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: 1644744
Sex: F
Age: 62
State: CA

Vax Date: 03/18/2021
Onset Date:
Rec V Date: 08/28/2021
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: dizzy; muscle pain/elt like she was beat up; bad headache; This spontaneous case was reported by a physician and describes the occurrence of in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045A21A and 001B21A) 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) (unknown route) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment information was reported. This case was linked to MOD-2021-283990 (Patient Link).

Other Meds:

Current Illness:

ID: 1644745
Sex: M
Age: 62
State: IL

Vax Date: 12/29/2020
Onset Date: 08/11/2021
Rec V Date: 08/28/2021
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: experienced sudden bleeding in lower leg like artery is broken; open skin 1mmx 1mm, small opening needle-stick like; This spontaneous case was reported by a physical therapist and describes the occurrence of HAEMORRHAGE (experienced sudden bleeding in lower leg like artery is broken) in a 63-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026L20A and 013L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Environmental allergy. Concomitant products included MULTIVITAMIN [VITAMINS NOS], VITAMIN D2, VITAMIN B12 NOS, FEXOFENADINE HYDROCHLORIDE (ALLEGRA), FLUTICASONE PROPIONATE, SALMETEROL XINAFOATE (WIXELA INHUB) and FLUTICASONE PROPIONATE (FLONASE [FLUTICASONE PROPIONATE]) for an unknown indication. On 29-Dec-2020, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 11-Aug-2021, the patient experienced HAEMORRHAGE (experienced sudden bleeding in lower leg like artery is broken) (seriousness criterion medically significant) and SKIN INJURY (open skin 1mmx 1mm, small opening needle-stick like). The patient was treated with NAPROXEN SODIUM (ALEVE) on 10-Aug-2021 for Headache, at a dose of 220 mg. At the time of the report, HAEMORRHAGE (experienced sudden bleeding in lower leg like artery is broken) and SKIN INJURY (open skin 1mmx 1mm, small opening needle-stick like) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication reported, as centrum. Company comment: 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. Further information has been requested; 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. Further information has been requested

Other Meds: MULTIVITAMIN [VITAMINS NOS]; VITAMIN D2; VITAMIN B12 NOS; ALLEGRA; WIXELA INHUB; FLONASE [FLUTICASONE PROPIONATE]

Current Illness: Environmental allergy

ID: 1644746
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: If a person received dose 1 and contracts symptomatic covid subsequently; 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 (If a person received dose 1 and contracts symptomatic covid subsequently) 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 COVID-19 (If a person received dose 1 and contracts symptomatic covid subsequently). At the time of the report, COVID-19 (If a person received dose 1 and contracts symptomatic covid subsequently) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided No treatment information was provided.

Other Meds:

Current Illness:

ID: 1644747
Sex: F
Age: 67
State: TN

Vax Date: 07/20/2021
Onset Date:
Rec V Date: 08/28/2021
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: covid arm that is not going away down to her elbow; Red; Hot; Peeling; Burning; Night sweats; Throat dry; Can't really eat; Mouth dry; feels like there are blisters in her mouth; Nauseous; Mild fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE REACTION (covid arm that is not going away down to her elbow), ERYTHEMA (Red), FEELING HOT (Hot), SKIN EXFOLIATION (Peeling) and BURNING SENSATION (Burning) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Jul-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 VACCINATION SITE REACTION (covid arm that is not going away down to her elbow), ERYTHEMA (Red), FEELING HOT (Hot), SKIN EXFOLIATION (Peeling), BURNING SENSATION (Burning), NIGHT SWEATS (Night sweats), DRY THROAT (Throat dry), DYSPHAGIA (Can't really eat), DRY MOUTH (Mouth dry), BLISTER (feels like there are blisters in her mouth), NAUSEA (Nauseous), PYREXIA (Mild fever) and CHILLS (Chills). At the time of the report, VACCINATION SITE REACTION (covid arm that is not going away down to her elbow), ERYTHEMA (Red), FEELING HOT (Hot), SKIN EXFOLIATION (Peeling), BURNING SENSATION (Burning), NIGHT SWEATS (Night sweats), DRY THROAT (Throat dry), DYSPHAGIA (Can't really eat), DRY MOUTH (Mouth dry), BLISTER (feels like there are blisters in her mouth), NAUSEA (Nauseous), PYREXIA (Mild fever) and CHILLS (Chills) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1644748
Sex: M
Age: 73
State: LA

Vax Date: 01/19/2021
Onset Date: 05/16/1997
Rec V Date: 08/28/2021
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: dizziness; vertigo; cold sweat; throwing up; nausea; high fever; Possible inner ear disease. She thinks it was from inner ear virus; This spontaneous case was reported by a consumer and describes the occurrence of VERTIGO (vertigo), COLD SWEAT (cold sweat), DIZZINESS (dizziness), LABYRINTHITIS (Possible inner ear disease. She thinks it was from inner ear virus) and VOMITING (throwing up) in a 73-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002M20A and 032L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Meniere's disease. Concomitant products included PANTOPRAZOLE for an unknown indication. On 19-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 16-May-1997, the patient experienced LABYRINTHITIS (Possible inner ear disease. She thinks it was from inner ear virus). On 16-May-2021, the patient experienced VERTIGO (vertigo), COLD SWEAT (cold sweat), VOMITING (throwing up), NAUSEA (nausea) and PYREXIA (high fever). On an unknown date, the patient experienced DIZZINESS (dizziness). At the time of the report, VERTIGO (vertigo), COLD SWEAT (cold sweat), DIZZINESS (dizziness), LABYRINTHITIS (Possible inner ear disease. She thinks it was from inner ear virus), VOMITING (throwing up), NAUSEA (nausea) and PYREXIA (high fever) outcome was unknown. Treatment medication was not provided by the reporter It was reported that patient was rushed to the hospital on 16 May 2021. Patient visited an ENT, and the ENT doctor said possible inner ear disease, but it was not diagnosed. Patient had MRI, CAT scan, and IV saline ? results not mentioned. Patient has an existing condition like Meniere disease.

Other Meds: PANTOPRAZOLE

Current Illness: Meniere's disease

ID: 1644749
Sex: F
Age:
State: TX

Vax Date: 01/17/2021
Onset Date:
Rec V Date: 08/28/2021
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: dementia; asthma; kind of sick; This spontaneous case was reported by a consumer and describes the occurrence of DEMENTIA (dementia) in a 72-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. The patient's past medical history included Bradycardia (patient had to be hospitalized.) in December 2019. On 17-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-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 DEMENTIA (dementia) (seriousness criterion medically significant), ASTHMA (asthma) and ILLNESS (kind of sick). At the time of the report, DEMENTIA (dementia), ASTHMA (asthma) and ILLNESS (kind of sick) outcome was unknown. No concomitant medication information was mentioned by reporter. No treatment medication information was mentioned by reporter. Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender's Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1644750
Sex: M
Age: 33
State: MN

Vax Date: 07/12/2021
Onset Date: 08/10/2021
Rec V Date: 08/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Date: 20210810; Test Name: heart rate; Result Unstructured Data: his heart rate to be 130bpm through 6am.; Test Date: 20210810; Test Name: Heart rate; Result Unstructured Data: couldn't get his heart rate below 110 the rest of the day

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: chest pain; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (chest pain) in a 33-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036C21A) for COVID-19 vaccination. No Medical History information was reported. On 12-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 10-Aug-2021, the patient experienced CHEST PAIN (chest pain) (seriousness criterion medically significant). At the time of the report, CHEST PAIN (chest pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 10-Aug-2021, Heart rate: 130 (High) his heart rate to be 130bpm through 6am. and high (High) couldn't get his heart rate below 110 the rest of the day. No concomitant medication information was mentioned by reporter The patient had blood work, an EKG and chest xray and results were unknown. The patient was put on a beta blocker and referred to a cardiologist. Company comment: 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.; 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.

Other Meds:

Current Illness:

ID: 1644751
Sex: F
Age: 25
State: TX

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 08/28/2021
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: Feeling going down to chest; Vomiting; Fever; Body aches; Headaches; Difficulty swelling/ like things would "stuck in his throat" ("not a breathing problem"); This spontaneous case was reported by a consumer and describes the occurrence of DYSPHAGIA (Difficulty swelling/ like things would "stuck in his throat" ("not a breathing problem")), FEELING ABNORMAL (Feeling going down to chest), VOMITING (Vomiting), PYREXIA (Fever) and MYALGIA (Body aches) in a 25-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 was provided. Concomitant products included SERTRALINE HYDROCHLORIDE (ZOLOFT) for an unknown indication. On 14-Apr-2021 at 2:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DYSPHAGIA (Difficulty swelling/ like things would "stuck in his throat" ("not a breathing problem")). On 15-Apr-2021, the patient experienced FEELING ABNORMAL (Feeling going down to chest), VOMITING (Vomiting), PYREXIA (Fever), MYALGIA (Body aches) and HEADACHE (Headaches). At the time of the report, DYSPHAGIA (Difficulty swelling/ like things would "stuck in his throat" ("not a breathing problem")), FEELING ABNORMAL (Feeling going down to chest), VOMITING (Vomiting), PYREXIA (Fever), MYALGIA (Body aches) and HEADACHE (Headaches) had resolved. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was withdrawn on an unknown date. Concomitant medications also included birth control pills. Treatment medication was not reported.

Other Meds: ZOLOFT

Current Illness:

ID: 1644752
Sex: F
Age: 69
State: GA

Vax Date: 06/30/2021
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: 100.4?F

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pain the hand; Could not lift arm very high; Chills; Fatigue did not bother much; Slight headache; Fever/100.4?F after first dose; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Pain the hand), MOBILITY DECREASED (Could not lift arm very high), CHILLS (Chills), FATIGUE (Fatigue did not bother much) and HEADACHE (Slight headache) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 078C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Cancer (cancer survivor). On 30-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In 2021, the patient experienced PAIN IN EXTREMITY (Pain the hand), MOBILITY DECREASED (Could not lift arm very high), CHILLS (Chills), FATIGUE (Fatigue did not bother much), HEADACHE (Slight headache) and PYREXIA (Fever/100.4?F after first dose). The patient was treated with CINNARIZINE (VERTEX [CINNARIZINE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Pain the hand), MOBILITY DECREASED (Could not lift arm very high), CHILLS (Chills), FATIGUE (Fatigue did not bother much), HEADACHE (Slight headache) and PYREXIA (Fever/100.4?F after first dose) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100.4 (High) 100.4?F. Concomitant medications include Blood Pressure tablets. Patient was advised to take Advil by HCP. This case was linked to MOD-2021-283839 (Patient Link).

Other Meds:

Current Illness:

ID: 1644753
Sex: U
Age:
State:

Vax Date: 05/18/2021
Onset Date:
Rec V Date: 08/28/2021
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: Feel fatigued; make my lymph nodes swell (causing a slight sore throat); This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Feel fatigued) and LYMPHADENOPATHY (make my lymph nodes swell (causing a slight sore throat)) 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 18-May-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 FATIGUE (Feel fatigued) and LYMPHADENOPATHY (make my lymph nodes swell (causing a slight sore throat)). At the time of the report, FATIGUE (Feel fatigued) and LYMPHADENOPATHY (make my lymph nodes swell (causing a slight sore throat)) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication was provided No treatment medication was provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644754
Sex: F
Age: 62
State: NC

Vax Date: 03/18/2021
Onset Date: 06/13/2021
Rec V Date: 08/28/2021
Hospital: Y

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: Had a stroke in her eye causing her to lose part of her vision in her only eye which was the left eye, Was in the closest hospital for a few hours, Hospitalized overnight and throughout the day; The clot broke off and went to her eye,plaque in her eye which killed off the blood vessels and a portion of her vision; Felt miserable, felt all over terrible; Laid in bed shaking from the chills; Breathing seems to be worse; Chills and laid in bed shaking from the chills; Headaches, having headaches on a regular basis, one about every day; This spontaneous case was reported by a consumer and describes the occurrence of BLINDNESS UNILATERAL (Had a stroke in her eye causing her to lose part of her vision in her only eye which was the left eye, Was in the closest hospital for a few hours, Hospitalized overnight and throughout the day) and EYE HAEMORRHAGE (The clot broke off and went to her eye,plaque in her eye which killed off the blood vessels and a portion of her vision) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 038A21A and 046B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Cancer (Cancer resulted in losing her right eye) and Headache. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Jun-2021, the patient experienced BLINDNESS UNILATERAL (Had a stroke in her eye causing her to lose part of her vision in her only eye which was the left eye, Was in the closest hospital for a few hours, Hospitalized overnight and throughout the day) (seriousness criteria hospitalization and medically significant). On an unknown date, the patient experienced EYE HAEMORRHAGE (The clot broke off and went to her eye,plaque in her eye which killed off the blood vessels and a portion of her vision) (seriousness criterion medically significant), FEELING ABNORMAL (Felt miserable, felt all over terrible), TREMOR (Laid in bed shaking from the chills), DYSPNOEA (Breathing seems to be worse), CHILLS (Chills and laid in bed shaking from the chills) and HEADACHE (Headaches, having headaches on a regular basis, one about every day). The patient was hospitalized from 13-Jun-2021 to 14-Jun-2021 due to BLINDNESS UNILATERAL. At the time of the report, BLINDNESS UNILATERAL (Had a stroke in her eye causing her to lose part of her vision in her only eye which was the left eye, Was in the closest hospital for a few hours, Hospitalized overnight and throughout the day), EYE HAEMORRHAGE (The clot broke off and went to her eye,plaque in her eye which killed off the blood vessels and a portion of her vision), FEELING ABNORMAL (Felt miserable, felt all over terrible), TREMOR (Laid in bed shaking from the chills), DYSPNOEA (Breathing seems to be worse), CHILLS (Chills and laid in bed shaking from the chills) and HEADACHE (Headaches, having headaches on a regular basis, one about every day) outcome was unknown. No relevant concomitant medications were reported. No treatment information was provided. She went to her closest hospital and was there for a few hours which didn't have the equipment to treat her. She was transferred to the emergency room of the second hospitalization facility which kept her overnight and throughout the day. She was discharged her 4-5PM 14JUN2021. After hospitalization, patient contacted her ophthalmologist who referred her to a retinal specialist who she has been seeing since. She has also seen both a cardiologist and neurologist. Patient had one about every day. She was prescribed some new eye drops after the stroke and has been taking the same medications for years. Company comment: 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. However, patient's underlying medical history remains a contributory factor.; 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. However, patient's underlying medical history remains a contributory factor.

Other Meds:

Current Illness:

ID: 1644755
Sex: F
Age:
State:

Vax Date: 05/01/2021
Onset Date:
Rec V Date: 08/28/2021
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: couldn't breathe; coughed for 10 days; severely sick; She did not receive the second dose at the scheduled time; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (couldn't breathe), COUGH (coughed for 10 days), ILLNESS (severely sick) and PRODUCT DOSE OMISSION ISSUE (She did not receive the second dose at the scheduled time) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 immunisation. The patient's past medical history included COVID-19 in November 2020. In May 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 DYSPNOEA (couldn't breathe), COUGH (coughed for 10 days), ILLNESS (severely sick) and PRODUCT DOSE OMISSION ISSUE (She did not receive the second dose at the scheduled time). At the time of the report, DYSPNOEA (couldn't breathe), COUGH (coughed for 10 days) and ILLNESS (severely sick) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (She did not receive the second dose at the scheduled time) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were reported. No Treatment information was reported. The patient got COVID in November 2020. She had the antibodies in January 2021. She received the Moderna COVID19 Vaccine in May 2021. Three weeks later, she got severely sick. She almost ended up in the hospital.

Other Meds:

Current Illness:

ID: 1644756
Sex: F
Age:
State: LA

Vax Date: 08/09/2021
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: High; Test Name: Heart rate; Result Unstructured Data: High

Allergies:

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

Symptoms: heartbeat faster; High fever; This spontaneous case was reported by a consumer and describes the occurrence of HEART RATE INCREASED (heartbeat faster) and PYREXIA (High fever) in a 39-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 ("long COVID" really bad in January 2021.) in January 2021. Concurrent medical conditions included Aneurysm and Kidney failure. On 09-Aug-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 HEART RATE INCREASED (heartbeat faster) and PYREXIA (High fever). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, HEART RATE INCREASED (heartbeat faster) and PYREXIA (High fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: high (High) High. On an unknown date, Heart rate: high heart beats per minute (High) High. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided.

Other Meds:

Current Illness: Aneurysm; Kidney failure

ID: 1644757
Sex: F
Age: 37
State: NE

Vax Date: 07/14/2021
Onset Date: 07/31/2021
Rec V Date: 08/28/2021
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: Test Date: 20210713; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive

Allergies:

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

Symptoms: The patient tested positive for COVID-19; This spontaneous case was reported by a pharmacist and describes the occurrence of COVID-19 (The patient tested positive for COVID-19) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 043B21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 31-Jul-2021, the patient experienced COVID-19 (The patient tested positive for COVID-19). At the time of the report, COVID-19 (The patient tested positive for COVID-19) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Jul-2021, SARS-CoV-2 test: positive (Positive) Positive. 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.

Other Meds:

Current Illness:

ID: 1644758
Sex: F
Age: 62
State: MS

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 08/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Date: 202104; Test Name: COVID-19; Test Result: Positive ; Result Unstructured Data: had COVID-19

Allergies:

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

Symptoms: Bones were aching,especially at my joints; This spontaneous case was reported by a consumer and describes the occurrence of BONE PAIN (Bones were aching,especially at my joints) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002F21A) for COVID-19 vaccination. The patient's past medical history included COVID-19 in April 2021. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Aug-2021, the patient experienced BONE PAIN (Bones were aching,especially at my joints). At the time of the report, BONE PAIN (Bones were aching,especially at my joints) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In April 2021, SARS-CoV-2 test: positive (Positive) had COVID-19. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds:

Current Illness:

ID: 1644759
Sex: M
Age:
State: FL

Vax Date: 02/21/2021
Onset Date:
Rec V Date: 08/28/2021
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: Patient did not receive second dose; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Patient did not receive second dose) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included COVID-19 (needed to be hospitalized) in March 2020. On 21-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 PRODUCT DOSE OMISSION ISSUE (Patient did not receive second dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Patient did not receive second dose) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided. It was reported that patient had never got the second dose because patient's doctor tested him for antibodies and he was full.

Other Meds:

Current Illness:

ID: 1644760
Sex: F
Age: 25
State: HI

Vax Date: 08/04/2021
Onset Date: 08/06/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: I went to the Emergency Room on Saturday the seventh of August. The Dr who saw me noted swelling (edema) of the leg and did an ultrasound which came out to show no blood clotting. I went back the next day because the pain was still there and I could not eat or sleep out of worrying about my leg. This Dr who saw me said that I may have had superficial thrombophlebitis but when he did an ultrasound he found no signs of clotting, and to be sure he had an ultrasound tech do a full leg ultrasound to make sure there was no clotting, which there was not. I followed up with my Primary Care Physician who said that the vein could have just been irritated by other factors. I listened to her advise to still take the second jab from Pfizer on the 25th of August. I still have intermittent pain in my leg and the vein still bulges since the fourth of August to the current date, the 27th of August. I have been elevating my legs a few times a day and using a compression stocking when I need to stand or sit for long periods of time. I am worried to run or over exert myself in fear of the vein popping out more. Before the vaccine I never had a vein bulge or pain in the area. I am an otherwise healthy 25 year-old.

Allergies: Pistachio nut

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

Symptoms: I received my first dose of the Pfizer vaccine in my left arm via injection on Wednesday the fourth of August, 2021. On Friday, two days later on the sixth of August I started to feel pain in my left leg and noticed a vein bulging out behind my knee. The pain comes at various parts of my leg (thigh, knee, calf, shin, foot) and leaves just as fast. It is not super painful, but it is enough for me to be irritated and worried.

Other Meds: None

Current Illness: None

ID: 1644761
Sex: F
Age: 66
State: AR

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: EKG showing I had a possible heart attack and now must see a cardiologist.

Allergies: I am hyper sensitive to most medications,yellow dye, pain medications, so I do not take drugs,(except thyroid medication) that includes over the counter medications. The only thing I use for pain is plain aspirin with no dyes or additives.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pounding heart,nausea,throwing up,diarrhea,dizziness,over all weakness,arm craps,high pulse rate

Other Meds: Levothyroxine 50mcg

Current Illness: I have since April 2020 battling chronic tonsillitis, swollen salivary glands and limp-nodes along with a now fixed abscessed tooth and had a root canal. I was on antibiotics (amoxicillin) the only antibiotic that does not cause serious side effects) repeatedly for those problems. Before I got the shot all those problems were taken care of.

ID: 1644762
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: Chronic coughing; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (Chronic 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 (Chronic coughing). At the time of the report, COUGH (Chronic coughing) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication were provided.

Other Meds:

Current Illness:

ID: 1644763
Sex: M
Age: 54
State: IN

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Soreness at injection site within 6 hours, shaking chills, headache, body ache, dizziness, fatigue, temperature increase to 102.6 within 20 hours. All symptoms gone after 36 hours.

Other Meds: Imatinib mesylate, atorvastatin, lisinopril, gabapentin, bupropion, clonazepam

Current Illness: None

ID: 1644764
Sex: F
Age:
State:

Vax Date: 07/20/2021
Onset Date: 07/20/2021
Rec V Date: 08/28/2021
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: Test Name: Blood pressure; Result Unstructured Data: High

Allergies:

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

Symptoms: Heart palpitations; Breathing problems; Lethargy; This spontaneous case was reported by a consumer and describes the occurrence of PALPITATIONS (Heart palpitations), DYSPNOEA (Breathing problems) and LETHARGY (Lethargy) 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 20-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Jul-2021, the patient experienced PALPITATIONS (Heart palpitations), DYSPNOEA (Breathing problems) and LETHARGY (Lethargy). At the time of the report, PALPITATIONS (Heart palpitations), DYSPNOEA (Breathing problems) and LETHARGY (Lethargy) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: high (High) High. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication reported. No treatment information was provided. It was reported that patient was declining the second dose.

Other Meds:

Current Illness:

ID: 1644765
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: Pains in my lower right side of my stomach; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN LOWER (Pains in my lower right side of my stomach) 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 ABDOMINAL PAIN LOWER (Pains in my lower right side of my stomach). At the time of the report, ABDOMINAL PAIN LOWER (Pains in my lower right side of my stomach) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1644766
Sex: F
Age: 69
State: GA

Vax Date: 06/30/2021
Onset Date:
Rec V Date: 08/28/2021
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: Arm was hurting/When patient press it hurts/pain the hand; Pain in the right side of throat; Could not lift arm very high; Vomiting; Chills; Fatigue did not bother much; Slight headache; Fever unknown after second dose; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Arm was hurting/When patient press it hurts/pain the hand), OROPHARYNGEAL PAIN (Pain in the right side of throat), MOBILITY DECREASED (Could not lift arm very high), VOMITING (Vomiting) and CHILLS (Chills) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Cancer (cancer survivor.). On 30-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Jul-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 PAIN IN EXTREMITY (Arm was hurting/When patient press it hurts/pain the hand), OROPHARYNGEAL PAIN (Pain in the right side of throat), MOBILITY DECREASED (Could not lift arm very high), VOMITING (Vomiting), CHILLS (Chills), FATIGUE (Fatigue did not bother much), HEADACHE (Slight headache) and PYREXIA (Fever unknown after second dose). The patient was treated with BETAHISTINE HYDROCHLORIDE (VERTEX [BETAHISTINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Arm was hurting/When patient press it hurts/pain the hand), OROPHARYNGEAL PAIN (Pain in the right side of throat), MOBILITY DECREASED (Could not lift arm very high), VOMITING (Vomiting), CHILLS (Chills), FATIGUE (Fatigue did not bother much), HEADACHE (Slight headache) and PYREXIA (Fever unknown after second dose) outcome was unknown. Concomitant medication included blood pressure tablets. It was reported that the healthcare professional recommended the patient to take Advil. This case was linked to MOD-2021-283816 (Patient Link).

Other Meds:

Current Illness:

ID: 1644767
Sex: M
Age: 37
State: PA

Vax Date: 06/07/2021
Onset Date: 07/10/2021
Rec V Date: 08/28/2021
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: Patient received 2 doses of the Astra Zeneca vaccine then received 1 dose of the Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Patient received 2 doses of the Astra Zeneca vaccine then received 1 dose of the Moderna vaccine) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051C21A) for COVID-19 vaccination. Co-suspect product included non-company product COVID-19 VACCINE NRVV AD (CHADOX1 NCOV-19) (COVID-19 VACCINE ASTRAZENECA) for COVID-19 vaccination. No Medical History information was reported. On 07-Jun-2021, the patient received second dose of COVID-19 VACCINE NRVV AD (CHADOX1 NCOV-19) (COVID-19 VACCINE ASTRAZENECA) (unknown route) dosage was changed to 1 dosage form. On 10-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient received first dose of COVID-19 VACCINE NRVV AD (CHADOX1 NCOV-19) (COVID-19 VACCINE ASTRAZENECA) (unknown route) 1 dosage form. On 10-Jul-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Patient received 2 doses of the Astra Zeneca vaccine then received 1 dose of the Moderna vaccine). On 10-Jul-2021, INTERCHANGE OF VACCINE PRODUCTS (Patient received 2 doses of the Astra Zeneca vaccine then received 1 dose of the Moderna 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 medications were reported. No treatment medications were provided by the reporter.

Other Meds:

Current Illness:

ID: 1644768
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: Terrible felling; Fever; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Terrible felling) 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 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 FEELING ABNORMAL (Terrible felling) and PYREXIA (Fever). At the time of the report, FEELING ABNORMAL (Terrible felling) and PYREXIA (Fever) outcome was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1644769
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data: Test Name: COVID-19 TEST; Test Result: Negative ; Result Unstructured Data: Negative.; Test Name: COVID-19 TEST; Test Result: Positive ; Result Unstructured Data: tested positive next day.

Allergies:

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

Symptoms: coughing bad; chills; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (coughing bad) and CHILLS (chills) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COUGH (coughing bad) and CHILLS (chills). At the time of the report, COUGH (coughing bad) and CHILLS (chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: (Negative) Negative. and (Positive) tested positive next day.. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication reported. No treatment medication reported.

Other Meds:

Current Illness:

ID: 1644770
Sex: F
Age:
State: CA

Vax Date: 02/04/2021
Onset Date:
Rec V Date: 08/28/2021
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: pain in left arm / feeling the needle is poking on arm; got thinner and lost weight after vaccination; high blood pressure; chest pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (pain in left arm / feeling the needle is poking on arm), WEIGHT DECREASED (got thinner and lost weight after vaccination), HYPERTENSION (high blood pressure) and CHEST PAIN (chest pain) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030L20A) for COVID-19 vaccination. No medical history was reported. Concomitant products included LISINOPRIL for Chest pain, HYDROCODONE and GABAPENTIN for Pain, METFORMIN and SIMVASTATIN for an unknown indication. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (pain in left arm / feeling the needle is poking on arm), WEIGHT DECREASED (got thinner and lost weight after vaccination), HYPERTENSION (high blood pressure) and CHEST PAIN (chest pain). The patient was treated with PARACETAMOL (TYLENOL) for Pain, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (pain in left arm / feeling the needle is poking on arm) had not resolved and WEIGHT DECREASED (got thinner and lost weight after vaccination), HYPERTENSION (high blood pressure) and CHEST PAIN (chest pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Reported that patient also used hot and cold compress and some ointment, not otherwise specified. Reporter did not allow further contact

Other Meds: METFORMIN; SIMVASTATIN; HYDROCODONE; GABAPENTIN; LISINOPRIL

Current Illness:

ID: 1644771
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: eyes pink; eyes swollen; This spontaneous case was reported by a patient and describes the occurrence of CONJUNCTIVITIS (eyes pink) and EYE SWELLING (eyes swollen) 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 CONJUNCTIVITIS (eyes pink) and EYE SWELLING (eyes swollen). At the time of the report, CONJUNCTIVITIS (eyes pink) and EYE SWELLING (eyes swollen) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644772
Sex: F
Age: 72
State: OR

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/28/2021
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: Hives; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Hives) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007D21A) for COVID-19 vaccination. No medical history was reported. Concomitant products included ROSUVASTATIN and VITAMINS NOS for an unknown indication. On 30-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Jul-2021, the patient experienced URTICARIA (Hives). At the time of the report, URTICARIA (Hives) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No treatment information was reported. The patient had an appointment on the 24th with PCP, to discuss the recommendation she was given to take J&J's vaccine as a second dose. She was hesitant of taking it while still having symptoms.

Other Meds: ROSUVASTATIN; VITAMINS NOS

Current Illness:

ID: 1644773
Sex: F
Age: 73
State: IL

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 08/28/2021
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: Did not get second dose in the series/ Scared to get the second dose; Fainted / collapsed; Passed out / unconscious; Fell face down; Black and blue bruising; Fever; This spontaneous case was reported by a consumer and describes the occurrence of SYNCOPE (Fainted / collapsed) and LOSS OF CONSCIOUSNESS (Passed out / unconscious) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Drug allergy (Unspecified pan shot). On 04-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, the patient experienced PYREXIA (Fever). On 05-May-2021, the patient experienced SYNCOPE (Fainted / collapsed) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (Passed out / unconscious) (seriousness criterion medically significant), FALL (Fell face down) and CONTUSION (Black and blue bruising). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Did not get second dose in the series/ Scared to get the second dose). At the time of the report, SYNCOPE (Fainted / collapsed), LOSS OF CONSCIOUSNESS (Passed out / unconscious), FALL (Fell face down), CONTUSION (Black and blue bruising), PRODUCT DOSE OMISSION ISSUE (Did not get second dose in the series/ Scared to get the second dose) and PYREXIA (Fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Patient was on no concomitant medications. Treatment medication was not provided by the reporter. Patient did not go the emergency room or hospital for evaluation. She decided not to get the second dose in the series at that time. The caller stated his wife was scared to get the second dose. Company Comment: 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: Drug allergy (Unspecified pan shot)

ID: 1644774
Sex: F
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: Broke out in rash, had to take Benadryl; This spontaneous case was reported by an other health care professional and describes the occurrence of RASH (Broke out in rash, had to take Benadryl) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) 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 RASH (Broke out in rash, had to take Benadryl). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Rash, at a dose of 1 dosage form. At the time of the report, RASH (Broke out in rash, had to take Benadryl) 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. Concomitant medications were not reported.

Other Meds:

Current Illness:

ID: 1644775
Sex: M
Age:
State: NH

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: he read in the newspaper about a man who had a blood clot after receiving the Moderna Covid-19 Vaccine; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (he read in the newspaper about a man who had a blood clot after receiving the Moderna Covid-19 Vaccine) 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 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 THROMBOSIS (he read in the newspaper about a man who had a blood clot after receiving the Moderna Covid-19 Vaccine) (seriousness criterion medically significant). At the time of the report, THROMBOSIS (he read in the newspaper about a man who had a blood clot after receiving the Moderna Covid-19 Vaccine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. no concomitant medications reported. no treatment medications reported. Reporter read in the newspaper about a man who had a blood clot after receiving the Moderna Covid-19 Vaccine. Company comment: Very limited information regarding this event has been provided at this time. However, 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.; Sender's Comments: Very limited information regarding this event has been provided at this time. However, 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.

Other Meds:

Current Illness:

ID: 1644776
Sex: F
Age:
State: MA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 08/28/2021
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: Body aches,soreness; Back Aches; Chills; Fever; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Body aches,soreness), BACK PAIN (Back Aches), CHILLS (Chills) and PYREXIA (Fever) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030M20A) for COVID-19 vaccination. No Medical History information was reported. On 27-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Feb-2021, the patient experienced PAIN (Body aches,soreness), BACK PAIN (Back Aches), CHILLS (Chills) and PYREXIA (Fever). On 28-Feb-2021, CHILLS (Chills) and PYREXIA (Fever) had resolved. On 01-Mar-2021, PAIN (Body aches,soreness) and BACK PAIN (Back Aches) had resolved. No concomitant medications were reported. No treatment medications were reported. This case was linked to MOD-2021-027213 (Patient Link).

Other Meds:

Current Illness:

ID: 1644777
Sex: F
Age:
State:

Vax Date: 07/06/2021
Onset Date:
Rec V Date: 08/28/2021
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: right arm hurt when she moved or put it in the air; sweats; massive headache; fatigue; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (right arm hurt when she moved or put it in the air), HYPERHIDROSIS (sweats), HEADACHE (massive headache) and FATIGUE (fatigue) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049C21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Jul-2021, 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 (right arm hurt when she moved or put it in the air), HYPERHIDROSIS (sweats), HEADACHE (massive headache) and FATIGUE (fatigue). At the time of the report, PAIN IN EXTREMITY (right arm hurt when she moved or put it in the air), HYPERHIDROSIS (sweats), HEADACHE (massive headache) and FATIGUE (fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment information was reported. This case was linked to MOD-2021-283888 (Patient Link).

Other Meds:

Current Illness:

ID: 1644778
Sex: M
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: He did not receive the second one as scheduled; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (He did not receive the second one as scheduled) 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 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 (He did not receive the second one as scheduled). At the time of the report, PRODUCT DOSE OMISSION ISSUE (He did not receive the second one as scheduled) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. Concomitant medication was not provided. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644779
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: injection site is red, itchy; injection site is red,red ring /circle size around it about 3" around injection site.; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (injection site is red, itchy) and VACCINATION SITE ERYTHEMA (injection site is red,red ring /circle size around it about 3" around injection site.) 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 VACCINATION SITE PRURITUS (injection site is red, itchy) and VACCINATION SITE ERYTHEMA (injection site is red,red ring /circle size around it about 3" around injection site.). At the time of the report, VACCINATION SITE PRURITUS (injection site is red, itchy) and VACCINATION SITE ERYTHEMA (injection site is red,red ring /circle size around it about 3" around injection site.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were reported. No Treatment information was reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644780
Sex: M
Age: 16
State: KS

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/28/2021
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: 16 Year old patient given 1st dose; This spontaneous case was reported by an other health care professional and describes the occurrence of OFF LABEL USE (16 Year old patient given 1st dose) in a 16-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007021A) for COVID-19 vaccination. No Medical History information was reported. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Aug-2021, the patient experienced OFF LABEL USE (16 Year old patient given 1st dose). On 11-Aug-2021, OFF LABEL USE (16 Year old patient given 1st dose) 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 treatment and concomitant drugs were provided. Reporter did not allow further contact.

Other Meds:

Current Illness:

ID: 1644781
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: The veins going down the arm feel swollen; The veins going down the arm feel tender to the touch; When I stretch my arm out I feel the pain down my veins; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (The veins going down the arm feel swollen), MYALGIA (The veins going down the arm feel tender to the touch) and PAIN IN EXTREMITY (When I stretch my arm out I feel the pain down my veins) 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 PERIPHERAL SWELLING (The veins going down the arm feel swollen), MYALGIA (The veins going down the arm feel tender to the touch) and PAIN IN EXTREMITY (When I stretch my arm out I feel the pain down my veins). At the time of the report, PERIPHERAL SWELLING (The veins going down the arm feel swollen), MYALGIA (The veins going down the arm feel tender to the touch) and PAIN IN EXTREMITY (When I stretch my arm out I feel the pain down my veins) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were reported No treatment medication were reported

Other Meds:

Current Illness:

ID: 1644782
Sex: F
Age:
State:

Vax Date: 08/06/2021
Onset Date: 08/01/2021
Rec V Date: 08/28/2021
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: light headed; Felt very cold; Every time they coughed they had a pain in their head; Nauseous; Extremely tired; Headache was stronger were they couldn't open their eyes; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (light headed), FEELING COLD (Felt very cold), COUGH (Every time they coughed they had a pain in their head), NAUSEA (Nauseous) and FATIGUE (Extremely tired) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 06-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In August 2021, the patient experienced DIZZINESS (light headed), FEELING COLD (Felt very cold), COUGH (Every time they coughed they had a pain in their head), NAUSEA (Nauseous), FATIGUE (Extremely tired) and HEADACHE (Headache was stronger were they couldn't open their eyes). At the time of the report, DIZZINESS (light headed), FEELING COLD (Felt very cold), COUGH (Every time they coughed they had a pain in their head), NAUSEA (Nauseous), FATIGUE (Extremely tired) and HEADACHE (Headache was stronger were they couldn't open their eyes) outcome was unknown. No concomitant medication information was provided. After the second dose patient couldn't lay on their side. No treatment medication were provided. This case was linked to MOD-2021-283875 (Patient Link).

Other Meds:

Current Illness:

ID: 1644783
Sex: F
Age: 85
State: OH

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/28/2021
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: Got 1 dose of moderna vaccine after completing the vaccination series with J&J vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Got 1 dose of moderna vaccine after completing the vaccination series with J&J vaccine) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No Medical History information was reported. On 07-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Aug-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Got 1 dose of moderna vaccine after completing the vaccination series with J&J vaccine). On 07-Aug-2021, INTERCHANGE OF VACCINE PRODUCTS (Got 1 dose of moderna vaccine after completing the vaccination series with J&J vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. No concomitant medication was provided. No treatment information was provided. On an unknown date in Mar-2021, the patient completed vaccination series with J & J COVID-19 vaccine. On 07-Aug-2021, the patient was supposed to get COVID-19 test done. Instead of the COVID test, the patient got first dose of the moderna COVID-19 vaccine. The patient was currently doing fine.

Other Meds:

Current Illness:

ID: 1644784
Sex: U
Age:
State: KY

Vax Date: 08/10/2021
Onset Date:
Rec V Date: 08/28/2021
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: patient vaccinated with vial where pharmacist not sure if punctured or not; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTRATION ERROR (patient vaccinated with vial where pharmacist not sure if punctured or not) in a 58-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 034C21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCT ADMINISTRATION ERROR (patient vaccinated with vial where pharmacist not sure if punctured or not). At the time of the report, PRODUCT ADMINISTRATION ERROR (patient vaccinated with vial where pharmacist not sure if punctured or not) 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 Medication was provided. No treatment was provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644785
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: nose was clogged; This spontaneous case was reported by a consumer and describes the occurrence of NASAL CONGESTION (nose was clogged) 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 NASAL CONGESTION (nose was clogged). At the time of the report, NASAL CONGESTION (nose was clogged) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment information was provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644786
Sex: F
Age: 17
State: CA

Vax Date: 04/15/2021
Onset Date: 08/11/2021
Rec V Date: 08/28/2021
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: Received pfizer vaccine; Vaccine received by a patient under 18 years of age; Swollen lymph nodes; Pains; Skin was hurting; Fuzzy headed; Started to get tired; Headaches; Injection site pain; Fever/low-grade fever/warm to touch/ fever has ranged between 101-102 Fahrenheit; Nausea; Aches; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (pains), PAIN OF SKIN ("skin was hurting"), FEELING ABNORMAL ("fuzzy headed"), FATIGUE ("started to get tired") and HEADACHE (headaches) in a 17-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 078l21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 15-Apr-2021, the patient received first dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (Intramuscular) 1 dosage form. On 06-May-2021, received second dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) dosage was changed to 1 dosage form. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Aug-2021, the patient experienced PAIN (pains), PAIN OF SKIN ("skin was hurting"), FEELING ABNORMAL ("fuzzy headed"), FATIGUE ("started to get tired"), HEADACHE (headaches), VACCINATION SITE PAIN (injection site pain), PYREXIA (FEVER/low-grade fever/warm to the touch/ fever has ranged between 101-102 Fahrenheit), NAUSEA (nausea) and MYALGIA (aches). On 12-Aug-2021, the patient experienced LYMPHADENOPATHY (swollen lymph nodes). On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (received pfizer vaccine) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (vaccine received by a patient under 18 years of age). At the time of the report, PAIN (pains), PAIN OF SKIN ("skin was hurting"), FEELING ABNORMAL ("fuzzy headed"), FATIGUE ("started to get tired"), HEADACHE (headaches), VACCINATION SITE PAIN (injection site pain), PYREXIA (FEVER/low-grade fever/warm to the touch/ fever has ranged between 101-102 Fahrenheit), NAUSEA (nausea), MYALGIA (aches) and LYMPHADENOPATHY (swollen lymph nodes) outcome was unknown and INTERCHANGE OF VACCINE PRODUCTS (received pfizer vaccine) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (vaccine received by a patient under 18 years of age) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product information was not provided. The patient was treated with Tylenol (dosed every 6 hours). On 11-Aug-2021 around 10:45 AM, the patient was supposed to be given a Hepatitis B vaccine as a school requirement, but instead, the patient was given the Moderna COVID-19 vaccine. Most recent FOLLOW-UP information incorporated above includes: On 12-Aug-2021: Added events : started to get tired" and "fuzzy headed, headaches, "skin was hurting",having a low-grade fever (warm to the touch)/fever/ fever has ranged between 101-102 Fahrenheit, nausea, aches and pains,enausea, swollen lymph nodes. All new events having outcome unknown. treatment was added. Co-suspect drug dosage information was added.

Other Meds:

Current Illness:

ID: 1644787
Sex: U
Age:
State: PA

Vax Date: 04/21/2021
Onset Date:
Rec V Date: 08/28/2021
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: patients who stated they received the first dose 6 weeks ago or longer; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (patients who stated they received the first dose 6 weeks ago or longer) 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 21-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 (patients who stated they received the first dose 6 weeks ago or longer). At the time of the report, PRODUCT DOSE OMISSION ISSUE (patients who stated they received the first dose 6 weeks ago or longer) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant product were reported No treatment information was provided.

Other Meds:

Current Illness:

ID: 1644788
Sex: F
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: started her period after a year of not having it; This spontaneous case was reported by a consumer and describes the occurrence of MENSTRUAL DISORDER (started her period after a year of not having it) in a 54-year-old female patient 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 MENSTRUAL DISORDER (started her period after a year of not having it). At the time of the report, MENSTRUAL DISORDER (started her period after a year of not having it) 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 treatment medication provided by the reporter. No concomitant medication provided by the reporter. No lab data information provided by the reporter Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644789
Sex: F
Age: 44
State: WI

Vax Date: 05/26/2021
Onset Date:
Rec V Date: 08/28/2021
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: headache; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (headache) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017C21A and 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 26-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jun-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 HEADACHE (headache). At the time of the report, HEADACHE (headache) outcome was unknown. Patient took a headache pill to treat symptoms. Patient takes concomitant medication but did not have them at hand to provide the names. This case was linked to MOD-2021-283780 (Patient Link).

Other Meds:

Current Illness:

ID: 1644790
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Feeling very on edge; Short tempered; This spontaneous case was reported by a consumer and describes the occurrence of HYPERVIGILANCE (Feeling very on edge) and ANGER (Short tempered) 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 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 HYPERVIGILANCE (Feeling very on edge) and ANGER (Short tempered). At the time of the report, HYPERVIGILANCE (Feeling very on edge) and ANGER (Short tempered) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were reported No treatment medication were reported

Other Meds:

Current Illness:

ID: 1644791
Sex: M
Age:
State: TN

Vax Date:
Onset Date:
Rec V Date: 08/28/2021
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: Patient hasn't received 2nd dose past 36 days; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Patient hasn't received 2nd dose past 36 days) 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 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 (Patient hasn't received 2nd dose past 36 days). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Patient hasn't received 2nd dose past 36 days) 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 medication reported. No treatment medication reported. Patient received first dose of vaccine in January and hadn't received 2nd dose past 36 days. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1644792
Sex: U
Age: 44
State: MA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/28/2021
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: A dose of Moderna Covid-19 vaccine was drawn up in a syringe on 10Aug2021 at 8:13a & was administered at 8:20p., I was wondering if there was a medication error.; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (A dose of Moderna Covid-19 vaccine was drawn up in a syringe on 10Aug2021 at 8:13a & was administered at 8:20p., I was wondering if there was a medication error.) in a 44-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 009C21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (A dose of Moderna Covid-19 vaccine was drawn up in a syringe on 10Aug2021 at 8:13a & was administered at 8:20p., I was wondering if there was a medication error.). On 10-Aug-2021, EXPIRED PRODUCT ADMINISTERED (A dose of Moderna Covid-19 vaccine was drawn up in a syringe on 10Aug2021 at 8:13a & was administered at 8:20p., I was wondering if there was a medication error.) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant Medications were reported No treatment medications were reported

Other Meds:

Current Illness:

ID: 1644793
Sex: F
Age: 78
State: NH

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 08/28/2021
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: swelling in the right arm; Right arm hurt; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (swelling in the right arm) and PAIN IN EXTREMITY (Right arm hurt) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 010A21A) for COVID-19 vaccination. Concurrent medical conditions included COPD, Drug allergy (Thimerosal) and Allergy multiple. Concomitant products included TIOTROPIUM BROMIDE MONOHYDRATE (SPIRIVA), FLUTICASONE FUROATE (ARNUITY ELLIPTA), MONTELUKAST, CETIRIZINE HYDROCHLORIDE (CETIRIZINE HCL) and LORATADINE 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 10-Mar-2021, the patient experienced PERIPHERAL SWELLING (swelling in the right arm) and PAIN IN EXTREMITY (Right arm hurt). In March 2021, PERIPHERAL SWELLING (swelling in the right arm) and PAIN IN EXTREMITY (Right arm hurt) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Other Concomitant medication includes ZATIDOR eye drops during allergy season. No Treatment medications were reported. This case was linked to MOD-2021-284124 (Patient Link).

Other Meds: SPIRIVA; ARNUITY ELLIPTA; MONTELUKAST; CETIRIZINE HCL; LORATADINE

Current Illness: Allergy multiple; COPD; Drug allergy (Thimerosal)

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am