current Illness:

ID: 1604739
Sex: F
Age: 57
State: NY

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Tinnitus; This spontaneous case was reported by a consumer and describes the occurrence of TINNITUS (Tinnitus) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014M20A) for COVID-19 vaccination. No Medical History information was reported. On 28-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Mar-2021, the patient experienced TINNITUS (Tinnitus). At the time of the report, TINNITUS (Tinnitus) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.

Other Meds:

Current Illness:

ID: 1604740
Sex: F
Age: 34
State: MD

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vaccine administered to pregnant patient; Diarrhea; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient) and DIARRHOEA (Diarrhea) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031M20A and 25A21A) for COVID-19 vaccination. Concurrent medical conditions included Depression. Concomitant products included BUPROPION for Depression, MULTIVITAMINS [VITAMINS NOS] for an unknown indication. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. The patient's last menstrual period was on 04-Jul-2020 and the estimated date of delivery was 23-Apr-2021. On 11-Feb-2021, the patient experienced EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient) and DIARRHOEA (Diarrhea). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the thirty-first week of the pregnancy. On 11-Feb-2021, EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient) had resolved. At the time of the report, DIARRHOEA (Diarrhea) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Treatment information was not provided. Company Comment: This is a case of product exposure during pregnancy with reported AEs, myalgia, fatigue and diarrhea in a 34 year old patient. Patient will be continued to be monitored for further AEs during her pregnancy. This case was linked to US-MODERNATX, INC.-MOD-2021-069796 (E2B Linked Report).; Sender's Comments: This is a case of product exposure during pregnancy with reported AEs, myalgia, fatigue and diarrhea in a 34 year old patient. Patient will be continued to be monitored for further AEs during her pregnancy. US-MODERNATX, INC.-MOD-2021-069796:Second dose case

Other Meds: BUPROPION; MULTIVITAMINS [VITAMINS NOS]

Current Illness: Depression

ID: 1604741
Sex: F
Age: 18
State: MI

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Lethargy; Nausea; This spontaneous case was reported by a consumer and describes the occurrence of LETHARGY (Lethargy) and NAUSEA (Nausea) in an 18-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Family history included COVID-19 (Family had COVID in November 2020.). On 05-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Apr-2021, the patient experienced LETHARGY (Lethargy) and NAUSEA (Nausea). At the time of the report, LETHARGY (Lethargy) and NAUSEA (Nausea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. This case was linked to MOD21-071205, MOD21-071243 (E2B Linked Report).; Sender's Comments: MOD21-071205: MOD21-071243:

Other Meds:

Current Illness:

ID: 1604742
Sex: F
Age: 83
State: MD

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: it felt like really bad acid reflux; weakness; burning sensation; dizziness; vaccination site swelling up; This spontaneous case was reported by a consumer and describes the occurrence of GASTROOESOPHAGEAL REFLUX DISEASE (it felt like really bad acid reflux), ASTHENIA (weakness), BURNING SENSATION (burning sensation), DIZZINESS (dizziness) and VACCINATION SITE SWELLING (vaccination site swelling up) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030B21A) for COVID-19 vaccination. Concomitant products included LOVASTATIN, FLUOXETINE and TRAMADOL for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced VACCINATION SITE SWELLING (vaccination site swelling up). On 07-Apr-2021, the patient experienced GASTROOESOPHAGEAL REFLUX DISEASE (it felt like really bad acid reflux), ASTHENIA (weakness), BURNING SENSATION (burning sensation) and DIZZINESS (dizziness). At the time of the report, GASTROOESOPHAGEAL REFLUX DISEASE (it felt like really bad acid reflux), ASTHENIA (weakness), BURNING SENSATION (burning sensation), DIZZINESS (dizziness) and VACCINATION SITE SWELLING (vaccination site swelling up) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. .

Other Meds: LOVASTATIN; FLUOXETINE; TRAMADOL

Current Illness:

ID: 1604743
Sex: F
Age: 55
State: TX

Vax Date: 03/23/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
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Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: big and itchy rash at the injection site (right arm); big and itchy rash at the injection site (right arm); a bit of pains; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (big and itchy rash at the injection site (right arm)), VACCINATION SITE RASH (big and itchy rash at the injection site (right arm)) and VACCINATION SITE PAIN (a bit of pains) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced VACCINATION SITE PRURITUS (big and itchy rash at the injection site (right arm)), VACCINATION SITE RASH (big and itchy rash at the injection site (right arm)) and VACCINATION SITE PAIN (a bit of pains). At the time of the report, VACCINATION SITE PRURITUS (big and itchy rash at the injection site (right arm)), VACCINATION SITE RASH (big and itchy rash at the injection site (right arm)) and VACCINATION SITE PAIN (a bit of pains) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were not reported. Treatment details not provided. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 08-Jul-2021: Event outcome updated.

Other Meds:

Current Illness:

ID: 1604744
Sex: M
Age:
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: joint pain; felt tired; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (joint pain) and FATIGUE (felt tired) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included AIDS (diagnosed in the 1980s.). In February 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Feb-2021, the patient experienced ARTHRALGIA (joint pain) and FATIGUE (felt tired). At the time of the report, ARTHRALGIA (joint pain) and FATIGUE (felt tired) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. 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: AIDS (diagnosed in the 1980s.)

ID: 1604745
Sex: F
Age: 66
State: IN

Vax Date: 04/13/2021
Onset Date: 05/13/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Bronchitis flare-ups; The inside of her nose is now dry; Puffy, pure soft white sticky balls or "snot"; Aspirin was "tearing her stomach apart".; Hard bump at the injection site; Huge bump at the injection site; Headache; Extreme fatigue; Ringing in the right ear; Left arm was swollen down to her elbow; This spontaneous case was reported by a consumer and describes the occurrence of TINNITUS (Ringing in the right ear), PERIPHERAL SWELLING (Left arm was swollen down to her elbow), BRONCHITIS (Bronchitis flare-ups), NASAL DRYNESS (The inside of her nose is now dry) and NASAL CONGESTION (Puffy, pure soft white sticky balls or "snot") in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036A21A and 016M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Spinal stenosis. Concurrent medical conditions included Knee arthritis (Arthritis in right knee with pain.), Bronchitis, Insulin resistance and Allergic reaction to drug (Allergic to Muscle relaxants.). Concomitant products included VITAMINS NOS for an unknown indication. On 13-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 13-May-2021, the patient experienced TINNITUS (Ringing in the right ear), PERIPHERAL SWELLING (Left arm was swollen down to her elbow), INJECTION SITE INDURATION (Hard bump at the injection site), INJECTION SITE SWELLING (Huge bump at the injection site), HEADACHE (Headache) and FATIGUE (Extreme fatigue). On an unknown date, the patient experienced BRONCHITIS (Bronchitis flare-ups), NASAL DRYNESS (The inside of her nose is now dry), NASAL CONGESTION (Puffy, pure soft white sticky balls or "snot") and ABDOMINAL DISCOMFORT (Aspirin was "tearing her stomach apart".). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] for Pain, at a dose of 1 dosage form. At the time of the report, TINNITUS (Ringing in the right ear), PERIPHERAL SWELLING (Left arm was swollen down to her elbow), BRONCHITIS (Bronchitis flare-ups), NASAL DRYNESS (The inside of her nose is now dry), NASAL CONGESTION (Puffy, pure soft white sticky balls or "snot"), ABDOMINAL DISCOMFORT (Aspirin was "tearing her stomach apart".), INJECTION SITE INDURATION (Hard bump at the injection site) and INJECTION SITE SWELLING (Huge bump at the injection site) outcome was unknown and HEADACHE (Headache) and FATIGUE (Extreme fatigue) had not resolved. Patient has not had to blow her nose ever since the injections. Most recent FOLLOW-UP information incorporated above includes: On 16-Jun-2021: Significant follow-up case appended. Follow-up received on 16-06-2021 contains the significant information such as Medical History, Concomitant Medication, Treatment Medication were updated. Events were also added. On 05-Aug-2021: Follow up received on 05-Aug-2021, no new information was recorded

Other Meds: VITAMINS NOS

Current Illness: Allergic reaction to drug (Allergic to Muscle relaxants.); Bronchitis; Insulin resistance; Knee arthritis (Arthritis in right knee with pain.)

ID: 1604746
Sex: F
Age: 56
State: NM

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: itching; red mark on her shoulder and was burning and itching; the pain and burning felt like a burn; eye was still irritated; like a rash at the injection site; Vaccination site swelling; left aye turned very red; Injection site itching; Cold sweat; Vaccination site pain/ burning at the injection site; nauseas; Dizzy; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (Dizzy), COLD SWEAT (Cold sweat), PRURITUS (itching), ERYTHEMA (red mark on her shoulder and was burning and itching) and PAIN (the pain and burning felt like a burn) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032H20P) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included No adverse event. Concomitant products included ERGOCALCIFEROL (VITAMIN D [ERGOCALCIFEROL]), ZINC and MULTIVITAMINS [VITAMINS NOS] for an unknown indication, FISH OIL, OENOTHERA BIENNIS OIL, TOCOPHERYL ACETATE (OMEGA 3 & 6). On 29-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Mar-2021, the patient experienced DIZZINESS (Dizzy) and NAUSEA (nauseas). On 30-Mar-2021, the patient experienced COLD SWEAT (Cold sweat), INJECTION SITE PRURITUS (Injection site itching) and VACCINATION SITE PAIN (Vaccination site pain/ burning at the injection site). On 01-Apr-2021, the patient experienced OCULAR HYPERAEMIA (left aye turned very red). On 05-Apr-2021, the patient experienced PRURITUS (itching), ERYTHEMA (red mark on her shoulder and was burning and itching), PAIN (the pain and burning felt like a burn), EYE IRRITATION (eye was still irritated), VACCINATION SITE RASH (like a rash at the injection site) and VACCINATION SITE SWELLING (Vaccination site swelling). The patient was treated with ACETAMINOPHEN ongoing since an unknown date at an unspecified dose and frequency. On 06-Apr-2021, OCULAR HYPERAEMIA (left aye turned very red) and EYE IRRITATION (eye was still irritated) outcome was unknown. At the time of the report, DIZZINESS (Dizzy), COLD SWEAT (Cold sweat), PRURITUS (itching), ERYTHEMA (red mark on her shoulder and was burning and itching), PAIN (the pain and burning felt like a burn), INJECTION SITE PRURITUS (Injection site itching), VACCINATION SITE RASH (like a rash at the injection site), NAUSEA (nauseas), VACCINATION SITE PAIN (Vaccination site pain/ burning at the injection site) and VACCINATION SITE SWELLING (Vaccination site swelling) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.

Other Meds: VITAMIN D [ERGOCALCIFEROL]; ZINC; OMEGA 3 & 6; MULTIVITAMINS [VITAMINS NOS]

Current Illness:

ID: 1604747
Sex: F
Age: 78
State: CO

Vax Date: 01/02/2021
Onset Date: 01/01/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: 90 days since her first dose; Got Covid; This spontaneous case was reported by a consumer and describes the occurrence of SARS-COV-2 TEST POSITIVE (Got Covid) and PRODUCT DOSE OMISSION ISSUE (90 days since her first dose) in a 78-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 02-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In January 2021, the patient experienced SARS-COV-2 TEST POSITIVE (Got Covid). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (90 days since her first dose). The patient was treated with BAMLANIVIMAB for Symptomatic treatment, at a dose of 1 dosage form. At the time of the report, SARS-COV-2 TEST POSITIVE (Got Covid) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (90 days since her first dose) had resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not reported. Most recent FOLLOW-UP information incorporated above includes: On 26-Jun-2021: received on 26-JUN-2021 in which No new information

Other Meds:

Current Illness:

ID: 1604748
Sex: F
Age: 57
State: NJ

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: flue like symptoms; Covid19 Positive after first vaccination; Pain at the injection arm; This spontaneous case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (flue like symptoms), SARS-COV-2 TEST POSITIVE (Covid19 Positive after first vaccination) and VACCINATION SITE PAIN (Pain at the injection arm) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030B21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 08-Mar-2021, the patient experienced VACCINATION SITE PAIN (Pain at the injection arm). On 23-Mar-2021, the patient experienced INFLUENZA LIKE ILLNESS (flue like symptoms) and SARS-COV-2 TEST POSITIVE (Covid19 Positive after first vaccination). On 31-Mar-2021, INFLUENZA LIKE ILLNESS (flue like symptoms) had resolved. At the time of the report, SARS-COV-2 TEST POSITIVE (Covid19 Positive after first vaccination) and VACCINATION SITE PAIN (Pain at the injection arm) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Mar-2021, SARS-CoV-2 test: positive Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds:

Current Illness:

ID: 1604749
Sex: F
Age: 67
State: NV

Vax Date: 02/18/2021
Onset Date: 03/18/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Second dose was not applied in the correct interval; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Second dose was not applied in the correct interval) in a 67-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 medical history reported). On 18-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Mar-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Second dose was not applied in the correct interval). On 18-Mar-2021, PRODUCT DOSE OMISSION ISSUE (Second dose was not applied in the correct interval) had resolved. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) dosing remained unchanged. No concomitant medication reported No treatment medication reported

Other Meds:

Current Illness:

ID: 1604750
Sex: F
Age: 48
State: OH

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Anxiety; hands shaking; feeling of weightlessness/feeling of floating; Invalid dose of 1ml of Moderna Vaccine; This spontaneous case was reported by a nurse and describes the occurrence of ANXIETY (Anxiety), TREMOR (hands shaking), FEELING ABNORMAL (feeling of weightlessness/feeling of floating) and ACCIDENTAL OVERDOSE (Invalid dose of 1ml of Moderna Vaccine) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 044A21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concurrent medical conditions included Sulfonamide allergy. On 06-Apr-2021 at 4:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced ANXIETY (Anxiety), TREMOR (hands shaking) and FEELING ABNORMAL (feeling of weightlessness/feeling of floating). 06-Apr-2021, the patient experienced ACCIDENTAL OVERDOSE (Invalid dose of 1ml of Moderna Vaccine). On 06-Apr-2021, ACCIDENTAL OVERDOSE (Invalid dose of 1ml of Moderna Vaccine) had resolved. On 10-Apr-2021, ANXIETY (Anxiety), TREMOR (hands shaking) and FEELING ABNORMAL (feeling of weightlessness/feeling of floating) 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. Treatment information was not provided. This case was linked to MOD21-071039, MOD21-071001, MOD21-070955, MOD21-071038, MOD21-071043, MOD21-071046, MOD21-071048 (E2B Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 26-May-2021: On 26-MAY-2021 a follow up was received, Patient demographics was updated. Batch number of suspect product details was added. Allergic conditions were added. New events were added. Event's start, stop dates and outcome was added. On 22-Jul-2021: A significant follow up was received on 22-JUL-2021 where outcome of the events were updated.; Sender's Comments: This report refers to a case of Accidental overdose, for mRNA-1273, lot # 044A21A, with no associated AEs. MOD21-071039: MOD21-071001: MOD21-070955: MOD21-071038: MOD21-071043: MOD21-071046: MOD21-071048:

Other Meds:

Current Illness: Sulfonamide allergy

ID: 1604751
Sex: F
Age: 44
State: CA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Started to feel Swelling in her throat; Tingling in Tongue; This spontaneous case was reported by a consumer and describes the occurrence of PHARYNGEAL SWELLING (Started to feel Swelling in her throat) and PARAESTHESIA ORAL (Tingling in Tongue) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040A21A) for COVID-19 vaccination. No Medical History information was reported. On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Mar-2021, the patient experienced PHARYNGEAL SWELLING (Started to feel Swelling in her throat) and PARAESTHESIA ORAL (Tingling in Tongue). The patient was treated with DIPHENHYDRAMINE ongoing since an unknown date for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, PHARYNGEAL SWELLING (Started to feel Swelling in her throat) and PARAESTHESIA ORAL (Tingling in Tongue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant drug information was not provided. Treatment information included Benadryl.

Other Meds:

Current Illness:

ID: 1604752
Sex: M
Age: 87
State: ME

Vax Date: 02/12/2021
Onset Date: 03/30/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Dull achy pain to the right side of abdomen; pain radiated to back; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN (Dull achy pain to the right side of abdomen) and BACK PAIN (pain radiated to back) in an 87-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 015M20A and 002P021A) for COVID-19 vaccination. Concomitant products included ATORVASTATIN, APIXABAN (ELIQUIS), LEVOTHYROXINE and DOFETILIDE for an unknown indication. On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Mar-2021, the patient experienced ABDOMINAL PAIN (Dull achy pain to the right side of abdomen) and BACK PAIN (pain radiated to back). The patient was treated with PARACETAMOL (ACETAMINOPHEN EXTRA STRENGTH) ongoing since an unknown date for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, ABDOMINAL PAIN (Dull achy pain to the right side of abdomen) and BACK PAIN (pain radiated to back) outcome was unknown. Not Provided Treatment medication includes: Extra Strength Tylenol. Action taken with mRNA-1273 in response to the event was not applicable.

Other Meds: ATORVASTATIN; ELIQUIS; LEVOTHYROXINE; DOFETILIDE

Current Illness:

ID: 1604753
Sex: F
Age: 52
State: WA

Vax Date: 02/12/2021
Onset Date: 02/16/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: -2021-069799, MOD21-071455 (E2B Linked Report).; Sender's Comments: Rash (neck,behind knee,lower back); sore injection site arm; This spontaneous case was reported by a consumer and describes the occurrence of RASH (Rash (neck,behind knee,lower back)) and VACCINATION SITE PAIN (sore injection site arm) in a 52-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 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Feb-2021, the patient experienced RASH (Rash (neck,behind knee,lower back)) and VACCINATION SITE PAIN (sore injection site arm). At the time of the report, RASH (Rash (neck,behind knee,lower back)) was resolving and VACCINATION SITE PAIN (sore injection site arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. This case was linked to US-MODERNATX, INC.-MOD-2021-069799, MOD21-071455 (E2B Linked Report).; Sender's Comments: US-MODERNATX, INC.-MOD-2021-069799:Case for second dose MOD21-071455:cross linked case

Other Meds:

Current Illness:

ID: 1604754
Sex: F
Age: 34
State: MD

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Body ache; Fatigue; Vaccine administered to pregnant patient; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of MATERNAL EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient), PAIN (Body ache) and FATIGUE (Fatigue) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031M20A and 25A21A) for COVID-19 vaccination. The patient's past medical history included Subfertility (Failed to conceive after a year plus of trying. Referred to fertility clinic for IVF.). Previously administered products included for an unreported indication: MARIJUANA from 2008 to 2013, NICOTINE (1 Pack/day- 3mg 60ml/week) from 2009 to February 2020, PHENCYCLIDINE (Daily) from 2012 to 2013 and TDAP. Concurrent medical conditions included Depression since 2020, Alcohol use (1 drink/week) since 2006 and Allergy to plants. Concomitant products included BUPROPION, MINERALS NOS, VITAMINS NOS (PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]), VITAMIN C [ASCORBIC ACID], VITAMIN D [VITAMIN D NOS] and FEXOFENADINE HYDROCHLORIDE (ALLEGRA) for an unknown indication. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. The patient's last menstrual period was on 04-Jul-2020 and the estimated date of delivery was 23-Apr-2021. On 11-Feb-2021, the patient experienced MATERNAL EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient). On 11-Mar-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PAIN (Body ache) and FATIGUE (Fatigue). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the thirty-first week of the pregnancy. The delivery occurred, which was reported as Full-term. For neonate 1, the birth weight was 4026 grams (8lbs 14oz) with an APGAR score of 7 and 9 at (1, 5 minutes). The outcome was reported as Term Birth w/o Complications. Length- 20 cm, Head circumference- 34.29 cm. On 11-Feb-2021, MATERNAL EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient) had resolved. On 13-Mar-2021, FATIGUE (Fatigue) had resolved. At the time of the report, PAIN (Body ache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In September 2020, Pregnancy test: Positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment medications were not reported. This case was linked to MOD-2021-069764 (Patient Link).

Other Meds: BUPROPION; PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; VITAMIN C [ASCORBIC ACID]; VITAMIN D [VITAMIN D NOS]; ALLEGRA

Current Illness: Alcohol use (1 drink/week); Allergy to plants; Depression

ID: 1604755
Sex: M
Age: 51
State: IL

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: This spontaneous case reported by a consumer, describes the occurrence of decreased appetite (loss of appetite), pain (body aches), pyrexia (fever) and chills in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 vaccine, batch/lot# 031M20A and 039A21A) for COVID-19 immunization. Concomitant products included vitamins (NOS) for an unknown indication. On Mar 4, 2021, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Apr 6, 2021, patient received the second dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On an unknown date, patient experienced decreased appetite (loss of appetite), pain (body aches), pyrexia (fever) and chills. At the time of the report, decreased appetite (loss of appetite), pain (body aches), pyrexia (fever) and chills outcome: unknown.

Other Meds: Vitamins (NOS)

Current Illness:

ID: 1604756
Sex: F
Age: 66
State: GA

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: joint pain; chills; fever; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (joint pain), CHILLS (chills) and PYREXIA (fever) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-Apr-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) (unknown route) 1 dosage form. On an unknown date, the patient experienced ARTHRALGIA (joint pain), CHILLS (chills) and PYREXIA (fever). At the time of the report, ARTHRALGIA (joint pain), CHILLS (chills) and PYREXIA (fever) outcome was unknown. Patient typically has joint pain and took tramadol and meloxicam. Concomitant product use was not provided by the reporter.

Other Meds:

Current Illness:

ID: 1604757
Sex: F
Age: 89
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Weakness in both lower limbs; Could not stand up; Hurts in both thighs, hip joints and knee joints.; Hurts in both thighs, hip joints and knee joints.; This spontaneous case was reported by a consumer and describes the occurrence of MUSCULAR WEAKNESS (Weakness in both lower limbs), LIMB DISCOMFORT (Could not stand up), PAIN IN EXTREMITY (Hurts in both thighs, hip joints and knee joints.) and ARTHRALGIA (Hurts in both thighs, hip joints and knee joints.) in an 89-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036A21A) for COVID-19 vaccination. The patient's past medical history included No adverse event. Concomitant products included Blood pressure pill for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Apr-2021, the patient experienced MUSCULAR WEAKNESS (Weakness in both lower limbs), LIMB DISCOMFORT (Could not stand up), PAIN IN EXTREMITY (Hurts in both thighs, hip joints and knee joints.) and ARTHRALGIA (Hurts in both thighs, hip joints and knee joints.). At the time of the report, MUSCULAR WEAKNESS (Weakness in both lower limbs), LIMB DISCOMFORT (Could not stand up), PAIN IN EXTREMITY (Hurts in both thighs, hip joints and knee joints.) and ARTHRALGIA (Hurts in both thighs, hip joints and knee joints.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No treatment medications were reported.

Other Meds: Blood pressure pill

Current Illness:

ID: 1604758
Sex: F
Age:
State: GA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Fever; pain on the injection site; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever) and VACCINATION SITE PAIN (pain on the injection site) 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. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Apr-2021, the patient experienced PYREXIA (Fever) and VACCINATION SITE PAIN (pain on the injection site). The patient was treated with PARACETAMOL (TYLENOL) at a dose of 1 dosage form. At the time of the report, PYREXIA (Fever) and VACCINATION SITE PAIN (pain on the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were reported.

Other Meds:

Current Illness:

ID: 1604759
Sex: F
Age: 64
State: NV

Vax Date: 03/20/2021
Onset Date: 03/25/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: producing a lot of gas in stomach and chest; does not want to eat; indigestion; producing a lot of gas in stomach and chest; This spontaneous case was reported by a consumer and describes the occurrence of DYSPEPSIA (indigestion), CHEST DISCOMFORT (producing a lot of gas in stomach and chest), FLATULENCE (producing a lot of gas in stomach and chest) and DECREASED APPETITE (does not want to eat) in a 64-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 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Mar-2021, the patient experienced DYSPEPSIA (indigestion), CHEST DISCOMFORT (producing a lot of gas in stomach and chest) and DECREASED APPETITE (does not want to eat). On an unknown date, the patient experienced FLATULENCE (producing a lot of gas in stomach and chest). At the time of the report, DYSPEPSIA (indigestion), CHEST DISCOMFORT (producing a lot of gas in stomach and chest) and DECREASED APPETITE (does not want to eat) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant and treatment medications were reported.

Other Meds:

Current Illness:

ID: 1604760
Sex: F
Age: 53
State: FL

Vax Date: 03/11/2021
Onset Date: 03/14/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: lymph nodes swollen on left side; can barely lift head; hot arm; it hurts a lot; headaches; very tired; nausea; This spontaneous case was reported by a consumer and describes the occurrence of LYMPHADENOPATHY (lymph nodes swollen on left side), HEAD DISCOMFORT (can barely lift head), FEELING HOT (hot arm), PAIN (it hurts a lot) and HEADACHE (headaches) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 024M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 11-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Mar-2021, the patient experienced LYMPHADENOPATHY (lymph nodes swollen on left side), HEAD DISCOMFORT (can barely lift head), FEELING HOT (hot arm), PAIN (it hurts a lot), HEADACHE (headaches), FATIGUE (very tired) and NAUSEA (nausea). At the time of the report, LYMPHADENOPATHY (lymph nodes swollen on left side), HEAD DISCOMFORT (can barely lift head), FEELING HOT (hot arm), PAIN (it hurts a lot), HEADACHE (headaches), FATIGUE (very tired) and NAUSEA (nausea) 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 by the reporter. No Treatment history was provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 24-May-2021: Significant FU - Update of event still ongoing / Denied further FU.

Other Meds:

Current Illness:

ID: 1604761
Sex: F
Age:
State: VA

Vax Date:
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: rash that ended up in shingles; rash that ended up in shingles; This spontaneous case was reported by a consumer and describes the occurrence of HERPES ZOSTER (rash that ended up in shingles) and RASH (rash that ended up in shingles) 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. 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 HERPES ZOSTER (rash that ended up in shingles) and RASH (rash that ended up in shingles). At the time of the report, HERPES ZOSTER (rash that ended up in shingles) and RASH (rash that ended up in shingles) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant and treatment medications were reported.

Other Meds:

Current Illness:

ID: 1604762
Sex: F
Age: 48
State: MI

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: bump, swelling; twitching right arm; psoriasis, legs, feet elbow, back, arms; pain at injection site right arm; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (bump, swelling), MUSCLE TWITCHING (twitching right arm), PSORIASIS (psoriasis, legs, feet elbow, back, arms) and VACCINATION SITE PAIN (pain at injection site right arm) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025B21A) for COVID-19 vaccination. The patient's past medical history included No adverse event. On 26-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Mar-2021, the patient experienced PERIPHERAL SWELLING (bump, swelling), MUSCLE TWITCHING (twitching right arm), PSORIASIS (psoriasis, legs, feet elbow, back, arms) and VACCINATION SITE PAIN (pain at injection site right arm). On 28-Mar-2021, PERIPHERAL SWELLING (bump, swelling) and VACCINATION SITE PAIN (pain at injection site right arm) outcome was unknown. At the time of the report, MUSCLE TWITCHING (twitching right arm) and PSORIASIS (psoriasis, legs, feet elbow, back, arms) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant and treatment medications were reported.

Other Meds:

Current Illness:

ID: 1604763
Sex: M
Age: 34
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Lump on clavicle that hurt; Arm hurt more; Pain at site of injection; Headache; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of MASS (Lump on clavicle that hurt), PAIN (Arm hurt more), VACCINATION SITE PAIN (Pain at site of injection), HEADACHE (Headache) and FATIGUE (Fatigue) in a 34-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016B21A) for COVID-19 vaccination. No Medical History information was reported. On 31-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 31-Mar-2021, the patient experienced PAIN (Arm hurt more), VACCINATION SITE PAIN (Pain at site of injection), HEADACHE (Headache) and FATIGUE (Fatigue). On 03-Apr-2021, the patient experienced MASS (Lump on clavicle that hurt). On 02-Apr-2021, PAIN (Arm hurt more), VACCINATION SITE PAIN (Pain at site of injection), HEADACHE (Headache) and FATIGUE (Fatigue) had resolved. At the time of the report, MASS (Lump on clavicle that hurt) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported by the reporter. On 26-Jun-2021, the patient reported that he still have the lump, it still hurt and he just wanted it to heal and go away. Treatment medication was not provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 26-Jun-2021: Follow up received on 26-Jun-2021 contain significant information: outcome of the event mass changed from unknown to not recovered.

Other Meds:

Current Illness:

ID: 1604764
Sex: F
Age: 83
State: KY

Vax Date: 03/09/2021
Onset Date: 04/07/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: it's a little red, dark pink, feels hot, it's swollen a little bit too; it's a little red, dark pink, feels hot, it's swollen a little bit too; it's a little red, dark pink, feels hot, it's swollen a little bit too; it's a little red, dark pink, feels hot, it's swollen a little bit too; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE DISCOLOURATION (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE WARMTH (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE SWELLING (it's a little red, dark pink, feels hot, it's swollen a little bit too) and VACCINATION SITE ERYTHEMA (it's a little red, dark pink, feels hot, it's swollen a little bit too) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 021B21A and 030A21A) for COVID-19 vaccination. No Medical History information was reported. On 09-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 07-Apr-2021, the patient experienced VACCINATION SITE DISCOLOURATION (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE WARMTH (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE SWELLING (it's a little red, dark pink, feels hot, it's swollen a little bit too) and VACCINATION SITE ERYTHEMA (it's a little red, dark pink, feels hot, it's swollen a little bit too). At the time of the report, VACCINATION SITE DISCOLOURATION (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE WARMTH (it's a little red, dark pink, feels hot, it's swollen a little bit too), VACCINATION SITE SWELLING (it's a little red, dark pink, feels hot, it's swollen a little bit too) and VACCINATION SITE ERYTHEMA (it's a little red, dark pink, feels hot, it's swollen a little bit too) had not resolved. Action taken with mRNA-1273 in response to the events was not applicable. No concomitant medications provided No treatment medications provided

Other Meds:

Current Illness:

ID: 1604765
Sex: F
Age: 70
State: MI

Vax Date: 03/05/2021
Onset Date: 03/08/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: itching; Shingles; This spontaneous case was reported by a consumer and describes the occurrence of HERPES ZOSTER (Shingles) and PRURITUS (itching) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 010A21A and 025B21A) for COVID-19 vaccination. Previously administered products included for an unreported indication: VARICELLA ZOSTER VACCINE in 2020. On 05-Mar-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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Mar-2021, the patient experienced HERPES ZOSTER (Shingles). On 03-Apr-2021, the patient experienced PRURITUS (itching). At the time of the report, HERPES ZOSTER (Shingles) and PRURITUS (itching) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications provided Treatment medication includes Benadryl This case was linked to US-MODERNATX, INC.-MOD-2021-069802 (E2B Linked Report).; Sender's Comments: US-MODERNATX, INC.-MOD-2021-069802:CROSS LINKED WITH DOSE 2

Other Meds:

Current Illness:

ID: 1604766
Sex: F
Age: 34
State: MD

Vax Date: 02/11/2021
Onset Date: 03/11/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Vaccine administered to pregnant patient; Body ache; Fatigue; This spontaneous prospective pregnancy case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient), PAIN (Body ache) and FATIGUE (Fatigue) in a 35-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. :25A21A and 031M20A) for COVID-19 vaccination. Concomitant products included BUPROPION for Depression, MULTIVITAMINS & MINERALS PLUS LUTEIN for an unknown indication. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. The patient's last menstrual period was on 04-Jul-2020 and the estimated date of delivery was 23-Apr-2021. On 11-Mar-2021, the patient experienced EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient), PAIN (Body ache) and FATIGUE (Fatigue). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the thirty-fifth week of the pregnancy. On 11-Mar-2021, EXPOSURE DURING PREGNANCY (Vaccine administered to pregnant patient) had resolved. At the time of the report, PAIN (Body ache) and FATIGUE (Fatigue) outcome was unknown. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Action taken with mRNA-1273 in response to the events was not applicable. No treatment medications were reported. This case was linked to MOD-2021-069764, US-MODERNATX, INC.-MOD-2021-069764 (E2B Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 07-Apr-2021: Internal review on 23-JUL-2021 resulted in update of Prospective, Birth type and fetal outcome; Sender's Comments: MOD-2021-069764:First dose case US-MODERNATX, INC.-MOD-2021-069764:Second dose case

Other Meds: BUPROPION; MULTIVITAMINS & MINERALS PLUS LUTEIN

Current Illness:

ID: 1604767
Sex: F
Age: 45
State: CA

Vax Date: 03/27/2021
Onset Date: 04/03/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: knot under the skin about the size of an egg-getting bigger at injection site; burning at injection site; hot at injection site; itchy area at injection site; red area at injection site; burning at injection site; swollen at injection site; This spontaneous case was reported by a consumer and describes the occurrence of NODULE (knot under the skin about the size of an egg-getting bigger at injection site), SKIN BURNING SENSATION (burning at injection site), VACCINATION SITE WARMTH (hot at injection site), VACCINATION SITE PRURITUS (itchy area at injection site) and VACCINATION SITE ERYTHEMA (red area at injection site) in a 45-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 27-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Apr-2021, the patient experienced NODULE (knot under the skin about the size of an egg-getting bigger at injection site), SKIN BURNING SENSATION (burning at injection site), VACCINATION SITE WARMTH (hot at injection site), VACCINATION SITE PRURITUS (itchy area at injection site), VACCINATION SITE ERYTHEMA (red area at injection site), VACCINATION SITE PAIN (burning at injection site) and VACCINATION SITE SWELLING (swollen at injection site). The patient was treated with RANITIDINE HYDROCHLORIDE (ZANTAC) on 05-Apr-2021 at a dose of UNK, bid and TRIAMCINOLONE (topical) on 05-Apr-2021 for Allergic reaction, at a dose of UNK, bid. At the time of the report, NODULE (knot under the skin about the size of an egg-getting bigger at injection site), SKIN BURNING SENSATION (burning at injection site), VACCINATION SITE WARMTH (hot at injection site), VACCINATION SITE PRURITUS (itchy area at injection site), VACCINATION SITE ERYTHEMA (red area at injection site), VACCINATION SITE PAIN (burning at injection site) and VACCINATION SITE SWELLING (swollen at injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications provided

Other Meds:

Current Illness:

ID: 1604768
Sex: M
Age: 45
State: NC

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: sore arm/pain in his left arm when he holds it parallel to the floor; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032L20A) 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 21-Jan-2021, the patient experienced PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor). At the time of the report, PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Apr-2021, COVID-19: positive (Positive) positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. It was reported that take Tylenol and Flonase for his symptoms. This case was linked to MOD-2021-069807, US-MODERNATX, INC.-MOD-2021-069883 (E2B Linked Report).; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. MOD-2021-069807:Second dose case US-MODERNATX, INC.-MOD-2021-069883:Crosslinked (First dose)

Other Meds:

Current Illness:

ID: 1604769
Sex: F
Age: 52
State: WA

Vax Date: 02/12/2021
Onset Date: 03/12/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: body aches; no appetite; chills; nausea; headaches; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (body aches), DECREASED APPETITE (no appetite), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headaches) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040A21A and 042L20A) for COVID-19 vaccination. No Medical History information was reported. On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 12-Mar-2021, the patient experienced PAIN (body aches), DECREASED APPETITE (no appetite), CHILLS (chills), NAUSEA (nausea) and HEADACHE (headaches). At the time of the report, PAIN (body aches), DECREASED APPETITE (no appetite), NAUSEA (nausea) and HEADACHE (headaches) was resolving and CHILLS (chills) outcome was unknown. Action taken with mRNA-1273 in response to the events was not Applicable. Concomitant and treatment information not provided This case was linked to US-MODERNATX, INC.-MOD-2021-069782 (E2B Linked Report).; Sender's Comments: US-MODERNATX, INC.-MOD-2021-069782:Case for first dose

Other Meds:

Current Illness:

ID: 1604770
Sex: M
Age: 36
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: arm soreness; mild headache; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (arm soreness) and HEADACHE (mild headache) in a 35-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LAMOTRIGINE (LAMICTAL) and GLIMEPIRIDE for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced PAIN IN EXTREMITY (arm soreness) and HEADACHE (mild headache). At the time of the report, PAIN IN EXTREMITY (arm soreness) and HEADACHE (mild headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Most recent FOLLOW-UP information incorporated above includes: On 25-Jun-2021: follow-up received with no new information

Other Meds: LAMICTAL; GLIMEPIRIDE

Current Illness:

ID: 1604771
Sex: F
Age: 67
State: FL

Vax Date: 03/02/2021
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: UTI; This spontaneous case was reported by a consumer and describes the occurrence of URINARY TRACT INFECTION (UTI) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 02-Mar-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced URINARY TRACT INFECTION (UTI). At the time of the report, URINARY TRACT INFECTION (UTI) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1604772
Sex: F
Age: 70
State: MI

Vax Date: 03/05/2021
Onset Date: 04/03/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: itching everywhere-- nose,head, hands, vagina and "just everywhere"; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (itching everywhere-- nose,head, hands, vagina and "just everywhere") in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 025B21A and 010A21A) for COVID-19 vaccination. The patient's past medical history included Shingles (The patient reported that for years, every year in April she gets shingles. In 2021, she got shingles in the early part of march (08-Mar-2021)). Previously administered products included for Herpes zoster: Shingles (September/ October 2020.) in October 2019. On 05-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 03-Apr-2021, the patient experienced PRURITUS (itching everywhere-- nose,head, hands, vagina and "just everywhere"). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, PRURITUS (itching everywhere-- nose,head, hands, vagina and "just everywhere") had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) negative (tests were done twice, both negative). Concomitant medications were not reported. On 03-Apr-2021, it was reported that the patient experienced itching, which started out as mild and then worsened. She reported that the she never had history of prior itching like the present which lasted so long. The patient reported that she did not have rash. This case was linked to US-MODERNATX, INC.-MOD-2021-069795 (E2B Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 17-May-2021: E-mail received includes no new information On 17-May-2021: Email received and included confirmation of previously reported event," itching" after the second dose of vaccine administration, outcome of event that it lasted for one week, doctor visit for medicines, no history of covid-19 infection with two negative Covid-19 tests. On 20-May-2021: Follow up was received included event was resolved. On 25-Jun-2021: Follow up received and added shingles shot date in medical history and treatment received yes for event itching; Sender's Comments: US-MODERNATX, INC.-MOD-2021-069795:CROSS LINKED WITH DOSE 1

Other Meds:

Current Illness:

ID: 1604773
Sex: F
Age: 66
State: MA

Vax Date: 03/29/2021
Onset Date: 04/06/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Painful Left Thumb; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Painful Left Thumb) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 021B21A) for COVID-19 vaccination. Concurrent medical conditions included Arthritis. On 29-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced PAIN IN EXTREMITY (Painful Left Thumb). The patient was treated with STEROIDS at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Painful Left Thumb) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Patient had a history of thumb problems. No concomitant medication information was provided. .

Other Meds:

Current Illness: Arthritis

ID: 1604774
Sex: F
Age: 69
State: TX

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pain only worsened; she woke up with a UTI; tendonitis; pain in her entire arm and tendons of the muscle; pain; minor arm pains started in her elbow down to her wrist in the muscles; minor arm pains started in her elbow down to her wrist in the muscles; little red spot; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of TENDONITIS (tendonitis), URINARY TRACT INFECTION (she woke up with a UTI), ERYTHEMA (little red spot), PAIN IN EXTREMITY (minor arm pains started in her elbow down to her wrist in the muscles) and PAIN (pain) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included UTI. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Mar-2021, the patient experienced ERYTHEMA (little red spot). On 21-Mar-2021, the patient experienced PAIN IN EXTREMITY (minor arm pains started in her elbow down to her wrist in the muscles) and MYALGIA (minor arm pains started in her elbow down to her wrist in the muscles). On 22-Mar-2021, the patient experienced PAIN (pain). On 23-Mar-2021, the patient experienced TENDON PAIN (pain in her entire arm and tendons of the muscle). On 24-Mar-2021, the patient experienced TENDONITIS (tendonitis). On an unknown date, the patient experienced URINARY TRACT INFECTION (she woke up with a UTI) and PAIN (pain only worsened). The patient was treated with CIPROFLOXACIN for UTI, at an unspecified dose and frequency and IBUPROFEN (ADVIL 12 HOUR) on 24-Mar-2021 at an unspecified dose and frequency. At the time of the report, TENDONITIS (tendonitis), URINARY TRACT INFECTION (she woke up with a UTI), ERYTHEMA (little red spot), PAIN IN EXTREMITY (minor arm pains started in her elbow down to her wrist in the muscles), PAIN (pain), TENDON PAIN (pain in her entire arm and tendons of the muscle), PAIN (pain only worsened) and MYALGIA (minor arm pains started in her elbow down to her wrist in the muscles) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications provided Treatment medication includes rovastatin shot .

Other Meds:

Current Illness: UTI

ID: 1604775
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Tinnitus; This spontaneous case was reported by a nurse and describes the occurrence of TINNITUS (Tinnitus) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced TINNITUS (Tinnitus). At the time of the report, TINNITUS (Tinnitus) outcome was unknown. 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 provided No treatment medications provided This case was linked to MOD21-071007 (Linked Report).; Sender's Comments: MOD21-071007:

Other Meds:

Current Illness:

ID: 1604776
Sex: M
Age: 45
State: NC

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: tested positive for COVID-19; Tiredness; sore arm/pain in his left arm when he holds it parallel to the floor; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor), SARS-COV-2 TEST POSITIVE (tested positive for COVID-19) and FATIGUE (Tiredness) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013M20A and 032L20A) for COVID-19 vaccination. The patient's past medical history included No adverse event. On 21-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Jan-2021, the patient experienced PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor). On 17-Feb-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced FATIGUE (Tiredness). On 05-Apr-2021, the patient experienced SARS-COV-2 TEST POSITIVE (tested positive for COVID-19). On 18-Feb-2021, FATIGUE (Tiredness) had resolved. At the time of the report, PAIN IN EXTREMITY (sore arm/pain in his left arm when he holds it parallel to the floor) outcome was unknown and SARS-COV-2 TEST POSITIVE (tested positive for COVID-19) had resolved. Patient was told to take Tylenol and Flonase for his symptoms This case was linked to MOD-2021-069798, US-MODERNATX, INC.-MOD-2021-069883 (E2B Linked Report).; Sender's Comments: MOD-2021-069798:First dose case US-MODERNATX, INC.-MOD-2021-069883:Crosslinked (second dose)

Other Meds:

Current Illness:

ID: 1604777
Sex: F
Age: 53
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 08/21/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: fingers and toes tingle/feel numb; fingers and toes tingle/feel numb; tongue felt like it was vibrating/itching; tongue felt like it was vibrating/itching; lips felt like pins and needles; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of VIBRATORY SENSE INCREASED (tongue felt like it was vibrating/itching), LIP PAIN (lips felt like pins and needles), PARAESTHESIA (fingers and toes tingle/feel numb), TONGUE PRURITUS (tongue felt like it was vibrating/itching) and HYPOAESTHESIA (fingers and toes tingle/feel numb) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Mar-2021, the patient experienced VIBRATORY SENSE INCREASED (tongue felt like it was vibrating/itching) and LIP PAIN (lips felt like pins and needles). 18-Mar-2021, the patient experienced TONGUE PRURITUS (tongue felt like it was vibrating/itching). On 28-Mar-2021, the patient experienced PARAESTHESIA (fingers and toes tingle/feel numb) and HYPOAESTHESIA (fingers and toes tingle/feel numb). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) at an unspecified dose and frequency and OMEPRAZOLE (PRILOSEC [OMEPRAZOLE]) at an unspecified dose and frequency. At the time of the report, VIBRATORY SENSE INCREASED (tongue felt like it was vibrating/itching), LIP PAIN (lips felt like pins and needles), PARAESTHESIA (fingers and toes tingle/feel numb), TONGUE PRURITUS (tongue felt like it was vibrating/itching) and HYPOAESTHESIA (fingers and toes tingle/feel numb) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 16-Jun-2021: TCR added

Other Meds:

Current Illness:

ID: 1604778
Sex: M
Age: 47
State: FL

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 08/21/2021
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Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: diarrhea; fever; has chills; is vomiting; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (diarrhea), PYREXIA ( fever), CHILLS ( has chills) and VOMITING ( is vomiting) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002B21A) for COVID-19 vaccination. Concomitant products included VITAMIN B NOS, VITAMIN E NOS, FISH OIL;VITAMINS NOS and MULTIVITAMINS, PLAIN for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Apr-2021, the patient experienced DIARRHOEA (diarrhea), PYREXIA (fever), CHILLS (has chills) and VOMITING (is vomiting). At the time of the report, DIARRHOEA (diarrhea), PYREXIA (fever), CHILLS (has chills) and VOMITING ( is vomiting) 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. No Treatment medication was provided.

Other Meds: VITAMIN B NOS; VITAMIN E NOS; FISH OIL;VITAMINS NOS; MULTIVITAMINS, PLAIN

Current Illness:

ID: 1605715
Sex: F
Age: 51
State:

Vax Date: 08/16/2021
Onset Date: 08/21/2021
Rec V Date: 08/21/2021
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Allergies: PCN Aspirin Iodine contrast

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

Symptoms: Sudden loss of hearing with extreme tinnitus.

Other Meds: none

Current Illness: none

ID: 1605716
Sex: M
Age: 60
State: VA

Vax Date: 03/16/2021
Onset Date: 05/01/2021
Rec V Date: 08/21/2021
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Allergies: None

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

Symptoms: Increase in skin reactions. Eczema (face, ears, neck), hives (leg, air pits); increased allergies (stuffy nose, sinuses) Ear infection (possibly caused by eczema)

Other Meds: irbesartan, Zyrtec, Vitamin D

Current Illness: None

ID: 1605717
Sex: F
Age: 40
State: NJ

Vax Date: 06/23/2021
Onset Date: 06/24/2021
Rec V Date: 08/21/2021
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Allergies: Past allergy to mango and banana; no reactions in recent years

Symptom List: Vomiting

Symptoms: Hives - first outbreak on arm the day after my 2nd dose, June 24th. Went to urgent care, was given Zyrtec Approximately a week later and ongoing, sporadic pains in hands and feet with red spots, often times crippling depending on site. Pain varies from a few hours to a few days. Occasional hives on skin on arms, legs and stomach. Multiple trips to primary in person and virtual. Sent for blood work & CT Scan. Pain in feet was so extreme recently went to ER and had leg ultrasound to rule out blood clots. Dx with hives.

Other Meds: None

Current Illness: None

ID: 1605718
Sex: F
Age: 55
State: IN

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 08/21/2021
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Allergies: Ceftin, Amaoxicillin, Nitrofuratoin, Wellbutrin, Steroid Responder

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Within ten minutes, I had pins and needles in my left hand. Within fifteen minutes, I had trigeminal neuralgia in my right cheek. Next morning, I had bruises all over my upper legs, arms, and breasts. Bruising issues lasted almost a month, and I was instructed by my PCP to stop ALL NSAIDS and any other meds that thin the blood. Within the next two weeks, I had two blood clots in my left leg after a VERY minor bump from my dog. The lump kept getting bigger, and it got the size of half a baseball until I stopped it from growing by the application of ice. Next day, I went to get out of bed, and my leg gave out on me when I went to get out of bed. I could not use it at all to walk due to weakness in the leg and pain at the sight of swelling. I put heat on it for twenty minutes, and it reduced swelling by half. Still had difficulty walking remainder of day. Put heat on it again in the evening, and the remainder of swelling disappeared. When I woke up the next morning, it was black from massive bruising. Dog bumped into me again a couple of days later, and another clot formed, and I repeated whathappenened as stated above. Two weeks after vaccination, I bumped my head on counter, and again, I got a bleed that did not want to stop. Had seizure like episode with my tongue hanging out and my left side of face was drooping.

Other Meds: Levothyroxine, Atorvostatin, Clonazapam, Donepezil, Baclofin, Venlafaxine, Atrovent, Ibuprophin, D3, Multi, Milk Thistle, Magnesium, B/C. Tumeric

Current Illness: Behcet's, Hashimotos

ID: 1605719
Sex: F
Age: 37
State: WA

Vax Date: 08/04/2021
Onset Date: 08/05/2021
Rec V Date: 08/21/2021
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Allergies: None

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

Symptoms: Started cramping the next day in stomach with it centered around left pelvic area. I left camping and by Saturday and Sunday it worsened in my pelvic area and could only sleep in certain positions. By the time I got home on Sunday it was to the point it would sharp shooting pains in left pelvic area, hurt to sleep and couldn?t stand upright fully, had to love slowly so called to make an appt and they got me in on Tuesday. By then it was slowly starting to get better

Other Meds: None

Current Illness: None

ID: 1605720
Sex: F
Age: 69
State: PA

Vax Date: 08/01/2021
Onset Date: 08/21/2021
Rec V Date: 08/21/2021
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Allergies: Sulphur

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sore Arm Chills Fatigue Fever 102.

Other Meds: AMLODOPINE BENSYLATE SYTHROID

Current Illness: Chronic Lymphatic Leukemia

ID: 1605722
Sex: F
Age: 56
State: IN

Vax Date: 01/28/2021
Onset Date: 03/27/2021
Rec V Date: 08/21/2021
Hospital: Y

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Allergies: NKA

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

Symptoms: Transverse Myelitis requiring IV solumedrol 1000 mg daily x 5 days then 32 mg oral BID weaning by 4 mg daily until off (last dose 4/20/21) Hospitalized x 12 days including rehab being discharged with a walker and previously fully ambulatory 8 weeks physical therapy Off work x 7 weeks Continue to require muscle relaxer at HS Effect to right leg with tightness, numbness to right axilla and side, pain at T1 area to right anterior and posterior, gait effected , but improving with no support Confirmed was not MS Treated for Guillain Barre post flu vaccine in 2013

Other Meds: Vitamin C 500 Daily Multiple vitamin daily Calcium with vitamin D daily Claritin 10 mg daily

Current Illness:

ID: 1605723
Sex: M
Age: 73
State: WA

Vax Date: 03/06/2021
Onset Date: 03/10/2021
Rec V Date: 08/21/2021
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Allergies: N/A

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

Symptoms: Woke up in the morning on March 10, 2021 with asthma symptoms. It continued through the day. Barely able to control with antihistamines and continuous usage of the antihistamines. Saw an allergist approximately March 20, 2021 because the asthma was constant. Doctor did pulse oximeter reading, listened to lungs, sent me home with inhalers. Inhalers helped take the edge off, but certainly did not cure the asthma symptoms, was slightly improving. Had the 2nd shot 3/27/21, and symptoms got worse again. Asthma continued for another several weeks; continued round the clock antihistamines and inhalers.

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am