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
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0922308
Sex: F
Age: 55
State: AZ

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Adhesive, Codeine

Symptoms: High fever to 102.5, chills, nausea, severe headache, body aches, unable to function with severe weakness for 1 day, very sore arm, swollen arm

Other Meds: Levothyroxine, Vitamin D, Vitamin B, Iron, Potassium, Lisinopril

Current Illness: None

ID: 0922309
Sex: M
Age: 29
State: PA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Mold

Symptoms: Mild nausea, diffuse myalgia, chills, fever to 101.5.

Other Meds: Advair, albuterol, spiriva

Current Illness:

ID: 0922310
Sex: F
Age: 35
State: MA

Vax Date: 12/23/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: N/A

Allergies: Peaches, plums, apples, kiwi, pears

Symptoms: After 1 week of receiving the vaccine, I woke up with my arm red, warm, swollen and itchy. It had become that way on the 3rd day but had resolved. It has now resolved.

Other Meds: Nexplanon

Current Illness:

ID: 0922311
Sex: F
Age: 58
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Elevated blood pressure, dizziness, difficulty concentrating, fatigue, nausea.

Other Meds: Lisinopril 10mg

Current Illness:

ID: 0922312
Sex: F
Age: 37
State: CT

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Migraine headache, vomiting 2pm day of Overnight fever 101.5

Other Meds: Zoloft 150 mg Synthroid 25 meg Prenatal vitamin

Current Illness:

ID: 0922313
Sex: F
Age: 36
State: MD

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Amoxicillin, percocet, steroids, seasonal

Symptoms: Day 1 of shot- soreness after a couple of hours at injection site Day 2- extreme fatigue (slept most of day), severe pain in left shoulder (couldn't move arm forward), chills, widespread muscle and joint aching Day 3- improved widespread S/S but still with pain specifically with left shoulder flexion and internal and external rotation Day 4- felt significantly better and able to raise arm overhead without pain, able to go about daily tasks Day 5- 5:45 am in morning- woke up with injection arm in severe spasm- painful to lift forward and rotate again, noticed decrease in sensation in anterolateral left shoulder to touch Day 6- 4:45 am- woke up with left arm in spasm again, pain with movement or weight bearing up to 8/10, feels swollen in chest and anterolateral left shoulder, referred pain in front of arm into biceps insertion, pain in injection site in anterolateral aspect of left shoulder

Other Meds: Iron, omega 3, prenatal vitamins, zyrtec, flonase

Current Illness: None

ID: 0922314
Sex: M
Age: 34
State: IA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: I will be contacting a dr today 1,6,21

Allergies: Macro antibiotics erythromycin

Symptoms: 1 hour after injection mild headache starts. 6 hours after injection headache intensity increases cold sweat starts run down feeling start cognitive fog sets in 9 hour after injection headache turn in to migraine. sweating on and off with hot and cold chills 12 hours after injection my joints began to hurt arm pain increases to the point its hard to move my arm and i now feel flu like and am more run down i am now 9 days out i still have arm pain still feel flu like and even more run down with a heavy chest i can still tease and smell but feel like i have a full blown flu and my skin is on fire but have no fever

Other Meds: N/a

Current Illness: Na

ID: 0922316
Sex: F
Age: 27
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Sudden onset shakiness and became light headed with tunnel vision. Almost passed out. Episode lasted about 5 minutes but generalized weakness lasted for about an hour.

Other Meds: Synthroid, Cetirizine

Current Illness:

ID: 0922317
Sex: F
Age: 43
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Codeine, erythromycin, wellbutrin, metronidazole, penicillin

Symptoms: Urticaria to neck at 11:00, approx 2.5 hrs after immunization. No airway involvement. Took Zyrtec 10mg.

Other Meds: Synthroid

Current Illness: None

ID: 0922318
Sex: F
Age: 28
State: NJ

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Body aches and fatigue about 5 hours after injection. Worsening body aches and head ache around 9pm on same day. 5am on 1/6 severe body aches and temperature of 100.3

Other Meds:

Current Illness:

ID: 0922319
Sex: F
Age: 37
State: VA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Fever

Other Meds: None

Current Illness: None

ID: 0922320
Sex: F
Age: 54
State: NJ

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: Levaquin,Reglan,Augmentin

Symptoms: at approximately 11:30 am 12/23/20 began to have: generalized body aches and weakness,headache,severe pain in left arm , chills, temperature max 99.9 degrees F; extreme fatigue,drowsy,small area of redness at injection site with mild itchiness. Symptoms resolved approximately 12 hours later. I took Motrin 800mg at onset of symptoms and Excedrin extra strength (2) caplets approximately 8 hours later for lingering headache.

Other Meds: Pepcid,Probiotic gummies,Multivitamin gummies,VitaminD3,Excedrin

Current Illness: none

ID: 0922321
Sex: F
Age: 42
State: MS

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Raised, itchy red circular area to left arm below injection site 1 week after injection

Other Meds: Provigil, multivitamin, Vit D3, b complex

Current Illness: None

ID: 0922322
Sex: F
Age: 28
State: FL

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Keflex

Symptoms: Around 1/5/2021 started feeling slight tingling of R foot which has carried on till present time 1/6/21 0600. Around 1/5/21 2100 started experiencing frequents stools leading to persistent diarrhea until present time.

Other Meds: Synthroid 88 mcg, Tylenol 500 mg

Current Illness:

ID: 0922323
Sex: F
Age: 23
State: NC

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: Latex

Symptoms: Fifteen minutes after getting vaccine passed out and went unconscious. Heart rate 148 and 02 at 85. Placed on 2l02 and brought to hospital to where I was dischsrhed.

Other Meds: None

Current Illness: None

ID: 0922324
Sex: F
Age: 46
State: WI

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: IV Iron

Symptoms: Initial sore arm, approximately 31 hours after injection developed a slight headache. By 6am on the 2nd day had an intense migraine headache.

Other Meds: none

Current Illness: none

ID: 0922325
Sex: F
Age: 61
State: TN

Vax Date: 12/29/2020
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: None

Allergies: Dilantin, penicillin, cleocin, zithromax, effexor,

Symptoms: Welts to lower extremity evening on the day of vaccination. Systemic rash 4 days later with severe itching.

Other Meds: Tylenol, Bystolic, Xeralto, vitamin D, famotidine

Current Illness: None

ID: 0922326
Sex: M
Age: 32
State: AZ

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: body aches / body chills / head ache / high fever / lack of appetite / irritability. rest / hydration / small amounts of food / light activity to avoid bed sorness. all at home

Other Meds: none

Current Illness: none

ID: 0922327
Sex: M
Age: 55
State: MN

Vax Date: 12/22/2020
Onset Date: 12/25/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: Clinic visit on monday 1/4 labs all normal, Covid swab yesterday negative.

Allergies: nka

Symptoms: Woke up very fatigued 12/25 only minimal activity performed creating additional fatigue. Was sleeping 12 plus hours a day without feeling rested in the least. No problems with sleep. Also had heaviness of chest - felt like rib cage made of iron- this dissipated by the 28-29th. No excessive cough or fever, did have dyspnea with any exertion and this continues but seems to be lessening. Was not able to work due to fatigue. Yesterday remained tired but felt noticeably different-felt lighter-and today seems promising.

Other Meds: multivitamin, melatonin 3mg, serequel 50mg

Current Illness: none

ID: 0922328
Sex: F
Age: 63
State: NH

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: non

Allergies: SULFA FUROSEMIDE

Symptoms: Developed itchy painful rash 8 days after vaccination at injection site about 4 inches x 4 inches

Other Meds: LISINOPRIL CLIMARA 0.25 MCG PATCH MULTIVITAMINS VITAMIN D VITAMIN K COQ10

Current Illness: NONE

ID: 0922329
Sex: F
Age: 53
State: PA

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data: I took pictures and treated with Zyrtec and mottin

Allergies: Nka

Symptoms: Swelling on chin area that was filled with juvaderm 7 months ago

Other Meds: Lisinopril Milk thistle. Mvm. Vit d

Current Illness: No

ID: 0922330
Sex: F
Age: 41
State: NY

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: 1/2/21-PCR COVID-negative at Urgent Care 1/4/21-rapid Covid, Flu A&B all negative 1/5/21 CBC and CMP-WBC low (only lab slightly out of whack), MD thinks as vaccine immune response

Allergies: none

Symptoms: enlarged lymphnodes not decreasing in size, chronic fatigue, NVDx5 days, fever, chills, general unwellness since vaccine. Nausea and Diarrhea hasn't subsided yet and lymphnodes still enlarged.

Other Meds: None

Current Illness: none

ID: 0922331
Sex: F
Age: 44
State: RI

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data: 1/5/21 Ultrasound CMP/CRP/CBC w DIFF IV Therapy Antibiotic Infusion x2 (1/5/21 and 1/6/21) Oral antibiotics

Allergies: Shellfish

Symptoms: Initial swelling and soreness right after injection. Swelling and pain continued for the next few days, Motrin 800mg and Benadryl 25mg at bedtime were taken. Swelling and pain persisted. Area became hard, red, itchy and raised over the holiday. Swelling, redness and itchiness became worse over the weeknd into Monday. I was unable to lift my arm, bring it behind my back or reach. It was very painful and hot. I then contacted employee health. They did not feel it was infected but was the delayed reaction to the moderna vaccine. I did not feel comfortable with this and I then contacted my physician who looked at it and felt it was in fact cellulitis, I was sent for a ultrasound to rule out a blood clot and labs and an IV infusion of Rocephin as well as oral antibiotics. I received my first infusion yesterday. The swelling has improved greatly, however the redness has spread beyond the marked area on my arm and I will be receiving another dose of IV Rocephin today. My labs showed my CRP was elevated and my ALT/AST were elevated as well.

Other Meds: Bystolic 5mg Levothyroxine 100mcg Pristiq 100mg alprazolam 0.05 mg flexaril 10mg prn motrin 800mg prn

Current Illness: N/A

ID: 0922332
Sex: F
Age: 30
State: TN

Vax Date: 01/02/2021
Onset Date: 01/03/2021
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: 99.7 fever, fatigue, swelling and painful blisters on tongue

Other Meds: Daily multivitamin, cetirizine, biotin, vitamin D

Current Illness: None

ID: 0922350
Sex: F
Age: 11
State: MO

Vax Date: 09/26/2019
Onset Date: 09/26/2019
Rec V Date: 01/06/2021
Hospital: Y

Lab Data: Test Date: 20190926; Test Name: pulse oximetry; Test Result: 96 %

Allergies:

Symptoms: mildlydiaphoretic / she did sweat; She complains of being thirsting; she felt like she was going to throw up; dizzy; This spontaneous report was received from a healthcare professional via Food and Drug Administration (FDA) referring to a 11 years old female patient on 22-OCT-2020. The patient's concomitant therapies included lithium carbonate and chlorpromazine hydrochloride (THORAZINE). The patient had no known allergies (NKA)/no known drug allergies (NKDA). The patient had no other illness at the time of vaccination or up to one month prior. The patient had no chronic or long-standing health conditions. The patient did not have an adverse event following the previous vaccine. On 26-SEP-2019, at 13:25, the patient came over to clinic and was vaccinated with the first dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) (lot# 1602289, not valid, expiration date and dose detail were not provided) intramuscularly in the right arm (also reported as left deltoid) for prophylaxis. The patient was also vaccinated with the first dose of meningococcal acyw conj vaccine (crm197) (MENVEO) (lot# U6543AA, expiration date, dose detail and indication were not provided) intramuscularly in the left arm (it was also reported the patient was given meningococcal ACYW conj vaccine (dip toxoid) (MENACTRA) injection in the right deltoid) in the medication room. On 26-SEP-2019, at 13:30, the patient walked out to hallway in clinic to get a stuffed animal and she complained of (c/o) being dizzy per a doctor. The doctor assigned her to a chair in the clinic. She was mildly diaphoretic. The nurse took her vital signs (VS) and the patient then said, she felt like she was going to throw up. She closed her eyes briefly. The nurse gave her a few sternal rubs. She responded to the sternal rubs, she c/o being thirsting. Epinephrine pen was given per the doctor. The patient was able to answer question appropriately then she stated she felt better. VS results as following: pulse oximetry was 96% to room air (RA), pulse was 84 (unit not provided), temperature was 97.5 (unit not provided), blood pressure (b/p) was 97/64 (unit not provided). The staff called 911. When ambulance arrived, she was able to answer questions by emergency personnel. She was transported to emergency room (ER) per ambulance. She returned from ER around 17:00 on the same day. The therapist checked in with the patient. She was monitored through out night and legal guardian was notified. The patient recovered from above events in 2019. The causal relationship between hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) and the events was not provided. Follow-up information has been received from a physician and a nurse on 31-DEC-2020, referring to a currently 12 year old female patient. The physician stated that it was not clear when this happened, but stated that the patient sweated and vomiting, however, did not experienced dizziness. Additionally, was reported that the clinic was a residential facility, where children were admitted and discharged and if this was the only child anything had ever happened with, she believed the child was still at the facility (hospitalization). Additional information received from the nurse that vaccinated the patient and stated that on 26-SEP-2019, the patient was vaccinated with HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (GARDASIL 9) lot # 1602284 (previously reported as "1602289"), expiration date 26-SEP-2021, intramuscularly in the left deltoid (previously reported as "right arm"), meningococcal ACYW conj vaccine (dip toxoid) (MENACTRA) lot # U6543AA, expiration date 23-FEB-2021 (lot # previously reported for meningococcal ACYW conj vaccine (CRM197) (MENVEO)), intramuscularly, in the left deltoid (previously reported as "right deltoid") and meningococcal ACYW conj vaccine (CRM197) (MENVEO). On the same date, the patient experienced hyperhidrosis, thirst, vomiting and dizziness. The patient recovered from adverse events. These adverse events were previously reported to doctor and to manufacturer. The vaccine was used according to the instruction leaflet. There was no a previous temperature excursion. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: 1602284; expirationdate: 26-SEP-2021; deviceage and unit: 0 ; malfunction: Unknown; productavailableforevaluation: No; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not suggest a causal association with the device or device constituent

Other Meds: lithium carbonate; THORAZINE; GARDASIL 9 SYRINGE (DEVICE);

Current Illness:

ID: 0922352
Sex: U
Age: 1
State: WA

Vax Date: 12/03/2020
Onset Date: 12/03/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: no additional AE; VARIVAX was improperly stored and administered; This spontaneous report was received from a medical assistant and refers to a 1-year-old old patient of unknown gender. No information regarding the patient's pertinent medical history, drug reactions or allergies and concomitant therapies was provided. On 03-DEC-2020, the patient was vaccinated with an improperly stored dose of varicella virus vaccine live (oka/merck)(VARIVAX) 0.5 milliliter, lot # T002843, expiry date 23-JAN-2022 for prophylaxis (strength and route of administration were not reported). There was no adverse event reported. Administered dose of vaccine experienced the temperature excursion of 31.6 degrees Fahrenheit for 22 days. Data logger was not involved. There were no previous excursions reported.

Other Meds:

Current Illness:

ID: 0922353
Sex: F
Age: 15
State: OH

Vax Date: 08/06/2012
Onset Date: 01/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: interchange of vaccine products; vaccine administered outside the recommended dosing schedule; This spontaneous report was received from a pharmacist and refers to a 23 year old female patient. The patients concurrent conditions, pertinent medical history or drug reactions were not reported. On 06-AUG-2012, at 15 years old, the patient began series with the initial dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, lot #, expiration date, dose, route and frequency were not reported), the next doses of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) were administered to the patient on 08-JAN-2020 and 15-JUN-2020, both for prophylaxis at 0.5 milliliter dosage (strength, lot #, expiration date, route and frequency were not reported) (interchange of vaccine products and inappropriate schedule of product administration).

Other Meds:

Current Illness:

ID: 0922354
Sex: M
Age:
State: PA

Vax Date: 12/15/2020
Onset Date: 12/15/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; Patient was inadvertently administered an expired dose of ROTATEQ; This spontaneous report has been received from a registered nurse concerning a 7 months-old male patient. The patient's concurrent conditions, historical drugs, medical history and concomitant therapies were not reported. On 15-DEC-2020, the patient was inadvertently vaccinated with an expired dose of rotavirus vaccine, live, oral, pentavalent(ROTATEQ) 2 ml, Lot # S017630, expiration date 06-DEC-2020 for prophylaxis (dosage regimen was not reported). The administered dose did not experience any temperature excursion and no additional adverse events were reported.

Other Meds:

Current Illness:

ID: 0922355
Sex: U
Age: 1
State: SD

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional adverse event; Improperly stored VARIVAX was administered to the patient; This spontaneous report was received from a registered nurse and refers to a 12 month old patient, gender not reported. The patient's concurrent conditions, drug reactions or allergies and pertinent medical history were not reported. On 21-DEC-2020, the patient was vaccinated with an improperly stored varicella virus vaccine live (oka/merck)(VARIVAX) lot # T000344, expiration date 05-JAN-2022 ( dose and route were not reported) for prophylaxis. The vaccine was stored at -8.5 Celsius degrees (?C) for 8 hours. The vaccine also had previous temperatures excursions at -14.1?C for 1 hour and -11.9?C for 2 hours and 30 minutes. The vaccine was reconstituted with a properly store sterile diluent (MERCK STERILE DILUENT). No additional adverse event. The call was made due to "data logger".

Other Meds: MERCK STERILE DILUENT

Current Illness:

ID: 0922356
Sex: U
Age:
State: CA

Vax Date: 11/05/2020
Onset Date: 11/05/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE/PQCs reported; Administration of improperly stored PROQUAD; This spontaneous report was received from a medical assistant concerning to a patient of unknown age and gender. The patient's medical history, historical drugs, allergies, concurrent conditions and concomitant therapies were not provided. On 05-NOV-2020, the patient was vaccinated with an improperly stored dose of measles, mumps, rubella and varicella (oka-merck) virus vaccine live (rHA) (PROQUAD) for prophylaxis, lot number reported as T015598 and expiration date as 02-NOV-2021 (dose, vaccination scheme and route of administration were not provided). No additional adverse event reported. The vaccine had a temperature excursion of 20.5?F (degree Fahrenheit) for a time frame of 1 hour 54 minutes, and the data was recorded by a digital data logger. It was also reported a previous temperature excursion of 6?F to 14?F (12.3F) for 23 hours.

Other Meds:

Current Illness:

ID: 0922357
Sex: U
Age:
State: CA

Vax Date: 11/02/2020
Onset Date: 11/02/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE/PQCs reported; Administration of improperly stored PROQUAD; This spontaneous report was received from a medical assistant concerning to a patient of unknown age and gender. The patient's medical history, historical drugs, allergies, concurrent conditions and concomitant therapies were not provided. On 02-NOV-2020, the patient was vaccinated with an improperly stored dose of measles, mumps, rubella and varicella (oka-merck) virus vaccine live (rHA) (PROQUAD) for prophylaxis, lot number reported as T015598 and expiration date as 02-NOV-2021 (dose, vaccination scheme and route of administration were not provided). No additional adverse event reported. The vaccine had a temperature excursion of 20.5?F (degree Fahrenheit) for a time frame of 1 hour 54 minutes, and the data was recorded by a digital data logger. It was also reported a previous temperature excursion of 6?F to 14?F (12.3?F) for 23 hours.

Other Meds:

Current Illness:

ID: 0922358
Sex: F
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant female patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922359
Sex: M
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant male patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922360
Sex: M
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant male patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922361
Sex: F
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant female patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922362
Sex: M
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant male patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922363
Sex: F
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant female patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922364
Sex: F
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant female patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922365
Sex: F
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant female patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922366
Sex: M
Age:
State: TX

Vax Date: 11/08/2020
Onset Date: 11/08/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE; multiple temperature excursions/multiple doses of ROTATEQ were administered to multiple patients; This spontaneous report was received from an office administrator referring to an infant male patient of unknown age. Information regarding the patient's pertinent medical history, historical drugs, concurrent conditions, concomitant therapies, and previous drug reactions or allergies was not reported. On 08-NOV-2020, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) lot # 1661000, expiration date 13-MAY-2021, at a dose of 2 milliliter once, orally for prophylaxis. There were multiple temperature excursions (temperature values and time frames were not reported) recorded by a data logger. No addtional adverse event reported. This is one of several reports received from the same reporter.

Other Meds:

Current Illness:

ID: 0922367
Sex: U
Age: 14
State: NJ

Vax Date: 12/15/2020
Onset Date: 12/15/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Caller reporting temperature excursion, product was administered; This spontaneous report was received from a registered nurse referring to a 14-year-old patient. The patient's pertinent concurrent conditions, medical history and concomitant medications were not reported. On 15-DEC-2020, the patient was vaccinated with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) (lot number 1637641 and expiration date reported 16-FEB-2022) and hepatitis a vaccine, inactivated (VAQTA) (lot number T013204 and reported expiration date 03-DEC-2021) both as prophylaxis at a dose of 0.5 milliliter, concentrations, vaccination scheme frequency, routes of administration and anatomical locations were not reported. According to the reporter, the temperature excursion of both vaccines was 0.38 degrees Celsius for a time frame of four hours and 45 minutes and 11.09 degrees Celsius for 1 hour and 30 minutes on an unspecified date (product storage error), hepatitis a vaccine, inactivated (VAQTA) without any previous temperature excursion, however the hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) vaccine had a previous temperature of excursion of 17.52 degrees Celsius for 2 hours and 42 minutes; which were detected by a digital data logger.

Other Meds:

Current Illness:

ID: 0922368
Sex: U
Age:
State: PA

Vax Date: 10/27/2020
Onset Date: 10/27/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Improperly stored PROQUAD was administered to patient; This spontaneous report was received from a medical assistant referring to a patient of unknown age and gender. Information regarding the patient's pertinent medical history, drug allergies or reactions or concomitant medications was not provided. On 27-OCT-2020, the patient was vaccinated with an improperly stored dose of measles, mumps, rubella and varicella (oka-merck) virus vaccine live (PROQUAD), for prophylaxis (dose, route of administration, vaccination scheme frequency, anatomical location were not reported; lot number S021326 verified to be valid with expiration date of 05-JAN-2021). The administered dose of the vaccine experienced a temperature excursion at an unknown temperature and timeframe. It was unknown by the reporter if there were previous temperature excursion.

Other Meds:

Current Illness:

ID: 0922369
Sex: U
Age: 17
State: NJ

Vax Date: 12/15/2020
Onset Date: 12/15/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Nurse reported temperature excursion with GARDASIL 9 and VAQTA.; This spontaneous report as received from a Registered Nurse referring to a 17 year old patient of unknown gender. The patient's medical history, concurrent conditions, concomitant medications, and historical drugs were not reported. On 15-DEC-2020, the patient was vaccinated with an improperly stored dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) 0.5 milliliter (strength, route, frequency, and anatomical location were unknown) with lot # 1637641 and expiration date on 16-FEB-2022; and finally with an improperly stored dose of Hepatitis A Vaccine, Inactivated(VAQTA) 0.5 milliliter (strength, route, frequency, and anatomical location were unknown) with lot # T013204 and expiration date on 03-DEC-2021 for prophylaxis. The administered doses of vaccines experienced temperature excursion (0.38 degrees Celsius) for 4 hours and 45 minutes and (11.09 degrees Celsius) for 1 hour and 30 minutes. There was a digital data logger invloved, but no previous temperature excursion for Hepatitis A Vaccine, Inactivated(VAQTA) but there was a previous temperature excursion with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) (17.52 degrees Celsius) for 2 hours and 42 minutes.

Other Meds:

Current Illness:

ID: 0922370
Sex: U
Age: 1
State: IL

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No other AE details available at this time; Caller reported temperature excursion.; This spontaneous report was received from a registered nurse, referring to a 12-months-old patient of unknown gender. The patient's pertinent medical history, current conditions, previous drug reactions or allergies and concomitant medications were not provided. On 21-DEC-2020, the patient was vaccinated with varicella virus vaccine live (oka/merck) (VARIVAX), at a dose of 0.5 milliliter (ml), as prophylaxis (formulation, strength, vaccination scheme, route of administration and anatomical site of vaccination were not reported; lot number T017688, which has been verified to be valid, expiration date reported and validated as 21-MAY-2022). The vaccine administered experienced a temperature excursion of -13.3 degrees Celsius (C), for a time frame of 4 hours and 15 minutes, as recorded by a data logger (product storage error). There was no previous temperature excursion reported. No additional adverse events were reported. This is one of several reports received from the same reporter.; Sender's Comments: US-009507513-2012USA013093: US-009507513-2012USA013095: US-009507513-2012USA013524: US-009507513-2012USA013539:

Other Meds:

Current Illness:

ID: 0922371
Sex: U
Age: 1
State: IL

Vax Date: 11/10/2020
Onset Date: 11/10/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE information provided.; Caller reported temperature excursion / Caller reported multiple administrations of product; This spontaneous report was received from a nurse, referring to a 12-month-old patient. The patient's pertinent medical history, concurrent conditions, previous drug reactions, or allergies were not reported. On 10-NOV-2020, the patient was vaccinated with varicella virus vaccine live (oka/merck) (VARIVAX) injection, at a dose of 0.5 milliliter (ml) (strength, vaccination scheme, anatomical site of injection and route of administration were not reported; lot number T017688, expiration date: 21-MAY-2022) as prophylaxis, that experienced a temperature excursion (product storage error). No additional adverse effect (AE) information provided. On unknown dates, the vaccine underwent a temperature excursion of minus 13.3 degrees Celsius (C) for 4 hours and 15 minutes, as recorded by a data logger. There was no previous temperature excursion.; Sender's Comments: US-009507513-2012USA013501:

Other Meds:

Current Illness:

ID: 0922372
Sex: F
Age:
State: IL

Vax Date:
Onset Date: 12/01/2020
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: This spontaneous report was received from a dentist referring to a 14-month-old Caucasian female patient. The patient's medical history, historical drugs, concurrent conditions and concomitant medications were not provided. On an unknown date, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) 1 dosage form (route of administration, lot number and expiration date were not provided) for prophylaxis. In December 2020 the patient experienced full body rash. On 16-DEC-2020 the patient experienced fussiness (irritability) and low-grade fever. The outcome of irritability and pyrexia was reported as recovered on that same day. The outcome of rash was unknown. The causal relationship between measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) and the events was reported as probably.

Other Meds:

Current Illness:

ID: 0922373
Sex: M
Age:
State: OH

Vax Date:
Onset Date:
Rec V Date: 01/06/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: hospitalized in 2016 because my temperature and white blood cell count were high.; hospitalized in 2016 because my temperature and white blood cell count were high.; I have ping-pong ball sized bumps on my armpits, neck, stomach, and knees.; I have rashes behind my knees and sometimes have sharp or throbbing pain in my arms and legs.; I have rashes behind my knees and sometimes have sharp or throbbing pain in my arms and legs./ I have needle-like pain in my feet when I walk.; I have lost my balance and fallen; fallen; I feel a sharp burst of pain in my brain and I have short term memory loss.; I feel a sharp burst of pain in my brain and I have short term memory loss.; smoke marijuana all the time."; My fingers twitch/spasm randomly without me feeling it.; I have ping-pong ball sized bumps on my armpits, neck, stomach, and knees.; I have ping-pong ball sized bumps on my armpits, neck, stomach, and knees.; I have ping-pong ball sized bumps on my armpits, neck, stomach, and knees.; diverticulitis; I couldn't eat because of the needle-like pain in my stomach. I had an endoscopy, colonoscopy, tests for Diverticulitis and Irritable Bowl Syndrome (IBS).; I couldn't eat because of the needle-like pain in my stomach. I had an endoscopy, colonoscopy, tests for Diverticulitis and Irritable Bowl Syndrome (IBS).; I couldn't eat because of the needle-like pain in my stomach. I had an endoscopy, colonoscopy, tests for Diverticulitis and Irritable Bowl Syndrome (IBS).; I threw up a lot and developed a hernia and lipoma on my side.; I threw up a lot and developed a hernia and lipoma on my side.; I threw up a lot and developed a hernia and lipoma on my side.; fingers feel ice cold but the rest of my fingers feel normal.; My fingers twitch/spasm randomly without me feeling it.; I started having seizures in 2014.; This spontaneous report was received from a male patient of unknown age via company representative, reporting on himself. The patient's medical history included sports injury involving knees. Information rgeading concurrent conditions and concomitant medications was not provided. On an unknown date in 2008 or 2009, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(GARDASIL)(strength, dose, frequency, lot # and expiration date were not provided), intramuscular for prophylaxis. It was reported that on an unknown date in 2011, the patient's son was born and had "delayed speech and learning abilities, asthma, and his legs hurt." The patient stated he is not sure if his son was experiencing these ailments due to the vaccine he received before his son was born (case cross reference 2101USA001097) Subsequently, after the patient received the vaccine he could not eat because of the needle-like pain in his stomach. He had an endoscopy, colonoscopy, tests for Diverticulitis and Irritable Bowl Syndrome (IBS), he threw up a lot and developed a hernia and lipoma on his side. Sometimes his middle fingers feel ice cold but the rest of his fingers feel normal. The patient's fingers twitch/spasm randomly without him feeling it. The patient started having seizures in 2014. He lost his job in 2016 because of all the medical issues he was experiencing. The patient was hospitalized in 2016 because of his temperature and white blood cell count were high. He had ping-pong ball sized bumps on my armpits, neck, stomach, and knees. He had rashes behind the knees and sometimes had sharp or throbbing pain in the arms and legs. The patien had needle-like pain in his feet when he walk. The patient had also lost the balance and fallen and feel a sharp burst of pain in the brain having short term memory loss. The patient also reported that he smoke marihuana all the time." The patient was treated with omeprazole Magnesium and cortisone shots. At the reporting time the outcome of the aforementioned events was reported as not recovered. The reporter did not provide the causality assessment between the events and quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(GARDASIL). Upon internal review, the events of diverticulitis and seizure were considered to be medically significant. All the events were considered to be disabling as the patient lost his job. This is one of 3 report from the same source.; Sender's Comments: US-009507513-2101USA001097: US-009507513-2101USA001098:

Other Meds:

Current Illness:

ID: 0922374
Sex: M
Age:
State: NM

Vax Date: 11/15/2013
Onset Date:
Rec V Date: 01/06/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: reoccurring pneumonia; congestive heart failure; herpes zoster dermatitis of the eyelid; Information has been received regarding a case in litigation from a lawyer and referred to a male patient of unknown age. No information was provided regarding medical history, concurrent conditions, or concomitant medications. On or around 15-NOV-2013, the patient was vaccinated with zoster vaccine live (ZOSTAVAX) for routine health maintenance and for its intended purpose: the prevention of shingles (herpes zoster). Shortly after receiving zoster vaccine live (ZOSTAVAX), the patient suffered reoccurring pneumonia resulting in multiple hospitalizations. The patient was diagnosed with pneumonia and congestive heart failure. The patient additionally suffered from and was diagnosed with herpes zoster dermatitis of the eyelid. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient's symptoms had resulted in physical limitations not present prior to using the product. The patient also experienced mental and emotional distress due to resulting physical limitations and seriousness of his condition. As a result of zoster vaccine live (ZOSTAVAX), the patient sustained severe and permanent personal injuries. Further, as a tragic consequence of zoster vaccine live (ZOSTAVAX), the patient suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient had suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of the events was considered as not recovered. The causality assessment between all the events and zoster vaccine live (ZOSTAVAX) was considered as related by the lawyer. Upon internal review, pneumonia, congestive heart failure and herpes zoster dermatitis of the eyelid were determined to be medically significant. The lawyer considered all the events to be disability.

Other Meds:

Current Illness: Prophylaxis; Routine health maintenance

ID: 0922375
Sex: F
Age:
State: OR

Vax Date: 01/28/2011
Onset Date:
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: varicella type rash; low-grade fever; Information has been received from a lawyer regarding a case in litigation referring to a female patient of unknown age. Information about medical history, concurrent condition and concomitant medication was not reported. In or around 28-JAN-2011, the patient was vaccinated with zoster vaccine live (ZOSTAVAX) (strength, dose, route, lot# and expiration date not reported) for routine health maintenance and for its intended purpose: the prevention of shingles (herpes zoster). On an unknown date (reported as shortly after receiving zoster vaccine live (ZOSTAVAX)), the patient suffered a varicella type rash on her body and a low-grade fever. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient's symptoms have resulted in physical limitations not present prior to using zoster vaccine live (ZOSTAVAX). The patient also experienced mental and emotional distress due to resulting physical limitations and seriousness of patient's condition. As a result of the manufacture, marketing, advertising, promotion, distribution and/or sale of zoster vaccine live (ZOSTAVAX), the patient sustained severe and permanent personal injuries. Further, as a tragic consequence of zoster vaccine live (ZOSTAVAX), the patient suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient had suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of the events varicella type rash on her body and a low-grade fever was not recovered. The lawyer considered varicella type rash on her body and a low-grade fever to be related to zoster vaccine live (ZOSTAVAX). The lawyer considered the events varicella type rash on her body and a low-grade fever to be disability.

Other Meds:

Current Illness: Routine health maintenance

ID: 0922377
Sex: F
Age: 52
State: FL

Vax Date: 05/22/2018
Onset Date:
Rec V Date: 01/06/2021
Hospital:

Lab Data:

Allergies:

Symptoms: glaucoma; Eye pain both eyes; burning eyes; Nuclear catarct; possible sinus problems; migraine; This case was reported by a lawyer and described the occurrence of glaucoma in a female patient who received Herpes zoster (Shingrix) for prophylaxis. On 22nd May 2018, the patient received Shingrix (intramuscular) .5 mg. On an unknown date, an unknown time after receiving Shingrix, the patient experienced glaucoma (serious criteria GSK medically significant) and eye pain. On an unknown date, the outcome of the glaucoma and eye pain were unknown. It was unknown if the reporter considered the glaucoma and eye pain to be related to Shingrix. The initial information received on 10 December 2020 via medical records. As per records the female patient was non smoker.As per records on 22 May 2018 and on 19 October 2018, she had Shingrix 50mcg injection 0.5 ml into the muscle, repeat in 2 to 6 months. On 19 February 2019, she had follow-up of ocular pain, both eyes. She described to have pain as aching and burning and stated that was an aggravating problem. This eye pain began several months ago and is symptomatic almost constantly. She states that this seems to be gradually improving. On 29 January 2019, she stated eyes have been painful since having the shingles shot. She had Ocular pain, possible sinus problems, Inflammation from shingles shot, nuclear cataract and migraine

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm