VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

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

COVID19 Lot Number

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

Incidents per State

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

ID: 1627588
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: my arm my left side of my body this is not normal,this is so very painful; chills; fever; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (my arm my left side of my body this is not normal,this is so very painful), CHILLS (chills) and PYREXIA (fever) in a patient of an unknown age and gender 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 MYALGIA (my arm my left side of my body this is not normal,this is so very painful), CHILLS (chills) and PYREXIA (fever). At the time of the report, MYALGIA (my arm my left side of my body this is not normal,this is so very painful), CHILLS (chills) and PYREXIA (fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant information provided. Patient had vaccine shot over 2 weeks ago. No treatment information provided.

Other Meds:

Current Illness:

ID: 1627589
Sex: F
Age:
State: NY

Vax Date: 06/11/2021
Onset Date:
Rec V Date: 08/24/2021
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: This spontaneous case reported by a consumer, describes the occurrence of peripheral swelling (arm is swollen), pain in extremity (arm has broken out a little bit), inappropriate schedule of product administration (first dose in November 2020; second dose on June 11, 2021) and rash on the arm in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. No medical history reported. Concomitant products included potassium and vitamins (NOS) for an unknown indication. November 2020, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), intramuscular; 1 dosage form. On Jun 11, 2021, patient received the second dose of mRNA-1273 (Moderna COVID-19 vaccine), intramuscular: unknown. On an unknown date, patient had peripheral swelling (arm is swollen), pain in extremity (arm has broken out a little bit), inappropriate schedule of product administration (first dose in November 2020; second dose on June 11, 2021) and rash on the arm. At the time of the report, peripheral swelling (arm is swollen), pain in extremity (arm has broken out a little bit) and rash on the arm outcome: unknown; and inappropriate schedule of product administration (first dose in November 2020; second dose on June 11, 2021) resolved. For the swelling on her arm, she used an icepack as a treatment. This case linked to MOD-2021-220945 (patient link).

Other Meds: Potassium; vitamins (NOS)

Current Illness:

ID: 1627590
Sex: M
Age:
State: CA

Vax Date: 06/11/2021
Onset Date: 06/12/2021
Rec V Date: 08/24/2021
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: sweating; his stomach hurt if he ate or drank anything/Stomach hurting a bit; had a really high fever/Still has fever; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN UPPER (his stomach hurt if he ate or drank anything/Stomach hurting a bit), HYPERHIDROSIS (sweating) and PYREXIA (had a really high fever/Still has fever) 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 11-Jun-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Jun-2021, the patient experienced PYREXIA (had a really high fever/Still has fever). On 13-Jun-2021, the patient experienced ABDOMINAL PAIN UPPER (his stomach hurt if he ate or drank anything/Stomach hurting a bit). On 14-Jun-2021, the patient experienced HYPERHIDROSIS (sweating). At the time of the report, ABDOMINAL PAIN UPPER (his stomach hurt if he ate or drank anything/Stomach hurting a bit) and PYREXIA (had a really high fever/Still has fever) had not resolved and HYPERHIDROSIS (sweating) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications was included. No treatment drug details was provided.

Other Meds:

Current Illness:

ID: 1627591
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: No energy; Flu like symptoms; Dry throat which makes patient cough a lot; Runny nose; Dry throat which makes patient cough a lot; Fatigue; Head aches; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (No energy), INFLUENZA LIKE ILLNESS (Flu like symptoms), DRY THROAT (Dry throat which makes patient cough a lot), RHINORRHOEA (Runny nose) and COUGH (Dry throat which makes patient cough a lot) in a patient of an unknown age and gender 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 an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ASTHENIA (No energy), INFLUENZA LIKE ILLNESS (Flu like symptoms), DRY THROAT (Dry throat which makes patient cough a lot), RHINORRHOEA (Runny nose), COUGH (Dry throat which makes patient cough a lot), FATIGUE (Fatigue) and HEADACHE (Head aches). At the time of the report, ASTHENIA (No energy), INFLUENZA LIKE ILLNESS (Flu like symptoms), DRY THROAT (Dry throat which makes patient cough a lot), RHINORRHOEA (Runny nose), COUGH (Dry throat which makes patient cough a lot), FATIGUE (Fatigue) and HEADACHE (Head aches) outcome was unknown. Concomitant medication information not provided. Treatment information not provided. Action taken with mRNA-1273 in response to the event/s was not applicable.

Other Meds:

Current Illness:

ID: 1627592
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: migraines constant; This spontaneous case was reported by a consumer and describes the occurrence of MIGRAINE (migraines constant) in a patient of an unknown age and gender 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 MIGRAINE (migraines constant). At the time of the report, MIGRAINE (migraines constant) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1627593
Sex: F
Age:
State:

Vax Date:
Onset Date: 06/13/2021
Rec V Date: 08/24/2021
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: Injection site is hot; Injection site is a bit blotchy; Felt terrible; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Injection site is hot), VACCINATION SITE DISCOLOURATION (Injection site is a bit blotchy) and FEELING ABNORMAL (Felt terrible) 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) (Intramuscular) 1 dosage form. On 13-Jun-2021, the patient experienced FEELING ABNORMAL (Felt terrible). On 14-Jun-2021, the patient experienced VACCINATION SITE WARMTH (Injection site is hot) and VACCINATION SITE DISCOLOURATION (Injection site is a bit blotchy). At the time of the report, VACCINATION SITE WARMTH (Injection site is hot) and VACCINATION SITE DISCOLOURATION (Injection site is a bit blotchy) outcome was unknown and FEELING ABNORMAL (Felt terrible) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported by the reporter. Treatment medication was not provided by the reporter. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1627594
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: non stop vomiting; non stop diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of VOMITING (non stop vomiting) and DIARRHOEA (non stop diarrhea) in a patient of an unknown age and gender 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 VOMITING (non stop vomiting) and DIARRHOEA (non stop diarrhea). At the time of the report, VOMITING (non stop vomiting) and DIARRHOEA (non stop diarrhea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient's concomitant medication was not reported. No treatment medication was reported.

Other Meds:

Current Illness:

ID: 1627595
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: left hand is twitching; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE TWITCHING (left hand is twitching) in a patient of an unknown age and gender 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced MUSCLE TWITCHING (left hand is twitching). At the time of the report, MUSCLE TWITCHING (left hand is twitching) outcome was unknown. No concomitant medication was reported. Treatment Information was not provided by the reporter. It was reported that the patient received the second dose yesterday. No treatment medication was reported .

Other Meds:

Current Illness:

ID: 1627596
Sex: F
Age: 71
State: TX

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 08/24/2021
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: very cold; Headache; Pain; a little pain in the injection site; This spontaneous case was reported by a patient family member or friend and describes the occurrence of NASOPHARYNGITIS (very cold), PAIN (Pain), INJECTION SITE PAIN (a little pain in the injection site) and HEADACHE (Headache) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 02-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Feb-2021, the patient experienced PAIN (Pain) and INJECTION SITE PAIN (a little pain in the injection site). On 03-Feb-2021, the patient experienced NASOPHARYNGITIS (very cold) and HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) for Headache, at a dose of 1 dosage form. On 03-Feb-2021, NASOPHARYNGITIS (very cold) and HEADACHE (Headache) had resolved. At the time of the report, PAIN (Pain) and INJECTION SITE PAIN (a little pain in the injection site) outcome was unknown.

Other Meds:

Current Illness:

ID: 1627597
Sex: F
Age: 76
State: WA

Vax Date: 02/27/2021
Onset Date: 04/02/2021
Rec V Date: 08/24/2021
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: Tinnitus; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of TINNITUS (Tinnitus) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046A21A and 002A21A) for COVID-19 vaccination. Concurrent medical conditions included Allergy to antibiotic (Sulfa drug), Drug allergy, Galactose intolerance, Fructose intolerance and Gluten intolerance. Concomitant products included ESTROGENS CONJUGATED (PREMARIN) for Hormone therapy, MULTIVITAMIN [VITAMINS NOS] and VITAMIN D [VITAMIN D NOS] for Supplementation therapy. On 27-Feb-2021 at 11:30 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Mar-2021 at 11:30 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 02-Apr-2021, the patient experienced TINNITUS (Tinnitus). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] for Tinnitus, at a dose of 1 UNK. At the time of the report, TINNITUS (Tinnitus) had not resolved. Patient reported a gradual worsening of the tinnitus until could hear it while talking. Patient stated that doctors exam showed no external ear problems and normal blood pressure. Concomitant medications include lutein and acidophilous. The patient had galactose, fructose, gluten allergy. Most recent FOLLOW-UP information incorporated above includes: On 07-Jul-2021: Follow-up was received to include reporter's contact information. On 10-Aug-2021: Significant F/UP: Onset date, doctors visit for Dose-2 event,concomitant medications addded

Other Meds: PREMARIN; MULTIVITAMIN [VITAMINS NOS]; VITAMIN D [VITAMIN D NOS]

Current Illness: Allergy to antibiotic (Sulfa drug); Drug allergy; Fructose intolerance; Galactose intolerance; Gluten intolerance

ID: 1627598
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: I had my first dose 7 weeks ago - is it to late to get the second dose?; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (I had my first dose 7 weeks ago - is it to late to get the second dose?) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (I had my first dose 7 weeks ago - is it to late to get the second dose?). At the time of the report, PRODUCT DOSE OMISSION ISSUE (I had my first dose 7 weeks ago - is it to late to get the second dose?) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No information regarding corrective treatment was reported by the patient.

Other Meds:

Current Illness:

ID: 1627599
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Shortness of breath; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Shortness of breath) in a patient of an unknown age and gender 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 DYSPNOEA (Shortness of breath). At the time of the report, DYSPNOEA (Shortness of breath) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication and treatment information were not reported.

Other Meds:

Current Illness:

ID: 1627600
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: was given the first dose approx. 2 moths ago; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (was given the first dose approx. 2 moths ago) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. 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 PRODUCT DOSE OMISSION ISSUE (was given the first dose approx. 2 moths ago). At the time of the report, PRODUCT DOSE OMISSION ISSUE (was given the first dose approx. 2 moths ago) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. The patient wanted to know what to do. No treatment medications were provided. Company Comment: This report refers to a case of Product dose omission for mRNA-1273 in an immunosuppressed patient, with no adverse events. Reporter did not allow further contact; Sender's Comments: This report refers to a case of Product dose omission for mRNA-1273 in an immunosuppressed patient, with no adverse events.

Other Meds:

Current Illness: Immunocompromised

ID: 1627601
Sex: U
Age:
State:

Vax Date: 06/13/2021
Onset Date: 06/14/2021
Rec V Date: 08/24/2021
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: This spontaneous case reported by a consumer, describes the occurrence of headache and myalgia (body aches) in a patient, of an unknown age and gender, who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. No medical history reported. On Jun 13, 2021, patient received the second dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On an unknown date, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Jun 14, 2021, patient experienced headache and myalgia (body aches). At the time of the report, headache and myalgia (body aches): unresolved. No concomitant medication or treatment information reported.

Other Meds:

Current Illness:

ID: 1627602
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: coughing; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (coughing) in a patient of an unknown age and gender 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 COUGH (coughing). At the time of the report, COUGH (coughing) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. Treatment medication was not provided.

Other Meds:

Current Illness:

ID: 1627603
Sex: U
Age:
State:

Vax Date: 06/13/2021
Onset Date: 06/01/2021
Rec V Date: 08/24/2021
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: bad rash on my arm with blisters in the center; blisters on the back of my tongue; bad rash on my arm with blisters in the center; Arm has a big knot the size of an egg which got bigger; arm red; Feel very hot to the touch/hotness; This spontaneous case was reported by a consumer and describes the occurrence of NODULE (Arm has a big knot the size of an egg which got bigger), ERYTHEMA (arm red), FEELING HOT (Feel very hot to the touch/hotness), TONGUE BLISTERING (blisters on the back of my tongue) and RASH VESICULAR (bad rash on my arm with blisters in the center) in a patient of an unknown age and gender 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 13-Jun-2021 at 11:00 AM, 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. In June 2021, the patient experienced NODULE (Arm has a big knot the size of an egg which got bigger), ERYTHEMA (arm red) and FEELING HOT (Feel very hot to the touch/hotness). On 16-Jun-2021, the patient experienced TONGUE BLISTERING (blisters on the back of my tongue) and RASH VESICULAR (bad rash on my arm with blisters in the center). On an unknown date, the patient experienced RASH (bad rash on my arm with blisters in the center). The patient was treated with AZITHROMYCIN (Z-PAK) for Blisters, at an unspecified dose and frequency. At the time of the report, NODULE (Arm has a big knot the size of an egg which got bigger), ERYTHEMA (arm red), FEELING HOT (Feel very hot to the touch/hotness) and RASH (bad rash on my arm with blisters in the center) outcome was unknown, TONGUE BLISTERING (blisters on the back of my tongue) had not resolved and RASH VESICULAR (bad rash on my arm with blisters in the center) had resolved. No concomitant medication was reported. Action taken with mRNA-1273 in response to the event/s was not applicable. Most recent FOLLOW-UP information incorporated above includes: On 03-Jul-2021: Follow up received on 03-Jul-2021. New events were added and Treatment medication were added.

Other Meds:

Current Illness:

ID: 1627604
Sex: F
Age:
State:

Vax Date: 02/04/2021
Onset Date:
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Test Name: heart beat rate; Test Result: Inconclusive ; Result Unstructured Data: 92 bpm

Allergies:

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

Symptoms: chest feels tight; fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (chest feels tight), PYREXIA (fever) and CHILLS (chills) 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 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CHEST DISCOMFORT (chest feels tight), PYREXIA (fever) and CHILLS (chills). At the time of the report, CHEST DISCOMFORT (chest feels tight), PYREXIA (fever) and CHILLS (chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Heart rate: 92 (Inconclusive) 92 bpm. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant drugs were reported. No treatment medication details were provided.

Other Meds:

Current Illness:

ID: 1627605
Sex: M
Age:
State: NJ

Vax Date: 04/06/2021
Onset Date: 05/04/2021
Rec V Date: 08/24/2021
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: Tingling in her hands and bottom of the foot and legs; Nerves are in overdrive; Injection site pain; Tiredness; Body aches; Rash; Chills; Fever; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PARAESTHESIA (Tingling in her hands and bottom of the foot and legs), NERVE INJURY (Nerves are in overdrive), VACCINATION SITE PAIN (Injection site pain), FATIGUE (Tiredness) and MYALGIA (Body aches) in a male patient of an unknown age 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 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-May-2021, the patient experienced VACCINATION SITE PAIN (Injection site pain), FATIGUE (Tiredness), MYALGIA (Body aches), RASH (Rash), CHILLS (Chills) and PYREXIA (Fever). On an unknown date, the patient experienced PARAESTHESIA (Tingling in her hands and bottom of the foot and legs) and NERVE INJURY (Nerves are in overdrive). The patient was treated with GABAPENTIN for Adverse event, at an unspecified dose and frequency. On 08-May-2021, VACCINATION SITE PAIN (Injection site pain), FATIGUE (Tiredness), MYALGIA (Body aches), RASH (Rash), CHILLS (Chills) and PYREXIA (Fever) had resolved. At the time of the report, PARAESTHESIA (Tingling in her hands and bottom of the foot and legs) and NERVE INJURY (Nerves are in overdrive) outcome was unknown. No concomitant medications were provided. No treatment was reported for the events. Action taken with the drug in response to events was not applicable.

Other Meds:

Current Illness:

ID: 1627606
Sex: F
Age:
State: CA

Vax Date: 03/10/2021
Onset Date:
Rec V Date: 08/24/2021
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: Since getting the vaccine, I noticed that I need 9-10 hours of sleep a night. Before, I needed 8 hrs sleep./now I need 10 hrs of sleep each night; before I needed 8 hrs; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (Since getting the vaccine, I noticed that I need 9-10 hours of sleep a night. Before, I needed 8 hrs sleep./now I need 10 hrs of sleep each night; before I needed 8 hrs) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036A21A and 042B21A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Sulfa drugs) and Drug allergy (Vitamin E topical). Concomitant products included FLUOXETINE from 09-Sep-2000 to an unknown date for an unknown indication. On 10-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Apr-2021 at 4:10 PM, 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 experienced SOMNOLENCE (Since getting the vaccine, I noticed that I need 9-10 hours of sleep a night. Before, I needed 8 hrs sleep./now I need 10 hrs of sleep each night; before I needed 8 hrs). At the time of the report, SOMNOLENCE (Since getting the vaccine, I noticed that I need 9-10 hours of sleep a night. Before, I needed 8 hrs sleep./now I need 10 hrs of sleep each night; before I needed 8 hrs) had not resolved. No treatment information was provided. Patient was experienced lethargy and body aches for 2 days after one of the shots. Most recent FOLLOW-UP information incorporated above includes: On 29-Jun-2021: Significant Follow-up received - Patient demographics, reporter details, suspect product, concomitant product details, vaccination facility details and narrative updated. On 04-Aug-2021: Non-Significant Follow up

Other Meds: FLUOXETINE

Current Illness: Drug allergy (Vitamin E topical); Drug allergy (Sulfa drugs)

ID: 1627607
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Certain side effect; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Certain side effect) in a patient of an unknown age and gender 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) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Certain side effect). At the time of the report, VACCINATION COMPLICATION (Certain side effect) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication were reported. No treatment information was reported

Other Meds:

Current Illness:

ID: 1627608
Sex: F
Age: 82
State: MD

Vax Date: 02/11/2021
Onset Date: 03/14/2021
Rec V Date: 08/24/2021
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: After 2-3 weeks from the 2nd dose I noticed a knot in my arm at the injection site/the knot is not hard to touch; It is getting worse and not getting better; It hurts real bad; Pain in arm/but it came right back after a week; After the 2nd dose, after a day or so I noticed pain in my arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (After the 2nd dose, after a day or so I noticed pain in my arm), VACCINATION SITE MASS (After 2-3 weeks from the 2nd dose I noticed a knot in my arm at the injection site/the knot is not hard to touch), CONDITION AGGRAVATED (It is getting worse and not getting better), PAIN IN EXTREMITY (Pain in arm/but it came right back after a week) and VACCINATION SITE PAIN (It hurts real bad) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 016M20A and 013L20A) for COVID-19 vaccination. Concurrent medical conditions included Diabetes, Thyroid disorder and Blood pressure. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 2 dosage form. On 14-Mar-2021, the patient experienced PAIN IN EXTREMITY (After the 2nd dose, after a day or so I noticed pain in my arm). On 20-Mar-2021, the patient experienced PAIN IN EXTREMITY (Pain in arm/but it came right back after a week). On 27-Mar-2021, the patient experienced VACCINATION SITE MASS (After 2-3 weeks from the 2nd dose I noticed a knot in my arm at the injection site/the knot is not hard to touch), CONDITION AGGRAVATED (It is getting worse and not getting better) and VACCINATION SITE PAIN (It hurts real bad). On 15-Mar-2021, PAIN IN EXTREMITY (After the 2nd dose, after a day or so I noticed pain in my arm) had resolved. At the time of the report, VACCINATION SITE MASS (After 2-3 weeks from the 2nd dose I noticed a knot in my arm at the injection site/the knot is not hard to touch), CONDITION AGGRAVATED (It is getting worse and not getting better) and VACCINATION SITE PAIN (It hurts real bad) had not resolved and PAIN IN EXTREMITY (Pain in arm/but it came right back after a week) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications included medications for diabetes, medications for thyroid and medications for high blood pressure. The pain in arm seemed to go away after the patient rubbed with alcohol. No treatment information was provided by the reporter.

Other Meds:

Current Illness: Blood pressure; Diabetes; Thyroid disorder.

ID: 1627609
Sex: U
Age:
State:

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 08/24/2021
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: New onset of tinittus; Rash; This spontaneous case was reported by a consumer and describes the occurrence of TINNITUS (New onset of tinittus) and RASH (Rash) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Cancer. In April 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In April 2021, the patient experienced TINNITUS (New onset of tinittus) and RASH (Rash). At the time of the report, TINNITUS (New onset of tinittus) and RASH (Rash) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported by the reporter. The patient had the events 24 hours after the first dose. Treatment medication was not provided by the reporter.

Other Meds:

Current Illness: Cancer

ID: 1627610
Sex: M
Age: 19
State: NC

Vax Date: 05/18/2021
Onset Date:
Rec V Date: 08/24/2021
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: Heart is racing/Feels palpitations; Heart hurts worse; This spontaneous case was reported by a consumer and describes the occurrence of PALPITATIONS (Heart is racing/Feels palpitations) and CARDIAC DISORDER (Heart hurts worse) in a 19-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PALPITATIONS (Heart is racing/Feels palpitations) and CARDIAC DISORDER (Heart hurts worse). At the time of the report, PALPITATIONS (Heart is racing/Feels palpitations) and CARDIAC DISORDER (Heart hurts worse) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. It was reported the patient felt his heart racing and palpitations and his heart hurt more when he was doing manual labor. Patient visited urgent care where an electrocardiogram was performed which revealed normal results. Patient was encouraged to go to the emergency department but couldn't. He was scheduled for an appointment with his doctor and was told not to get the second dose. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1627611
Sex: F
Age: 71
State: LA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 08/24/2021
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: bruising at injection site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE BRUISING (bruising at injection site) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012M70A) for COVID-19 vaccination. No medical history was reported by the reporter. Concomitant products included ESTRIOL, SIMVASTATIN, OMEPRAZOLE, ALPRAZOLAM (XANAX), VALACICLOVIR HYDROCHLORIDE (VALTREX), ASPIRIN [ACETYLSALICYLIC ACID], VITAMIN D3, ZINC, VITAMIN C [ASCORBIC ACID], COENZYME Q10 [UBIDECARENONE] and CALCIUM for an unknown indication. On 05-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Feb-2021, the patient experienced VACCINATION SITE BRUISING (bruising at injection site). At the time of the report, VACCINATION SITE BRUISING (bruising at injection site) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication include Multivitamins. No treatment medication was reported.

Other Meds: ESTRIOL; SIMVASTATIN; OMEPRAZOLE; XANAX; VALTREX; ASPIRIN [ACETYLSALICYLIC ACID]; VITAMIN D3; ZINC; VITAMIN C [ASCORBIC ACID]; COENZYME Q10 [UBIDECARENONE]; CALCIUM

Current Illness:

ID: 1627612
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: tested positive (COVID-19)between first and second doses; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (tested positive (COVID-19)between first and second doses) in a patient of an unknown age and gender 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 COVID-19 (tested positive (COVID-19)between first and second doses). At the time of the report, COVID-19 (tested positive (COVID-19)between first and second doses) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: (Positive) No concomitant medications were reported. No treatment information was provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1627613
Sex: F
Age: 76
State: GA

Vax Date: 01/15/2021
Onset Date:
Rec V Date: 08/24/2021
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: pink rash on her stomach and back; This spontaneous case was reported by a consumer and describes the occurrence of RASH ERYTHEMATOUS (pink rash on her stomach and back) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 828L20A) for COVID-19 vaccination. The patient's past medical history included Arthritis. Concurrent medical conditions included Diabetic. Concomitant products included HYDROXYCHLOROQUINE for Arthritis, EZETIMIBE, SIMVASTATIN (VYTORIN) for High cholesterol. On 15-Jan-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH ERYTHEMATOUS (pink rash on her stomach and back). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Rash, at a dose of UNK dosage form. At the time of the report, RASH ERYTHEMATOUS (pink rash on her stomach and back) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient wants to know is it safe for her to get vaccination as she is Diabetic and having Arthritis.

Other Meds: HYDROXYCHLOROQUINE; VYTORIN

Current Illness: Diabetic

ID: 1627614
Sex: F
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: 59 days out from her first dose of the Moderna Covid 19 vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (59 days out from her first dose of the Moderna Covid 19 vaccine) 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 PRODUCT DOSE OMISSION ISSUE (59 days out from her first dose of the Moderna Covid 19 vaccine). At the time of the report, PRODUCT DOSE OMISSION ISSUE (59 days out from her first dose of the Moderna Covid 19 vaccine) 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 drugs were provided. No treatment information was provided by the reporter. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1627615
Sex: F
Age: 44
State: CT

Vax Date: 03/27/2021
Onset Date: 04/24/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Test Date: 202104; Test Name: COVID-19; Test Result: Negative ; Result Unstructured Data: Test results - Negative

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Cold-like symptoms; Loss taste; tender arm; had arm tenderness right after the 2nd dose; This spontaneous case was reported by a consumer and describes the occurrence of NASOPHARYNGITIS (Cold-like symptoms), AGEUSIA (Loss taste), TENDERNESS (had arm tenderness right after the 2nd dose) and TENDERNESS (tender arm) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048B21A and 018B21A) for COVID-19 vaccination. Concomitant products included CETIRIZINE HYDROCHLORIDE (ZYRTEC [CETIRIZINE HYDROCHLORIDE]) for an unknown indication. On 27-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Apr-2021, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 2 dosage form. On 24-Apr-2021, the patient experienced TENDERNESS (had arm tenderness right after the 2nd dose). On 14-Jun-2021, the patient experienced TENDERNESS (tender arm). On an unknown date, the patient experienced NASOPHARYNGITIS (Cold-like symptoms) and AGEUSIA (Loss taste). At the time of the report, NASOPHARYNGITIS (Cold-like symptoms), AGEUSIA (Loss taste), TENDERNESS (had arm tenderness right after the 2nd dose) and TENDERNESS (tender arm) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In April 2021, COVID-19: negative (Negative) Test results - Negative. No treatment details were reported. Most recent FOLLOW-UP information incorporated above includes: On 02-Jul-2021: Follow up received and it contains the information :Patient said that she is doing fine and declined for further follow-up

Other Meds: ZYRTEC [CETIRIZINE HYDROCHLORIDE]

Current Illness:

ID: 1627616
Sex: M
Age: 77
State: FL

Vax Date: 04/13/2021
Onset Date:
Rec V Date: 08/24/2021
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: Missed second dose of the Moderna COVID-19 vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Missed second dose of the Moderna COVID-19 vaccine) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 immunisation. The patient's medical history was not reported. Concomitant products included METFORMIN for an unknown indication. On 13-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose of the Moderna COVID-19 vaccine). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Missed second dose of the Moderna COVID-19 vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No treatment medications were provided by the reporter.

Other Meds: METFORMIN

Current Illness:

ID: 1627617
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: losing taste; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of AGEUSIA (losing taste) in a patient of an unknown age and gender 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced AGEUSIA (losing taste). At the time of the report, AGEUSIA (losing taste) outcome was unknown. Concomitant medications were not provided by the reporter. Treatment information was not reported.

Other Meds:

Current Illness:

ID: 1627618
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Side effects about two months after The last dose/delayed symptoms of side effects months after the second dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Side effects about two months after The last dose/delayed symptoms of side effects months after the second dose) in a patient of an unknown age and gender 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Side effects about two months after The last dose/delayed symptoms of side effects months after the second dose). At the time of the report, VACCINATION COMPLICATION (Side effects about two months after The last dose/delayed symptoms of side effects months after the second dose) outcome was unknown. No relevant concomitant medications were reported. Patient experienced side effects about two months after vaccination. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1627619
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Flu-like symptoms 2 days after the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (Flu-like symptoms 2 days after the vaccine) 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) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced INFLUENZA LIKE ILLNESS (Flu-like symptoms 2 days after the vaccine). At the time of the report, INFLUENZA LIKE ILLNESS (Flu-like symptoms 2 days after the vaccine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Relevant concomitant medications was reported. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1627620
Sex: F
Age: 65
State: CA

Vax Date: 03/17/2021
Onset Date:
Rec V Date: 08/24/2021
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: Dizzy; Cant walk very well; Memory issue; weak/ falling down; Vomiting; Headache; Pyrexia; Vaccination site erythmea; Vaccination site swelling; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (Dizzy), GAIT DISTURBANCE (Cant walk very well), MEMORY IMPAIRMENT (Memory issue), ASTHENIA (weak/ falling down) and VOMITING (Vomiting) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cancer since 25-Dec-2007. Concomitant products included MULTIVITAMIN [VITAMINS NOS] for an unknown indication. On 17-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DIZZINESS (Dizzy), GAIT DISTURBANCE (Cant walk very well), MEMORY IMPAIRMENT (Memory issue), ASTHENIA (weak/ falling down), VOMITING (Vomiting), HEADACHE (Headache), PYREXIA (Pyrexia), VACCINATION SITE ERYTHEMA (Vaccination site erythmea) and VACCINATION SITE SWELLING (Vaccination site swelling). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) at an unspecified dose and frequency. At the time of the report, DIZZINESS (Dizzy), GAIT DISTURBANCE (Cant walk very well), MEMORY IMPAIRMENT (Memory issue), ASTHENIA (weak/ falling down), VOMITING (Vomiting), HEADACHE (Headache) and PYREXIA (Pyrexia) had not resolved and VACCINATION SITE ERYTHEMA (Vaccination site erythmea) and VACCINATION SITE SWELLING (Vaccination site swelling) had resolved. Not Provided Dose 2 case. Dose 1 case: MOD-2021-039583

Other Meds: MULTIVITAMIN [VITAMINS NOS]

Current Illness: Cancer

ID: 1627621
Sex: F
Age:
State:

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 08/24/2021
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: can barely move the arm; Pain on the arm,lots of pain throughout her body; This spontaneous case was reported by a patient and describes the occurrence of MOBILITY DECREASED (can barely move the arm) and MYALGIA (Pain on the arm,lots of pain throughout her 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 07-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Feb-2021, the patient experienced MOBILITY DECREASED (can barely move the arm) and MYALGIA (Pain on the arm,lots of pain throughout her body). At the time of the report, MOBILITY DECREASED (can barely move the arm) and MYALGIA (Pain on the arm,lots of pain throughout her body) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication was not provided. Treatment medication was not provided.

Other Meds:

Current Illness:

ID: 1627622
Sex: F
Age:
State: OH

Vax Date: 04/06/2021
Onset Date:
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Test Name: Body Temperature; Result Unstructured Data: 103 Fever

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Second dose was scheduled for 04MAY2021, but she did not receive it due to the advice of her doctor; Started noticing a rash / the rash kept getting worse; 103 fever; This spontaneous case was reported by a consumer and describes the occurrence of OFF LABEL USE (Second dose was scheduled for 04MAY2021, but she did not receive it due to the advice of her doctor), RASH (Started noticing a rash / the rash kept getting worse) and PYREXIA (103 fever) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017B21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced OFF LABEL USE (Second dose was scheduled for 04MAY2021, but she did not receive it due to the advice of her doctor), RASH (Started noticing a rash / the rash kept getting worse) and PYREXIA (103 fever). At the time of the report, OFF LABEL USE (Second dose was scheduled for 04MAY2021, but she did not receive it due to the advice of her doctor), RASH (Started noticing a rash / the rash kept getting worse) and PYREXIA (103 fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 103 (High) 103 Fever. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were mentioned. Treatment medication reported included Two antibiotics, pain medication and steroids. She went to the ER twice. On her second visit she was asked to follow up with her primary care physician who prescribed a steroid for her. The second dose was scheduled for 04MAY2021, but she did not receive it due to the advice of her doctor.

Other Meds:

Current Illness:

ID: 1627623
Sex: F
Age: 62
State: CA

Vax Date: 05/13/2021
Onset Date:
Rec V Date: 08/24/2021
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: bruised very easily on her tummy, legs, waist, thigh and arm; bruised on shot area; little sore on shot area; This spontaneous case was reported by a consumer and describes the occurrence of CONTUSION (bruised very easily on her tummy, legs, waist, thigh and arm), VACCINATION SITE BRUISING (bruised on shot area) and VACCINATION SITE PAIN (little sore on shot area) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 023C21A) for COVID-19 vaccination. Concurrent medical conditions included Cholesterol and Blood pressure. Concomitant products included AMLODIPINE for Blood pressure, ATORVASTATIN CALCIUM (LIPITOR) for Cholesterol, CLOPIDOGREL BISULFATE (PLAVIX) for an unknown indication. On 13-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced CONTUSION (bruised very easily on her tummy, legs, waist, thigh and arm), VACCINATION SITE BRUISING (bruised on shot area) and VACCINATION SITE PAIN (little sore on shot area). At the time of the report, CONTUSION (bruised very easily on her tummy, legs, waist, thigh and arm) and VACCINATION SITE BRUISING (bruised on shot area) was resolving and VACCINATION SITE PAIN (little sore on shot area) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Treatments were reported. Concomitant medication included hormone for an unknown indication. This case was linked to MOD-2021-220863 (Patient Link).

Other Meds: PLAVIX; AMLODIPINE; LIPITOR

Current Illness: Blood pressure; Cholesterol

ID: 1627624
Sex: U
Age:
State:

Vax Date: 01/05/2021
Onset Date:
Rec V Date: 08/24/2021
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: I was scared too take the second... is it too late; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (I was scared too take the second... is it too late) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 05-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (I was scared too take the second... is it too late). At the time of the report, PRODUCT DOSE OMISSION ISSUE (I was scared too take the second.. is it too late) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. Patient reported to have had adverse effects after first dose and was scared to have the second shot No treatment medications were provided.

Other Meds:

Current Illness:

ID: 1627625
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: armpit on the arm I received the shot is swollen; armpit on the arm I received the shot is sore; was running 100 degree temp; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 14-Jun-2021 and was forwarded to Moderna on 14-Jun-2021. This spontaneous case was reported by a consumer and describes the occurrence of SWELLING (armpit on the arm I received the shot is swollen), AXILLARY PAIN (armpit on the arm I received the shot is sore) and PYREXIA (was running 100 degree temp) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided by the reporter. 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 SWELLING (armpit on the arm I received the shot is swollen), AXILLARY PAIN (armpit on the arm I received the shot is sore) and PYREXIA (was running 100 degree temp). At the time of the report, SWELLING (armpit on the arm I received the shot is swollen), AXILLARY PAIN (armpit on the arm I received the shot is sore) and PYREXIA (was running 100 degree temp) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were provided by the reporter. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1627626
Sex: U
Age:
State: AZ

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: patient was administered dose of vaccine from vial that was refrigerated over 30 days; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient was administered dose of vaccine from vial that was refrigerated over 30 days) in a patient of an unknown age and gender 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 EXPIRED PRODUCT ADMINISTERED (patient was administered dose of vaccine from vial that was refrigerated over 30 days). At the time of the report, EXPIRED PRODUCT ADMINISTERED (patient was administered dose of vaccine from vial that was refrigerated over 30 days) 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 relevant concomitant medications were reported. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1627627
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Arm hurt so bad it went all the way up an around back of my neck; I had migraines; Lost weight; Real fatigued; Fever; Chills; Throwing up; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Arm hurt so bad it went all the way up an around back of my neck), MIGRAINE (I had migraines), WEIGHT DECREASED (Lost weight), FATIGUE (Real fatigued) and PYREXIA (Fever) in a patient of an unknown age and gender 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 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 PAIN IN EXTREMITY (Arm hurt so bad it went all the way up an around back of my neck), MIGRAINE (I had migraines), WEIGHT DECREASED (Lost weight), FATIGUE (Real fatigued), PYREXIA (Fever), CHILLS (Chills) and VOMITING (Throwing up). At the time of the report, PAIN IN EXTREMITY (Arm hurt so bad it went all the way up an around back of my neck), MIGRAINE (I had migraines), WEIGHT DECREASED (Lost weight), FATIGUE (Real fatigued), PYREXIA (Fever), CHILLS (Chills) and VOMITING (Throwing up) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. All these symptoms went on for a week. No concomitant information was reported. No treatment information was reported. This case was linked to MOD-2021-220850 (Patient Link).

Other Meds:

Current Illness:

ID: 1627628
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: 48 hours of body aches; 48 hours of tiredness; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (48 hours of body aches) and FATIGUE (48 hours of tiredness) in a patient of an unknown age and gender 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) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PAIN (48 hours of body aches) and FATIGUE (48 hours of tiredness). At the time of the report, PAIN (48 hours of body aches) and FATIGUE (48 hours of tiredness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment drug details was provided.

Other Meds:

Current Illness:

ID: 1627629
Sex: M
Age: 74
State: HI

Vax Date: 01/14/2021
Onset Date:
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Test Date: 20210126; Test Name: COVID-19 TEST; Test Result: Positive ; Result Unstructured Data: patient came down with COVID

Allergies:

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

Symptoms: patient came down with COVID; fever; chills; headache; myalgia; This spontaneous case was reported by a health care professional and describes the occurrence of COVID-19 (patient came down with COVID), PYREXIA (fever), CHILLS (chills), HEADACHE (headache) and MYALGIA (myalgia) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014c21a) for COVID-19 vaccination. The patient's past medical history included COVID-19 virus test positive on 27-Jan-2021. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-May-2021, 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 experienced COVID-19 (patient came down with COVID), PYREXIA (fever), CHILLS (chills), HEADACHE (headache) and MYALGIA (myalgia). At the time of the report, COVID-19 (patient came down with COVID), PYREXIA (fever), CHILLS (chills), HEADACHE (headache) and MYALGIA (myalgia) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 26-Jan-2021, SARS-CoV-2 test: positive (Positive) patient came down with COVID. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. This case was linked to MOD-2021-226267 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 17-Jun-2021: Follow-up information received on 17-Jun-2021 contains the patient details updated and dosage 2 added in products tab.

Other Meds:

Current Illness:

ID: 1627630
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: rash; This spontaneous case was reported by a consumer and describes the occurrence of RASH (rash) 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH (rash). At the time of the report, RASH (rash) outcome was unknown. No information regarding concomitant medication was provided. No information regarding treatment was provided .

Other Meds:

Current Illness:

ID: 1627631
Sex: F
Age:
State: AZ

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: Missed 2nd dose; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose) 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, received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to at an unspecified dose. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) and 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 medications were not reported.

Other Meds:

Current Illness:

ID: 1627632
Sex: F
Age: 63
State: NJ

Vax Date: 01/12/2021
Onset Date:
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Test Date: 202004; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: COVID Positive

Allergies:

Symptom List: Vomiting

Symptoms: severe psoriasis; Eczema; Mild itching on both her hands and feet; Fishers on her feet; This spontaneous case was reported by a consumer and describes the occurrence of PSORIASIS (severe psoriasis), ECZEMA (Eczema), PRURITUS (Mild itching on both her hands and feet) and SKIN FISSURES (Fishers on her feet) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included COVID-19 in April 2020. Concurrent medical conditions included Autoimmune disorder (autoimmune diseases). On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PSORIASIS (severe psoriasis), ECZEMA (Eczema), PRURITUS (Mild itching on both her hands and feet) and SKIN FISSURES (Fishers on her feet). At the time of the report, PSORIASIS (severe psoriasis), ECZEMA (Eczema), PRURITUS (Mild itching on both her hands and feet) and SKIN FISSURES (Fishers on her feet) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In April 2020, SARS-CoV-2 test: positive (Positive) COVID Positive. No concomitant medications were reported by the reporter. The patient had fishers three weeks after her second dose. Treatment medication was not provided by the reporter. This case was linked to MOD-2021-220879 (Patient Link).

Other Meds:

Current Illness: Autoimmune disorder (autoimmune diseases)

ID: 1627633
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: got real sick; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (got real sick) in a patient of an unknown age and gender 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 ILLNESS (got real sick). At the time of the report, ILLNESS (got real sick) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication was reported.

Other Meds:

Current Illness:

ID: 1627634
Sex: F
Age: 19
State: SC

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 08/24/2021
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: Test Date: 20210519; Test Name: Covid-19 test; Test Result: Positive ; Result Unstructured Data: positive (all symptoms resolved on 25May2021)

Allergies:

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

Symptoms: got sick; headache; diarrhea; cold symptoms; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (got sick), HEADACHE (headache), DIARRHOEA (diarrhea) and NASOPHARYNGITIS (cold symptoms) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-May-2021, the patient experienced ILLNESS (got sick), HEADACHE (headache), DIARRHOEA (diarrhea) and NASOPHARYNGITIS (cold symptoms). On 25-May-2021, ILLNESS (got sick), HEADACHE (headache), DIARRHOEA (diarrhea) and NASOPHARYNGITIS (cold symptoms) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-May-2021, SARS-CoV-2 test: positive (Positive) positive (all symptoms resolved on 25May2021). 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 medication was reported. The patient took cold medicine for treatment, not specified. No other treatment information provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1627635
Sex: F
Age:
State: NC

Vax Date: 03/18/2021
Onset Date: 03/21/2021
Rec V Date: 08/24/2021
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: Hair loss/hair started falling out; Left arm achy; body aches; alopecia areata diagnosed after the vaccine.; This spontaneous pregnancy case was reported by a consumer and describes the occurrence of ALOPECIA (Hair loss/hair started falling out), ALOPECIA AREATA (alopecia areata diagnosed after the vaccine.), PAIN IN EXTREMITY (Left arm achy) and MYALGIA (body aches) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036A2119 and 030B2117) for COVID-19 vaccination. Previously administered products included for an unreported indication: SHINGRIX in January 2021. Concurrent medical conditions included Blood pressure high since 2018. Concomitant products included LISINOPRIL for Blood pressure high, DOXYCYCLINE for Rosacea, FLUOXETINE and CLONAZEPAM for an unknown indication. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 21-Mar-2021, the patient experienced ALOPECIA AREATA (alopecia areata diagnosed after the vaccine.). On an unknown date, the patient experienced ALOPECIA (Hair loss/hair started falling out), PAIN IN EXTREMITY (Left arm achy) and MYALGIA (body aches). At the time of the report, ALOPECIA (Hair loss/hair started falling out) had not resolved, ALOPECIA AREATA (alopecia areata diagnosed after the vaccine.) outcome was unknown and PAIN IN EXTREMITY (Left arm achy) and MYALGIA (body aches) had resolved. It was reported that patient had thyroid test normal. Treatment information was not provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 28-Jun-2021: Follow up received on 28-June-2021which contains added events: Body ache, Left arm achy and alopecia areata. Added event outcome: unknown to recovered. Added medical history: Shingles vaccine. Added concomitant medications : Lisinopril, Fluoxetine, Doxycycline and Clonazepam.Added product details : Dose number, drug start ate and Batch number.Added patient demographics : age On 08-Jul-2021: Follow up received on 08-June-2021which contains . Added concomitant medications dose details.Added patient demographics : Hight weight and pregnancy informationAdded medical history: High blood pressureAdded Vaccine facility information.; Sender's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.

Other Meds: LISINOPRIL; DOXYCYCLINE; FLUOXETINE; CLONAZEPAM

Current Illness: Blood pressure high

ID: 1627636
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/24/2021
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: can no longer smell or taste anything; can no longer smell or taste anything!; This spontaneous case was reported by a consumer and describes the occurrence of ANOSMIA (can no longer smell or taste anything) and AGEUSIA (can no longer smell or taste anything!) in a patient of an unknown age and gender 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) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced ANOSMIA (can no longer smell or taste anything) and AGEUSIA (can no longer smell or taste anything!). At the time of the report, ANOSMIA (can no longer smell or taste anything) and AGEUSIA (can no longer smell or taste anything!) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant drug details were provided. No treatment details were provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1627637
Sex: F
Age: 54
State: PA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 08/24/2021
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: Tiredness; Injection arm soreness; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Tiredness) and VACCINATION SITE PAIN (Injection arm soreness) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 032L20A and 023M20A) for COVID-19 vaccination. The patient's past medical history included Breast cancer (left side). On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Jan-2021, the patient experienced FATIGUE (Tiredness) and VACCINATION SITE PAIN (Injection arm soreness). At the time of the report, FATIGUE (Tiredness) and VACCINATION SITE PAIN (Injection arm soreness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment information was provided.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am