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: 0974540
Sex: M
Age: 48
State: CA

Vax Date: 01/10/2021
Onset Date: 01/19/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: n/a

Allergies: PCN, coconut

Symptoms: 1st Dose admininstered 1/10/2021 @0800 hrs. Approx. 5 min later, 1st whole body Goosebumps/Chills lasting 3-5min. with clear nasal dripping/congestion. On 1/19/2021 in AM, started having SOB at rest, Febrile (101.1F), extreme fatigue, whole body goosebumps/chills preceding every episode of SOB (upper airway compromised) and a total autoimmune response, I am having episodes of whole body immune responses with severe SOB (>30 bpm), fever (Tmax 105.1F), whole body goosebumps (chills) preceding every episode. Never became hypoxemia/hypoxic. SpO2 was always >95%, with Blood Pressure and Heartrate always were WNL (115\75 +-20mmHg, HR 75-100 bpm, . Episodes lasted 4-5 days, after that episodes in a 'tolerable' range with full body goosebumps preceding each episode. Tx with 50-100mg Benadryl, 400-600mg Ibuprofen.

Other Meds: famotidine 20 mg, lovastatin 40 mg, armodafinil 150 mg, guanFACINE 3 mg ER, lisinopril 10 MG, triamcinolone 0.5 % ointment, guanFACINE 1 mg , traZODone 50 mg, adderall 30 MG, DHEA 50mg tab, Fish Oil 1.5g, CoEnzyme Q10 150mg, Mg+,Zn+ vitami

Current Illness: n/a

ID: 0974541
Sex: F
Age: 30
State: AZ

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies: N/a

Symptoms: Migraine, light sensitive, nausea

Other Meds: N/a

Current Illness: N/a

ID: 0974542
Sex: F
Age: 58
State: KY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: none

Allergies: Augmentin

Symptoms: Felt fatigued after first Moderna Covid vaccine (fatigue, arm soreness, malaise). Took motrin, did well and able to work. Second vaccine worked 12 hour day. Still with malaise, cold but able to work. Went home. Still cold but able to eat. Took shower went to bed. Woke up at 11:40 chilled, severe body aches, severe headache, Temp 99, nausea (emesis x1). Unable to take any motrin at this time due to nausea. Called into work at 4:30 AM since headaches and body aches still severe at that time, unable to work today. Able at 5;30 to take some Motrin. Slept till 11;30 AM, before getting out of bed. Still with slight headache and body aches but improving at this time 1:10 PM today 1/26. Motrin starting to help now,

Other Meds: Ropinirole (Requip) 1 Tablet nightly Stress B Comples 1 tablet nightly Centrum Silver 1 tablet nightly

Current Illness: None

ID: 0974543
Sex: F
Age: 54
State: NC

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Individual experienced nausea and vomiting.

Other Meds:

Current Illness:

ID: 0974544
Sex: F
Age: 81
State: MI

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None noted

Allergies: Oxycodone, Contrast (Iodinated diagnostic agents

Symptoms: Temperature of 103.3 degrees Fahrenheit on 1/18/2021 @ 5:42pm. Acetaminophen 650mg administered as well as cold compresses. Temperature of 101.5 degrees Fahrenheit on 1/18/2021 @ 9:18pm. Orders obtained to administer one liter of normal saline via intravenous route due to patient's poor oral intake. IV fluids initiated. Temperature of 99.9 degrees Fahrenheit on 1/18/2021 @ 11:25pm. Patient resting comfortably. Temperature of 98.4 degrees Fahrenheit on 1/19/2021 @ 05:47am.

Other Meds: Boost Breeze drink two times daily. Acetaminophen 650mg two times daily. Aricept 10mg one time daily. Brimonidine Tartrate Soltuion 0.2% 1 drop in both eyes two times daily. Celexa 20mg one time daily. Gabapentin 300mg one time daily. Latan

Current Illness: None

ID: 0974545
Sex: F
Age: 45
State: CA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Body aches, malayes, soreness around the injection.

Other Meds:

Current Illness:

ID: 0974546
Sex: F
Age: 61
State: KS

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/26/2021
Hospital: Y

Lab Data:

Allergies: Amoxicillin, Topamax, Biaxin, Invokana, Victoza, Sulfa

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA I went to bed at 8 pm and noticed my arm was sore. I awoke at 11 pm to use the restroom and when I returned to bed I had a cough and SOB. This continued with copious secretions with worsening over time until I was fighting for air at 4:30 am. My husband called the ambulance because he did not feel he could get me to the hospital in time. In the ambulance I was started on 4L of O2. Upon arrival at the ER I was given a breathing treatment and started on the BiPap. I was admitted to the hospital and received 3 more breathing treatments and recovered to be on room air by 11:00 pm. The tests and observations, the doctor reported that there was no other cause than the vaccine.

Other Meds: Basaglar KwikPen U-100, carbidopa-levodopa 10-100 mg, sodium bicrbonate 650 mg, metoprolol succinate 100 mg , lisinopriL 10 mg, atorvastatin 40 mg, amLODIPine 10 mg, cloNIDine HCL 0.2 mg, isosorbide mononitrate 60 mg, ZurTeC 10 mg, Vitamin

Current Illness: IDDM, HTN, Stage 4 Kidney Disease

ID: 0974547
Sex: F
Age: 32
State: MI

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies: Enbrel, Sorbitan, Nickel, Hazelnut, Hops Oil, Peanuts, Tocilizumab,

Symptoms: HISTORY OF PRESENT ILLNESS: SHORTNESS OF BREATH (CHEST PAIN, sob , BACK PAIN STARTING TODAY AT 0900, STATES ADVIL AT 1000, SSENCOND COVID VACCINE YESTERDAY AT 1500) 32-year-old female with past medical history of anxiety, asthma, Hashimoto's thyroiditis, psoriasis who presents the emergency department with chief complaint of body aches and shortness of breath. Patient is a nurse. She received her 2nd dose of the Moderna vaccine for COVID-19 the day prior to arriving in the emergency department. This morning she did feel some mild body aches but otherwise was feeling fine. Starting later today after her shift at work she developed severe body aches bilateral upper shoulders and down her spine, she also reports some shortness of breath, dizziness. She felt unsafe to drive home feeling like this. She had taken some Advil earlier in the day around 10:00. She denies any fever, nausea or vomiting. No history of severe vaccine reaction or anaphylaxis. She has had anaphylactic reaction to Enbrel prior. She denies any throat swelling, muffled voice, difficulty swallowing, abdominal pain. patient is mildly tachycardic and hypertensive. Likely due to pain. Patient is experiencing adverse reaction to the 2nd dose of the Moderna COVID-19 vaccine. I discussed with her she is having an immune response to the vaccine. She does have a history of rheumatoid arthritis which could contribute to the elevated immune response as well. The patient is given 30 mg of IM Toradol for body aches here in the emergency department. She is instructed to call PCP for close follow-up, rest, drink plenty of fluids. She has no signs or symptoms consistent with anaphylaxis at this point.

Other Meds: cetirizine, cholecalciferol, levothyroxine, medroxyPROGESTERone, montelukast, norethindrone, prenatal vitamins, Rinvoq extended release

Current Illness:

ID: 0974548
Sex: F
Age: 77
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache / Pruritus / erythema/flushed / elevated B/P

Other Meds:

Current Illness:

ID: 0974550
Sex: F
Age: 26
State: OH

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Pt got her second dose of Moderna on 01/22/2021 01/23/2021 @ 9AM pt states feeling pain in her left arm. She noticed a red bump around site of injection (deltoid) She contacted her provider yesterday and was instructed to take Benadryl. Today she still has the rash, warm at touch. She will see her provider for FU on Thursday.

Other Meds: Adderall

Current Illness: None

ID: 0974551
Sex: M
Age: 41
State: UT

Vax Date: 01/23/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Swollen lymph node in axilla and sore left arm. Started on 1/24. Took ibuprofen for symptoms. Has full ROM of shoulder. Symptoms persisting but improving. Pt to use ibuprofen and warm packs on site, will follow up with clinic if symptoms do not continue to improve.

Other Meds:

Current Illness:

ID: 0974552
Sex: F
Age: 49
State: MD

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: Latex

Symptoms: At about 3 -4 am on the morning after the vaccine I went to the Bathroom to Urinate, upon rising I slumped to the floor and passed out. I also had sweating and profound weakness. I crawled back to the bedroom and was placed in bed with assistance. I also experience feverish ness, sweating, chills, insomnia, muscle aches, and nausea throughout the night. The next morning I am able to stand, eat, and walk. I still have a headache, muscle aches, and fatigue. It is now 1pm on 1/26.

Other Meds: None

Current Illness: None

Date Died:

ID: 0974553
Sex: F
Age: 66
State: NY

Vax Date: 01/20/2021
Onset Date: 01/24/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: RESIDENT RECEIVED THE VACCINE ON 1/20/2021, RESIDENT HAD BEEN MONITORED EVERY SHIFT AND HAS NOT EXHIBITED ANY SYMPTOMS. RESIDENT WAS OBSERVED TO BE UNRESPONSIVE WITH NO PRESENCE OF VITAL SIGNS ON 1/24/2021. RESIDENT WAS A FULL CODE, CPR INITIATED UNSUCESSFULLY. BASED ON REVIEW WITH PRIMARY CARE PHYSICIAN AND MEDICAL DIRECTOR, THE RESIDENT HAD NOT HAVE ANY OTHER EVENTS PRIOR TO RECEIVING THE COVID VACCINE 4 DAYS PRIOR TO EVENT.

Other Meds: MOBIC, MVI, OLANZAPINE, REMERON, COLACE, TYLENOL

Current Illness:

ID: 0974554
Sex: F
Age: 89
State: FL

Vax Date: 01/09/2021
Onset Date: 01/11/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None.

Allergies: None.

Symptoms: Had vaccine, didn't feel much at all. Came home, did not feel bad, day and half later started feeling bad, as well as kind of like a cold with drainage to her throat, a little coughing. Has had diarrhea for the last 3 days, nausea and generally feeling bad. The first week had a lot of drowsiness, had fogginess as far as thinking. The first few days took Tylenol and did not take anymore as her daughter said it contained aspirin for the pain. Still having the headache, feeling like she is not thinking real good. About a month ago had blood work and everything was perfect, no problems. Due to the fact that she is still having these reactions 2 weeks from the injections wanted to report it.

Other Meds: Omeprazole.

Current Illness: None.

ID: 0974555
Sex: F
Age: 77
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Headache / Pruritus / erythema/flushed / elevated B/P

Other Meds:

Current Illness:

ID: 0974556
Sex: F
Age: 50
State:

Vax Date: 01/14/2021
Onset Date: 01/20/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: all labs in normal range done on 1/22/21

Allergies: NO

Symptoms: On 1/20/21 9am had swollen right hand knuckles and numbness of hand and right toes. Knuckles on hands are still swollen. On 1/25/21 at 2am had difficulty breathing, itchy eyes and hives. Took albuterol for breathing, Zyrtec generic and 2 Quercetin with Bromlein. Resolved in 1 hour.

Other Meds: FLAX SEED, AMBIEN CR, VITAMIN E, VITAMIN D, NAC, GLUTATHIONE, KRILL OIL

Current Illness: NO

ID: 0974557
Sex: F
Age: 41
State: VT

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: none, clinical exam

Allergies:

Symptoms: ?Moderna COVID-19 Vaccine EUA. Mild-moderate exacerbation of asthma

Other Meds:

Current Illness: none

ID: 0974558
Sex: F
Age: 69
State: FL

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: I didn't go to the doctor. I normally do NOT experience aches or pains. I am physically active and participate in sports. I attributed the condition to the injection, but I have no proof.

Allergies: None

Symptoms: Two days (Friday) after the injection (Wednesday) a pain arose in my shoulder muscle on my left side just behind the injection site. By Sunday afternoon the pain became debilitating and the pain spread to my underarm and the edge of the breast area. I applied heat and rested. The sharp pain interfered with sleep and regular life activities. On Tuesday morning I applied an ice pack, which relieved the pain. After applying ice for two more times, the pain subsided and the swelling under my arm disappeared. I was able to resume normal activities with slight discomfort.

Other Meds: aspirin 81 mg daily, vitamin D 5000 mg, fish oil

Current Illness: None

ID: 0974560
Sex: F
Age: 48
State: HI

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Symptoms: Lightheaded, elevated blood pressure. Treatment: Given water, monitored another 15 minutes. No further symptoms or treatment.

Other Meds:

Current Illness:

ID: 0974561
Sex: M
Age: 0
State: NH

Vax Date: 08/17/2019
Onset Date: 08/19/2019
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: Not known

Symptoms: Arching of the back that lasted for weeks after the 19th. The lining of his eyes was off - strabismus that resolved itself months after the vaccine. Silent seizures, problems with digestion.

Other Meds: No

Current Illness: Not known

ID: 0974563
Sex: F
Age: 39
State: KS

Vax Date: 12/31/2020
Onset Date: 01/07/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: Environmental only, gluten sensitivity

Symptoms: Right arm induration - aching swelling redness golf ball size started on day 8 post vaccine and lasted until day 10- I have pictures if needed

Other Meds: Zoloft, loratadine, vitamin d, probiotic, singluiar

Current Illness: None

ID: 0974566
Sex: M
Age: 34
State: PR

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies: corticosone

Symptoms: dizziness, and increased of high blood pressure,

Other Meds: synthroid 150 mcg

Current Illness: hypothyroidism

ID: 0974567
Sex: F
Age: 70
State: NC

Vax Date: 01/08/2021
Onset Date: 01/17/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: None known

Symptoms: Rash and Swelling of injection site, itching of injection site, down left arm, itching and tingling in left hand.

Other Meds: Lisinipril 10 mg, 1x day Multivitamin Vitamin C 2,000 mg Vitamin D3 2,000 mg

Current Illness: None

ID: 0974570
Sex: M
Age: 70
State: CA

Vax Date: 01/12/2021
Onset Date: 01/16/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: COVID-19 PCR neg 1/20/2021 CBC, CMP, ESR normal 1/20/2021

Allergies: scallops, lobster, codeine

Symptoms: chills, fever, nausea, fatigue lasting 10 days

Other Meds: lisinipril, Bystolic, asa, Imodium, Crestor, Wu Shu (herb)

Current Illness: no

ID: 0974571
Sex: F
Age: 48
State: CA

Vax Date: 01/12/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None - took advil and benadryl (which didn't seem to help much).

Allergies: None

Symptoms: Had the Moderna vaccine on 1/12/21 and started with mild itching sensations on the palms of my hands on 1/14/21. This became worse between 1/21/21 through 1/25/21 with intense itching, burning sensation, palms turning red, feeling "lots of cuts" through out my hand and developing small lumps through out my palms and in between my fingers. This also spread to my feet but not as severe and not as long (a couple of days with intense itching and small lumps).

Other Meds: None

Current Illness: None

ID: 0974572
Sex: F
Age: 65
State: OH

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: unknown

Allergies: Any ibuprofen - cannot take ibuprofen since I am a kidney transplant patient.

Symptoms: A very high spike in blood pressure. My normal BP is 117/74. For about 4 hours after the vaccination was administered, my BP was 158/95.

Other Meds: Prescription Medications: ALPRAZolam (generic Xanax) IC Clonidine HCL IC Diltiazem 24H ER(CD) IC Cephalexin Mycophenolic DR TAB (generic immunosuppressant) Tacrolimus (generic immunosuppressant) Zolpidem Tartrate (generic Ambien) OTC meds:

Current Illness: I am a kidney transplant patient. Date of transplant: June 2016. I was never on dialysis.

Date Died: 01/22/2021

ID: 0974573
Sex: M
Age: 95
State: MI

Vax Date: 01/05/2021
Onset Date: 01/21/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: NONE- PALLIATIVE CARE

Allergies: STATINS

Symptoms: ON 1/21/2020 RESIDENT WAS EXPERINCING CHILLS AND LOOSE STOOLS. FOLLOWING THIS EPISODE BECAME UNRESPONSIVE, PALE, DIAPHORETIC AND BRADYCARDIC. PALLIATIVE CARE WAS PROVIDED. RESIDENT PASSED AWAY APPROX. 10 HOURS LATER.

Other Meds: SYNTHROID 25MCG DAILY PRILOSEC 10MG DAILY CASODEX 50MG DAILY TYLENOL 500MG THREE TIMES DAILY MULTIVITAMIN DAILY ZOLOFT 25MG DAILY NAPROXEN 440MG DAILY

Current Illness: URINARY TRACT INFECTION

ID: 0974574
Sex: F
Age: 76
State: AZ

Vax Date: 01/24/2021
Onset Date: 01/25/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies: Sulfa, penicillin, Ibesartan,

Symptoms: I felt worse than when I began covid in Dec. Temp up to 102, achy body, just felt terrible

Other Meds: Eliquis , Nexium, Pryor to Jan 21. I was taking multi vitamin, c, d, e,, EmergenC, beadryl fo occasional allergy. Had allergy shot Jan21

Current Illness: Covid 19

ID: 0974575
Sex: M
Age: 76
State: FL

Vax Date: 01/13/2021
Onset Date: 01/22/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: None

Allergies: No

Symptoms: Redness, swelling, itching, bumpy rash

Other Meds: Multiple vitamins, fish oil, Qunol, Crestor, HCTZ

Current Illness: No

ID: 0974576
Sex: U
Age:
State: OR

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No further AE; received an improperly stored dose; This spontaneous report was received from a registered nurse and refers to a patient of unknown age and gender. The patient's pertinent medical history, concomitant medications and drug reactions or allergies were not provided. On 12-JAN-2021, the patient was vaccinated with improperly stored pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) 1 injection, lot # T024557 was valid with an expiration date of 15-MAR-2022 (exact dose, route of administration and anatomical location were not reported) for prophylaxis (product storage error). The temperature excursion was reported as above 9 degrees Celsius (C) (8.7C) for 25 minutes. There was no previous temperature excursion. A digital data logger was used to capture the temperature. No further adverse event reported. The outcome of the event was unknown.

Other Meds:

Current Illness:

ID: 0974577
Sex: U
Age:
State: WV

Vax Date: 10/03/2012
Onset Date:
Rec V Date: 01/26/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: shingles; ill defined disorder; This spontaneous report as received from a lawyer refers to a patient of unknown age and gender. Medical history, concurrent conditions and concomitant medications were not reported. On or about 03-OCT-2012, the patient was vaccinated with a dose of zoster vaccine live(ZOSTAVAX) for prophylaxis (dose, route, anatomical location, lot number and expiration date were not provided) for the long-term prevention of shingles and zoster-related conditions. Subsequent, on unknown date, after zoster vaccine live(ZOSTAVAX) inoculation, the pt was treated by healthcare providers, including the physiciaN for shingles, and other zoster-related conditions. As a direct and proximate result of zoster vaccine live(ZOSTAVAX), the pt had and would continue to suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and will continue to suffer such losses, and damages in the future.

Other Meds:

Current Illness:

ID: 0974578
Sex: F
Age: 12
State: OH

Vax Date: 10/01/2020
Onset Date: 10/01/2020
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A couple weeks ago she started developing ticks.; Information has been received from a pharmacist via an unspecified reporter, referring to a 13 years old female patient. The patient's medical history, concurrent conditions and concomitant therapies were not reported. On an unknown date in October 2020, the patient was vaccinated with a dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9), intramuscularly (dose, lot number, expiration date and anatomical location were not reported) for prophylaxis. On an unspecified date in October 2020 (discrepant information also reported as "a couple weeks ago"), the patient started developing tics (also reported as"ticks"). The reporter stated that she researched and found there were some nasty side effects for hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) and tics was one of them. Now the patient's mother was taking her to a neurologist. The outcome of tic was reported as not resolved. The casuality assessment between the vaccination with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) and the tics was not provided.

Other Meds:

Current Illness:

ID: 0974579
Sex: M
Age:
State: VA

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Squalene in Anthrax vaccine has caused the reaction; Spontaneous report received on 02DEC2020 from P?zer. A healthcare professional reported regarding a male consumer to whom "squalene in anthrax vaccine has caused the reaction" (PT: Vaccination complication). The healthcare professional was inquiring if COVID-19 mRNA vaccine (BNT162) had squalene in it. The patient was exposed to squalene in his career with anthrax vaccine and it was documented that there was squalene in that vaccine that had caused the reaction to him. The outcome of the reported event was unknown at the time of report. Company Comment: It was reported that squalene in anthrax vaccine has caused the reaction (vaccination complication) in a consumer who received presumably BioThrax. Further information of the event is limited. Squalene is an adjuvant used in several vaccinations, and considering the case information the causality of vaccination complication is assessed as related.; Sender's Comments: It was reported that squalene in anthrax vaccine has caused the reaction (vaccination complication) in a consumer who received presumably BioThrax. Further information of the event is limited. Squalene is an adjuvant used in several vaccinations, and considering the case information the causality of vaccination complication is assessed as related.

Other Meds:

Current Illness:

ID: 0974580
Sex: M
Age:
State:

Vax Date: 12/01/2020
Onset Date: 12/01/2020
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vivotif was expired on November 30th and the patient started his course on December 1st and completed the course correctly; Spontaneous report received on 10DEC2020. A pharmacist reported regarding a male consumer where "Vivotif was expired on November 30th and the patient started his course on December 1st and completed the course correctly" (PT: Expired product administered). He was receiving Vivotif for immunisation. On 01DEC2020, the consumer started his course of Vivtoif, which had been expired on 30NOV2020. It was reported that the consumer completed his course correctly. Action taken with Vivotif with respect to reported event was not applicable. The outcome of the reported event was unknown. Company Comment: It was reported that a consumer started Vivotif course after the expiration date and completed the course correctly (expired product administered). Further information of the event is limited. The causality of expired product administered is not applicable with Vivotif due to the nature of the event.; Sender's Comments: It was reported that a consumer started Vivotif course after the expiration date and completed the course correctly (expired product administered). Further information of the event is limited. The causality of expired product administered is not applicable with Vivotif due to the nature of the event.

Other Meds:

Current Illness:

ID: 0974581
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data: Test Name: Tuberculosis test; Result Unstructured Data: Positive

Allergies:

Symptoms: Lip got very swollen; Spontaneous report received on 11JAN2021 from P?zer. A female consumer reported that her "lip got very swollen" (PT: Lip swelling) following the administration of anthrax vaccine. She inquired if it was safe for her to take Pfizer-Biontech coronavirus disease 2019 (COVID-19) vaccine as she had allergies. She reported that when she took other vaccines (smallpox and rubella) when she was at work she had to go to the hospital and get a spinal tap, and was informed that she cannot get those vaccines. She was not given any vaccine but received 2 rounds of anthrax vaccine. Her lip got very swollen the next day and was given Benadryl (diphenhydramine). She was tuberculosis (TB) positive and did not complete her isonicotinic acid hydrazide (INH) treatment due to her joint hurting. When she got a booster for Hep A (hepatitis A vaccine), she had to be given epinephrine. For typhoid her arm got swollen, more than regular, and for meningococcal she had a small reaction. Currently, she had rhabdomyolysis and malignant hyperthermia. She added that it could be due to other vaccines being live vaccines. The outcome of the reported event was unknown at the time of report. Company Comment: It was reported that a consumer had lip swelling the next day after receiving presumably BioThrax (Anthrax vaccine). In response to the event, she was treated with Benadryl. This consumer developed several reactions (allergies) to various vaccines over the course of many years. Considering the case information and known effects of BioThrax, the causality of lip swelling is assessed as possible.; Sender's Comments: It was reported that a consumer had lip swelling the next day after receiving presumably BioThrax (Anthrax vaccine). In response to the event, she was treated with Benadryl. This consumer developed several reactions (allergies) to various vaccines over the course of many years. Considering the case information and known effects of BioThrax, the causality of lip swelling is assessed as possible.

Other Meds: Isoniazid

Current Illness:

ID: 0974583
Sex: F
Age: 82
State: AZ

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fainted; A spontaneous report was received from a consumer, who was an 82-year old, female, patient who received Moderna's COVID-19 vaccine (mRNA-1273) and fainted. The patient's medical history was not provided. No relevant concomitant medications were reported. On 07 Jan 2021, approximately 6 hours prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 07 Jan 2021 at 19:30, the patient fainted. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, fainted, was unknown.; Reporter's Comments: This case concerns a 82 year old female patient who experienced a serious unexpected event of Syncope. The event occurred 6 hours after first dose of mRNA-1273. Very limited information regarding this event has been provided at this time. Based on 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: 0974584
Sex: M
Age:
State: FL

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/26/2021
Hospital: Y

Lab Data: Test Date: 202101; Test Name: CT scan; Test Date: 202101; Test Name: MRI brain

Allergies:

Symptoms: Stroke like symptoms; Water in lungs; A spontaneous report was received from a consumer concerning an 83-year-old, male, patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced stroke like symptoms and water in lungs. The patient's medical history was not provided. Concomitant products known to have been used by the patient included, insulin aspart, insulin glargine, ticagrelor, sacubitril valsartan sodium hydrate, furosemide, carvedilol, omeprazole, and sertraline. On 04 Jan 2021, one day prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 05 Jan 2021, the patient began experiencing stroke-like symptoms and had water in his lungs. On 06 Jan 2021, the patient was hospitalized and had a computed tomography (CT) scan and magnetic imaging resonance (MRI) scan of the brain. On 09 Jan 2021, the patient was discharged from the hospital. Treatment information for the events was not provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, stroke like symptoms and water in lungs , was not reported.; Reporter's Comments: This case concerns an 83 year old male patient who experienced serious unexpected events of Cerebrovascular accident and Pulmonary oedema. The events occurred the next day of their first dose of their first of two planned doses of mRNA-1273. Concomitant medications included, insulin aspart, insulin glargine, ticagrelor, sacubitril valsartan sodium hydrate, furosemide, carvedilol, omeprazole, and sertraline. 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: NOVOLOG; ZOLOFT; OMEPRAZOLE; CARVEDILOL; FUROSEMIDE; ENTRESTO; BRILINTA; TOUJEO

Current Illness:

ID: 0974585
Sex: F
Age: 80
State: TN

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Appeared that most of the vaccine flowed down patient's left arm during administration; vaccination was given in left arm between elbow and shoulder not upper shoulder; Nurse said she overfilled the syringe/Appeared that most of the vaccine flowed down patient's left arm during administration; A spontaneous report was received from a consumer who was an 80-year-old, female patient who received Moderna's COVID-19 vaccine in her left arm between her elbow and shoulder not the upper shoulder, from an overfilled syringe, and most of the vaccine flowed down her arm during administration. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 01 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025L20A) in the left arm for prophylaxis of COVID-19 infection. On 01 Jan 2021, the patient was administered the vaccine between her elbow and shoulder. It was reported the vaccine was not given in her upper shoulder. During administration of the vaccine, most of it flowed down her left arm. The patient stated the nurse advised her the syringe had been overfilled. No treatment information was provided for the event. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the events, of the vaccine given in between her elbow and shoulder, an overfilled syringe and the vaccine that flowed down the patient's arm, were not provided.; Reporter's Comments: This case concerns a 80-year-old, female patient, who experienced an unexpected event of incorrect dose administered, vaccine leakage and Product administered at inappropriate site. The event occurred during the administration of the first dose of mRNA-1273 (Lot number: 025L20A). This report refers to product administration error for mRNA-1273 (Lot number: 025L20A).

Other Meds:

Current Illness:

ID: 0974586
Sex: M
Age: 67
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: After the vaccines lost temperature they were administered; A spontaneous report was received from a nurse concerning a 67-year-old, White, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the event, after the vaccines lost temperature they were administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021, a refrigerator in a vaccine clinic lost power and rose up to room temperature overnight. At approximately 9 p.m., the vaccines inside the refrigerator reached room temperature. On 12 Jan 2021, after the vaccine lost temperature, the patient received their first of two planned doses of mRNA-1273 (Lot number: 027L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The event, after the vaccines lost temperature they were administered, was considered resolved on 12 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use for mRNA-1273, lot # 027L20A. There were no reported AEs associated with this case of out of specification product use.

Other Meds:

Current Illness:

ID: 0974587
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Four Moderna vaccine doses that were administered from vials which had been more than 6 hours post initial puncture; A spontaneous report was received from a physician concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and had four Moderna vaccine doses that were administered from vials which had been more than 6 hours post initial puncture. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unspecified date, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. The physician reported that four Moderna vaccine doses were administered from vials which had been more than 6 hours post initial puncture. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event had four Moderna vaccine doses that were administered from vials which had been more than 6 hours post initial puncture was considered resolved on an unspecified date.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Out of specification product use.

Other Meds:

Current Illness:

ID: 0974588
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vaccine administered to a 16 year old; A spontaneous report was received from a nurse concerning a 16-year-old patient who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, vaccine administered to a 16-year-old. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The patient was 16-year-old. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccine administered to a 16-year-old, was considered resolved.; Reporter's Comments: This case concerns a 16-year-old patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product administered to patient of inappropriate age.

Other Meds:

Current Illness:

ID: 0974589
Sex: F
Age: 55
State: KY

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 5 - 6 bowel movements; A little achy; Passed out; Dizziness; Arm tingling; Shaking; Chest burn; Triggered acid reflux; Stomach rolling around; Vision was blurry; Eyes bloodshot; Weakness; Funny feeling; Felt like a heart attack from the bad heart burn; Headache; Sore arm; Nausea; A spontaneous report was received from a consumer concerning a 55-years-old, female patient who received Moderna's COVID-19 Vaccine, and who experienced passed out, headache, sore arm, dizziness, arm tingling, shaking, chest burn, triggered acid reflux, stomach rolling around, 5 - 6 bowel movements, vision was blurry, eyes bloodshot, a funny feeling, nausea, weakness, achy and felt like a heart attack from bad heartburn. The patient's medical history included acid reflux. Concomitant medication included lansoprazole. On 08 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number 012L20A) at 13:07 intramuscularly in the deltoid muscle of her left arm for prophylaxis of COVID-19 infection. On 08 Jan 2021, right after the first vaccination, the patient reported that she got a headache and sore arm but over all felt okay. As the day went on, she got dizzy and lightheaded. She went to bed around 22:30 but had to get up to use the bathroom. As she was getting up, she felt bad to the point where her husband asked her if she was okay, which she told him that her head felt funny and dizzy, and a couple of seconds later she couldn't see him anymore as if her vision was going blurry. Her husband took her to the couch, and she blacked out or passed out for a few seconds according to her husband. Shortly after she had aroused, her husband noticed that her eyes were bloodshot, and she said she felt weak, she was shaking, and her arm was tingly. At that time, her husband took her to the emergency room (this was about 12 hours after she got the Moderna COVID-19 shot). On arrival to the emergency room she felt confused and shaky. Shortly after arrival to the emergency room she was better and the worst of it was subsiding. The emergency room (ER) nurse said she could take paracetamol. The patient stated that she felt like she was physically there, but she was not mentally there. That day, the patient was discharged from the emergency room. Once home she had 5-6 bowel movements throughout the night (but not diarrhea), her stomach was rolling around almost as if she had a stomach virus, nausea, bad acid reflux to the point where her chest really burned. She felt like she was having a heart attack from the bad heart burn. She ended up taking lansoprazole to help. On 09 Jan 2021, her head was still hurting while eating breakfast, so she took paracetamol, and it helped. She was a little achy but not a whole lot; it wasn't bad. On 10 Jan 2021, she felt a little better but did still feel weak and shaky; however, her headache was gone. On 11 Jan 2021, she had a funny feeling and dizziness. Action taken with mRNA-1273 in response to the events was unknown. The events of passed out and vision was blurry were considered resolved on 08 Jan 2021. The event of arm tingling was considered resolved on 09 Jan 2021. The event of headache was considered resolved on 10 Jan 2021. The event of shaking was considered resolved on 11 Jan 2021. The outcome of the events sore arm, dizziness, chest burn, triggered acid reflux, stomach rolling around, 5 - 6 bowel movements, eyes bloodshot, and funny feeling were unknown.; Reporter's Comments: This case concerns a 55-year-old female patient with medical history acid reflux who experienced a serious event of passed out and non-serious events of dizziness, felt weak, shaking and her arm was tingly, confused, 5-6 bowel movements through the night, nauseous, triggered her acid reflux, felt like she was having a heart attack from the bad heart burn, chest burn, vision blurry, eyes bloodshot, funny feeling, headache, sore arm, little achy and weak, within one day of the administration of the first and only dose of the mRNA-1273 (Lot number 012L20A, Exp. date: unknown). Based on temporal association between the use of the product and the start date of the reported events and the absence of any other etiology factors, a causal association cannot be excluded. The events of headache and sore arm are consistent with the known safety profile of the vaccine.

Other Meds: PREVACID

Current Illness:

ID: 0974590
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Not sure if she received or not the vaccine in the syringe, they do not know if there was vaccine or air on it; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 Vaccine, and who is not sure if she received the vaccine in the syringe. They do not know if there was vaccine or air on it. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 on an unspecified date intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, a patient was not sure if she received the COVID-19 vaccine or if there was only air in the vaccine syringe Treatment information was not provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event "not sure if she received the vaccine in the syringe, they do not know if there was vaccine or air on it" is considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot#: unknown) intramuscularly for prophylaxis of COVID-19 infection and patient was not sure if she received the COVID-19 vaccine or if there was only air in the vaccine syringe. There were no reported AEs associated with this case of not sure if she received the COVID-19 vaccine or if there was only air in the vaccine syringe.

Other Meds:

Current Illness:

ID: 0974591
Sex: F
Age: 71
State: NC

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: When the plunger was pushed the liquid ran down the side of her arm; When the plunger was pushed the liquid ran down the side of her arm; when the plunger was pushed the liquid ran down the side of her arm; A spontaneous report was received from a nurse who was a 71-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and when the plunger was pushed the liquid ran down the side of her arm. The patient's medical history, as provided by the reporter, included an allergy to Macrobid, breast cancer, hypothyroidism, and hypertension. Concomitant medications included Metoprolol Succinate, Bupropion Hydrochloride, Fluoxetine Hydrochloride, Liothyronine Sodium, and Valaciclovir Hydrochloride. On 07 Jan 2021 at 10:45 a.m., the patient received their first of two planned doses of mRNA-1273 (Lot Number: 011J20A) in her right deltoid for prophylaxis of COVID-19 infection. On 07 Jan 2021, the patient noticed that when the vaccine plunger was pushed, liquid ran down the side of her arm. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events, when the plunger was pushed the liquid ran down the side of her arm, was considered resolved on 07 Jan 2021.; Reporter's Comments: This report refers to a case of incorrect dose administered, exposure via skin contact, and syringe issue for mRNA-1273, lot # 011J20A. There were no reported AEs associated with this case of incorrect dose administered, exposure via skin contact, and syringe issue.

Other Meds: TOPROL XL; WELLBUTRIN; PROZAC; CYTOMEL; VALTREX

Current Illness: Allergy to antibiotic (Allergic to Macrobid)

ID: 0974592
Sex: F
Age: 82
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data: Test Name: unrefrigerated vaccine; Result Unstructured Data: room temperature.

Allergies:

Symptoms: A spontaneous report was received from a nurse concerning a White, 82-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the event, after the vaccines lost temperature they were administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021, a refrigerator in a vaccine clinic lost power and rose up to room temperature overnight. At approximately 9 p.m., the vaccines inside the refrigerator reached room temperature. On 12 Jan 2021, after the vaccine lost temperature, the patient received their first of two planned doses of mRNA-1273 (Lot number: 027L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The event, after the vaccines lost temperature they were administered, was considered resolved on 12 Jan 2021. .; Reporter's Comments: This case concerns a 82-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot: 027L20A), reporting Out of specification product use.

Other Meds:

Current Illness:

ID: 0974593
Sex: M
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A spontaneous report was received from a pharmacist concerning a male patient of unspecified age, who received Moderna's COVID-19 vaccine, where more than half of patient's 1st dose of Moderna COVID19 vaccine was leaked from the syringe. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. The pharmacist reported that, during the administration of vaccine more than half of the dose was leaked from the syringe. No treatment information was provided. Action taken with mRNA-1273 in response to the event more than half of patient's 1st dose of Moderna COVID19 vaccine was leaked from the syringe was not reported. The outcome of the event more than half of patient's 1st dose of Moderna COVID19 vaccine was leaked from the syringe was resolved on an unspecified date. Reporter's Comments: This spontaneous report refers to a case of male patient who experienced non-serious event of more than half of patient's 1st dose of Moderna COVID19 vaccine leaked from the syringe, (Incomplete dose administered, syringe issue) for mRNA-1273 (lot # unknown), Exp. date-unknown). There were no reported AEs associated with the event of more than half of patient's 1st dose of Moderna COVID19 vaccine leaked from the syringe

Other Meds:

Current Illness:

ID: 0974594
Sex: F
Age: 36
State:

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

Lab Data: Test Date: 20210106; Test Name: Blood pressure; Result Unstructured Data: Low mmHg; Test Date: 20210107; Test Name: Blood pressure; Result Unstructured Data: Low mmHg

Allergies:

Symptoms: Full anaphylactic shock; Hives; Low blood pressure; Dizziness; Stuffy nose; Bad headache; Nausea; A spontaneous report was received from a healthcare facility staff member who was a 36-year-old, female patient who received Moderna's COVID-19 Vaccine, and who developed full anaphylactic shock, nausea, hives, low blood pressure, dizziness, bad headache, and stuffy nose. The patient's medical history included a latex allergy and pregnancy. Concomitant product use was not provided by the reporter. On 06-Jan-2021, approximately 30 minutes prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (LOT 01122019) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient received her Moderna vaccine on 06 Jan 2021 at noon. She reported that approximately 30 minutes after receiving the vaccine, she went into full anaphylactic shock. She stated that the reaction began with nausea. She then developed hives, got low blood pressure, and was dizzy. She was taken to the hospital. There, she received two rounds of epinephrine along with diphenhydramine and famotidine. She was released that same day from the hospital once she stabilized. On 07-Jan-2021, a full 24 hours after receiving her vaccine, she experienced another anaphylactic reaction. She stated that the reaction happened exactly like it did on 06 Jan 2021 and presented with all the same symptoms. Patient injected herself with the epinephrine pen that she had at home as soon as the symptoms started. In addition to the anaphylactic reactions she experienced, patient reported that she had a bad headache since receiving the vaccine as well as a stuffy nose that comes and goes and coincides with hives. As of 10 Jan 2021, she stated that the flare ups had finally subsided, however, she continued taking diphenhydramine and famotidine as prophylaxis for anaphylactic reaction. Treatment for the event included epinephrine, diphenhydramine, and famotidine. Action taken with mRNA-1273 in response to the events, full anaphylactic shock, nausea, hives, low blood pressure, dizziness, bad headache, and stuffy nose, was not provided. The events, full anaphylactic shock and low blood pressure were considered resolved on 07 Jan 2021. The events, nausea, hives, and dizziness were considered recovered/resolved on 10 Jan 2021. The outcome of the events, bad headache and stuffy nose, were not reported.; Reporter's Comments: This case concerns a 36-year-old female patient with medical history of latex allergy, who received their first of two planned doses of mRNA-1273 (Lot 01122019), and who experienced the serious unlisted event of Anaphylactic shock, the non-serious listed events of Headache and Nausea, and the non-serious unlisted events of Urticaria, Hypotension, Dizziness, and Nasal congestion. Based on the current available information and temporal associon between the use of the product and the onset of events starting on the day of vaccination, a causal relationship cannot be excluded and the events are considered possibly related to the vaccine.

Other Meds: ZOLOFT

Current Illness: Latex allergy

ID: 0974595
Sex: F
Age: 77
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: After the vaccines lost temperature they were administered; A spontaneous report was received from a healthcare professional concerning a 77-year-old, White female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the event, after the vaccines lost temperature they were administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021, a refrigerator in a vaccine clinic lost power and rose up to room temperature overnight. At approximately 9 p.m., the vaccines inside the refrigerator reached room temperature. On 12 Jan 2021, after the vaccine lost temperature, the patient received their first of two planned doses of mRNA-1273 (Lot number: 027L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The event, after the vaccines lost temperature they were administered, was considered resolved on 12 Jan 2021.; Reporter's Comments: This case concerns a 77-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Out of specification product use.

Other Meds:

Current Illness:

ID: 0974596
Sex: F
Age: 65
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A spontaneous report was received from a healthcare professional concerning a 65-year-old, White, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the event, after the vaccines lost temperature they were administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021, a refrigerator in a vaccine clinic lost power and rose up to room temperature overnight. At approximately 9 p.m., the vaccines inside the refrigerator reached room temperature. On 12 Jan 2021, after the vaccine lost temperature, the patient received their first of two planned doses of mRNA-1273 (Lot number: 027L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The event, after the vaccines lost temperature they were administered, was considered resolved on 12 Jan 2021.; Reporter's Comments: This case concerns a 65-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot number: 027L20A), reporting Out of specification product use.

Other Meds:

Current Illness:

ID: 0974597
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/26/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Administered vials that were exposed to room temperature for more than 12 hours; A spontaneous report was received from an employee and a physician concerning a patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and was administered with product that was exposed to room temperature for more than twelve hours. The patient's medical history was not provided. No relevant concomitant medications were reported. On 04 Jan 2021, a freezer containing a vial of mRNA-1273 failed. At 1:11 A.M. the vial experienced a temperature excursion, exceeding 8 degrees Celsius. Over time the dose thawed and reached room temperature. On 04 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection and was administered with product that was exposed to room temperature for more than twelve hours. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, administered with product that was exposed to room temperature for more than twelve hours, was resolved on 04 Jan 2021.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product that was exposed to room temperature for more than twelve hours without any associated adverse events.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm