VAERS 2021 Database www.vaers.hhs.gov

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

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

COVID19 Lot Number

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

Incidents per State

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

ID: 1672467
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PYREXIA (Fever). At the time of the report, PYREXIA (Fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided by reporter. No treatment details were provided by reporter.

Other Meds:

Current Illness:

ID: 1672468
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Very sore arm; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Very sore arm) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History was provided. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYALGIA (Very sore arm). At the time of the report, MYALGIA (Very sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant Medications were provided. No Treatment Medications were provided.

Other Meds:

Current Illness:

ID: 1672469
Sex: M
Age: 72
State: CA

Vax Date: 02/14/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: some tremor; was in bed for for 7 to 10 days; muscle soreness; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (some tremor), BEDRIDDEN (was in bed for for 7 to 10 days) and MYALGIA (muscle soreness) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. Concomitant products included AMLODIPINE BESILATE, BENAZEPRIL HYDROCHLORIDE (LOTREL [AMLODIPINE BESILATE;BENAZEPRIL HYDROCHLORIDE]), ROSUVASTATIN CALCIUM (CRESTOR) and ZOLPIDEM TARTRATE (AMBIEN) for an unknown indication. On 14-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced TREMOR (some tremor), BEDRIDDEN (was in bed for for 7 to 10 days) and MYALGIA (muscle soreness). At the time of the report, TREMOR (some tremor), BEDRIDDEN (was in bed for for 7 to 10 days) and MYALGIA (muscle soreness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Treatment information was reported. This case was linked to MOD-2021-290104 (Patient Link).

Other Meds: LOTREL [AMLODIPINE BESILATE;BENAZEPRIL HYDROCHLORIDE]; CRESTOR; AMBIEN

Current Illness:

ID: 1672470
Sex: M
Age:
State: NC

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: This spontaneous case was reported by a consumer and describes the occurrence of DIARRHEA (Diarrhea) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 15-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Aug-2021, the patient experienced DIARRHEA (Diarrhea). At the time of the report, DIARRHOEA (Diarrhea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were reported. No Treatment information was reported.

Other Meds:

Current Illness:

ID: 1672471
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Dizzy; arm hurt; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (Dizzy) and PAIN IN EXTREMITY (arm hurt) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DIZZINESS (Dizzy) and PAIN IN EXTREMITY (arm hurt). At the time of the report, DIZZINESS (Dizzy) and PAIN IN EXTREMITY (arm hurt) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. No concomitant drugs were provided. No treatment drugs were provided

Other Meds:

Current Illness:

ID: 1672472
Sex: M
Age: 51
State: CA

Vax Date: 03/16/2021
Onset Date: 04/17/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: This spontaneous case was reported by a consumer and describes the occurrence of BURNING SENSATION (felt burning on the side of my face like a hot iron), HYPOAESTHESIA (experienced facial numbness, numbness was sporadic, have occasional numbness and weakness in hands), MUSCULAR WEAKNESS (occasional numbness and weakness in hands), PARAESTHESIA ORAL (feeling tingling at the tip and top of his tongue) and PARAESTHESIA (tingling) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 038B21A and 036821A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history information was reported. Concomitant products included ASPIRIN [ACETYLSALICYLIC ACID], ROSUVASTATIN CALCIUM (CRESTOR) and HYDROCHLOROTHIAZIDE for an unknown indication. On 16-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Apr-2021, the patient experienced BURNING SENSATION (felt burning on the side of my face like a hot iron), HYPOAESTHESIA (experienced facial numbness, numbness was sporadic, have occasional numbness and weakness in hands), MUSCULAR WEAKNESS (occasional numbness and weakness in hands), PARAESTHESIA ORAL (feeling tingling at the tip and top of his tongue), PARAESTHESIA (tingling) and HEADACHE (headaches for six weeks). At the time of the report, BURNING SENSATION (felt burning on the side of my face like a hot iron), HYPOAESTHESIA (experienced facial numbness, numbness was sporadic, have occasional numbness and weakness in hands), MUSCULAR WEAKNESS (occasional numbness and weakness in hands), PARAESTHESIA ORAL (feeling tingling at the tip and top of his tongue), PARAESTHESIA (tingling) and HEADACHE (headaches for six weeks) had not resolved. The patient had CAT scans, blood tests and an MRI while also feeling tingling at the tip and top of his tongue. He claimed that his health care provider could not determine the cause and was not sure how to treat him. Treatment information was not provided.

Other Meds: ASPIRIN [ACETYLSALICYLIC ACID]; CRESTOR; HYDROCHLOROTHIAZIDE.

Current Illness:

ID: 1672473
Sex: M
Age:
State: MD

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Back pain; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (Back pain) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced BACK PAIN (Back pain). At the time of the report, BACK PAIN (Back pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not reported. Treatment information was also not reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1672474
Sex: F
Age: 54
State: IN

Vax Date: 02/01/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: only received one moderna vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (only received one moderna vaccine) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In February 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (only received one moderna vaccine). At the time of the report, PRODUCT DOSE OMISSION ISSUE (only received one moderna vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. The treatment information was unknown.

Other Meds:

Current Illness:

ID: 1672475
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Numbness in arm and hand of the right side; Experiencing anxiety; Digestion issues; Itching of injection site; Redness of injection site; Swelling of injection site; Headache; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (Numbness in arm and hand of the right side), ANXIETY (Experiencing anxiety), DYSPEPSIA (Digestion issues), VACCINATION SITE PRURITUS (Itching of injection site) and VACCINATION SITE ERYTHEMA (Redness of injection site) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced HYPOAESTHESIA (Numbness in arm and hand of the right side), ANXIETY (Experiencing anxiety), DYSPEPSIA (Digestion issues), VACCINATION SITE PRURITUS (Itching of injection site), VACCINATION SITE ERYTHEMA (Redness of injection site), VACCINATION SITE SWELLING (Swelling of injection site) and HEADACHE (Headache). At the time of the report, HYPOAESTHESIA (Numbness in arm and hand of the right side), VACCINATION SITE PRURITUS (Itching of injection site), VACCINATION SITE ERYTHEMA (Redness of injection site) and VACCINATION SITE SWELLING (Swelling of injection site) outcome was unknown and ANXIETY (Experiencing anxiety), DYSPEPSIA (Digestion issues) and HEADACHE (Headache) had not resolved. Not Provided Concomitant medications were not provided by the reporter. Treatment information was not provided. This case was linked to MOD-2021-260290 (Patient Link).

Other Meds:

Current Illness:

ID: 1672476
Sex: F
Age:
State: TX

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: This spontaneous case was reported by a consumer and describes the occurrence of EXTRA DOSE ADMINISTERED (got the third dose of the Moderna COVID-19 vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concomitant products included LORATADINE (CLARITIN [LORATADINE]) for an unknown indication. On 16-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Aug-2021, the patient experienced EXTRA DOSE ADMINISTERED (got the third dose of the Moderna COVID-19 vaccine). At the time of the report, EXTRA DOSE ADMINISTERED (got the third dose of the Moderna COVID-19 vaccine) had resolved. No treatment information was reported. The patient wanted to know if she could take an antihistamine she regularly took (claritin) and wanted to be sure it would not interfere with the vaccine.

Other Meds: CLARITIN [LORATADINE]

Current Illness:

ID: 1672477
Sex: F
Age: 18
State: MS

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: got the Pfizer vaccine first dose 21 days ago and today, 17Aug2021, got a dose of the Moderna vaccine as a second dose; This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (got the Pfizer vaccine first dose 21 days ago and today, 17Aug2021, got a dose of the Moderna vaccine as a second dose) in an 18-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient received first dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (got the Pfizer vaccine first dose 21 days ago and today, 17Aug2021, got a dose of the Moderna vaccine as a second dose). On 17-Aug-2021, INTERCHANGE OF VACCINE PRODUCTS (got the Pfizer vaccine first dose 21 days ago and today, 17Aug2021, got a dose of the Moderna vaccine as a second dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment medication were not reported. Patient takes some medication but nothing long term.

Other Meds:

Current Illness:

ID: 1672478
Sex: F
Age: 63
State: IA

Vax Date: 08/11/2021
Onset Date: 08/01/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: Test Date: 202108; Test Name: Blood sugar; Result Unstructured Data: Higher than normal.

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Mild soreness of the arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Mild soreness of the arm) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. Concurrent medical conditions included Diabetic. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In August 2021, the patient experienced PAIN IN EXTREMITY (Mild soreness of the arm). At the time of the report, PAIN IN EXTREMITY (Mild soreness of the arm) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In August 2021, Blood glucose: high (High) Higher than normal. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication information was provided.

Other Meds:

Current Illness: Diabetic

ID: 1672479
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Hands trembling uncontrollable; All the side effects; Headaches; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Hands trembling uncontrollable), VACCINATION COMPLICATION (All the side effects) and HEADACHE (Headaches) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included COVID-19 in February 2021. Concurrent medical conditions included Lung scarring and Aortic aneurysm enlargement. In 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced TREMOR (Hands trembling uncontrollable), VACCINATION COMPLICATION (All the side effects) and HEADACHE (Headaches). At the time of the report, TREMOR (Hands trembling uncontrollable) and HEADACHE (Headaches) had not resolved and VACCINATION COMPLICATION (All the side effects) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) dosing remained unchanged. Relevant concomitant medications were not provided. Treatment medication was not provided. Reporter did not allow further contact

Other Meds:

Current Illness: Aortic aneurysm enlargement; Lung scarring

ID: 1672480
Sex: F
Age: 38
State:

Vax Date: 01/21/2021
Onset Date: 03/05/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Test Date: 20210330; Test Name: Pregnancy test; Test Result: Positive ; Result Unstructured Data: Positive for pregnancy test.; Test Date: 20210712; Test Name: Ultrasound; Result Unstructured Data: The baby had Cleft lip; Test Date: 20210726; Test Name: Ultrasound; Result Unstructured Data: The baby had Cleft palate.

Allergies:

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

Symptoms: First Dose 21 Jan 2021 and 2nd Dose 05 March 2021; The patient was 2 weeks pregnant at the time; This spontaneous retrospective pregnancy case was reported by a consumer and describes the occurrence of MATERNAL EXPOSURE BEFORE PREGNANCY (The patient was 2 weeks pregnant at the time) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 21 Jan 2021 and 2nd Dose 05 March 2021) in a 38-year-old female patient (gravida 2) who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 023M20A and 029L20A) for COVID-19 vaccination. The patient's past medical history included Alcohol use (2 drinks most days.) on 30-Mar-2021, Ectopic pregnancy on 23-Dec-2020 and Spontaneous abortion on 23-Dec-2020. Concurrent medical conditions included Attention deficit hyperactivity disorder. Concomitant products included AMFETAMINE ASPARTATE, AMFETAMINE SULFATE, DEXAMFETAMINE SACCHARATE, DEXAMFETAMINE SULFATE (ADDERALL) for ADD. On 21-Jan-2021 at 3:30 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Mar-2021 at 1:45 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. The patient's last menstrual period was on 22-Feb-2021 and the estimated date of delivery was 29-Nov-2021. On 05-Mar-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced MATERNAL EXPOSURE BEFORE PREGNANCY (The patient was 2 weeks pregnant at the time). On an unknown date, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 21 Jan 2021 and 2nd Dose 05 March 2021). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the first week of the pregnancy. The delivery occurred on an unknown date, which was reported as Spontaneous Abortion. For foetus 1, The outcome was reported as Ectopic pregnancy. On 05-Mar-2021, MATERNAL EXPOSURE BEFORE PREGNANCY (The patient was 2 weeks pregnant at the time) had resolved. At the time of the report, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 21 Jan 2021 and 2nd Dose 05 March 2021) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Mar-2021, Pregnancy test: positive (Positive) Positive for pregnancy test.. On 12-Jul-2021, Ultrasound abdomen: abnormal (abnormal) The baby had Cleft lip. On 26-Jul-2021, Ultrasound abdomen: abnormal (abnormal) The baby had Cleft palate.. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment information was not provided. The lab test includes amniocentesis on 26-Jul-2021. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was not applicable. This is a case of product exposure before pregnancy with associated AEs for the fetus, in this 38-year-old female. Patient will continue to be contacted for further monitoring of AEs during the pregnancy. A new case for Adverse events in the fetus has been created. This case was linked to MOD-2021-278592 (Parent-Child Link). See case MOD-2021-278592 for details regarding the child case. Most recent FOLLOW-UP information incorporated above includes: On 19-Aug-2021: Follow up document received on 19-Aug-2021 included current pregnancy details, previous pregnancy history, maternal medical history, reporter details, dose and patient details were updated. Second reporter and new event ectopic pregnancy were added.; Sender's Comments: This is a case of product exposure before pregnancy with associated AEs for the fetus, in this 38-year-old female. Patient will continue to be contacted for further monitoring of AEs during the pregnancy. A new case for Adverse events in the fetus has been created.

Other Meds: ADDERALL

Current Illness: Attention deficit hyperactivity disorder

ID: 1672481
Sex: F
Age: 80
State: MD

Vax Date: 01/09/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: sore arm; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (sore arm) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025J20A) for COVID-19 vaccination. No Medical History information was reported. On 09-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYALGIA (sore arm). At the time of the report, MYALGIA (sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. No treatment medications were provided. This case was linked to MOD-2021-290627, MOD-2021-291235 (Patient Link).

Other Meds:

Current Illness:

ID: 1672482
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: having side effects that are 300% worse than the first two; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (having side effects that are 300% worse than the first two) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was reported by reporter. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (having side effects that are 300% worse than the first two). At the time of the report, VACCINATION COMPLICATION (having side effects that are 300% worse than the first two) outcome was unknown. It was reported that the patient received the booster dose and had adverse events. No concomitant medications were reported. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1672483
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Had vivid symptoms; This spontaneous case was reported by a consumer and describes the occurrence of ADVERSE EVENT FOLLOWING IMMUNISATION (Had vivid symptoms) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 07-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ADVERSE EVENT FOLLOWING IMMUNISATION (Had vivid symptoms). At the time of the report, ADVERSE EVENT FOLLOWING IMMUNISATION (Had vivid symptoms) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1672484
Sex: M
Age: 12
State: ID

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccine administered to a 12-year-old patient; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Vaccine administered to a 12-year-old patient) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 009D21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Aug-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Vaccine administered to a 12-year-old patient). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Vaccine administered to a 12-year-old patient) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Patient aged almost 13 years

Other Meds:

Current Illness:

ID: 1672485
Sex: M
Age:
State: MN

Vax Date: 01/15/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: fever; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (fever) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 088D21A, 031M20A and 025L20A) for COVID-19 vaccination. Concurrent medical conditions included Cancer. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PYREXIA (fever). At the time of the report, PYREXIA (fever) outcome was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. patient stated that he got a mole treatment for cancer on his nose

Other Meds:

Current Illness: Cancer

ID: 1672486
Sex: U
Age:
State:

Vax Date: 03/01/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: breathing is worse than it has ever been since getting the vaccine/breathing has been compromised; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (breathing is worse than it has ever been since getting the vaccine/breathing has been compromised) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Asthma. In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In April 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DYSPNOEA (breathing is worse than it has ever been since getting the vaccine/breathing has been compromised). At the time of the report, DYSPNOEA (breathing is worse than it has ever been since getting the vaccine/breathing has been compromised) outcome was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness: Asthma

ID: 1672487
Sex: M
Age: 50
State: TX

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: left arm was hurting, where I got the shot; body aches; headaches; muscle pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (body aches), HEADACHE (headaches), MYALGIA (muscle pain) and VACCINATION SITE PAIN (left arm was hurting, where I got the shot) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) for COVID-19 vaccination. No Medical History information was reported. On 16-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Aug-2021, the patient experienced PAIN (body aches), HEADACHE (headaches) and MYALGIA (muscle pain). On 17-Aug-2021, the patient experienced VACCINATION SITE PAIN (left arm was hurting, where I got the shot). At the time of the report, PAIN (body aches), HEADACHE (headaches), MYALGIA (muscle pain) and VACCINATION SITE PAIN (left arm was hurting, where I got the shot) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication of the patient was not reported. On 16-Aug-2021, the symptoms started a little, but it started again on 17-Aug-2021 after work. No treatment information was provided by the reporter.

Other Meds:

Current Illness:

ID: 1672488
Sex: M
Age: 68
State: FL

Vax Date: 01/29/2021
Onset Date: 02/26/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: dizzy; could not walk without holding to an object; felt the need to relax and little tired; headachy; muscle aches; chills; little tired; patient received third shot within minutes of receiving second shot; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (dizzy), GAIT DISTURBANCE (could not walk without holding to an object), RESTLESSNESS (felt the need to relax and little tired), ACCIDENTAL OVERDOSE (patient received third shot within minutes of receiving second shot) and HEADACHE (headachy) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012M20A and 011A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included APIXABAN (ELIQUIS), CARVEDILOL and ROSUVASTATIN for an unknown indication. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Feb-2021, the patient experienced ACCIDENTAL OVERDOSE (patient received third shot within minutes of receiving second shot). On an unknown date, the patient experienced DIZZINESS (dizzy), GAIT DISTURBANCE (could not walk without holding to an object), RESTLESSNESS (felt the need to relax and little tired), HEADACHE (headachy), MYALGIA (muscle aches), CHILLS (chills) and FATIGUE (little tired). On 26-Feb-2021, ACCIDENTAL OVERDOSE (patient received third shot within minutes of receiving second shot) had resolved. At the time of the report, DIZZINESS (dizzy), GAIT DISTURBANCE (could not walk without holding to an object), RESTLESSNESS (felt the need to relax and little tired), HEADACHE (headachy), MYALGIA (muscle aches) and CHILLS (chills) was resolving and FATIGUE (little tired) outcome was unknown. No treatment medication was reported by patient. Within a few minutes of receiving second shot, patient received a third shot of the Moderna vaccine. Patient said this was a confusion made by the nurse. Right away, he didn't experience any symptoms. However, when his night shift started, patient felt headachy, dizzy, had muscle aches, chills, could not walk without holding to an object, and felt the need to relax. His shift ended at 7 o'clock in the morning, and when he went to bed and woke up around noon, he felt much better. Patient felt a little tired, but nothing compared to what he experienced before.

Other Meds: ELIQUIS; CARVEDILOL; ROSUVASTATIN

Current Illness:

ID: 1672489
Sex: M
Age: 17
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 1 dose of Moderna COVID 19 vaccine given to a patient who is 17 years old; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (1 dose of Moderna COVID 19 vaccine given to a patient who is 17 years old) in a 17-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (1 dose of Moderna COVID 19 vaccine given to a patient who is 17 years old). On 17-Aug-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (1 dose of Moderna COVID 19 vaccine given to a patient who is 17 years old) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant Medications were provided.

Other Meds:

Current Illness:

ID: 1672490
Sex: F
Age: 19
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Name: Heart beat; Result Unstructured Data: 75-80 beats per minute; Test Date: 20210817; Test Name: Heart beat; Result Unstructured Data: Fast heart beat around 6-7 PM 80-100 beats per minute

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Soreness of arm; Fever; Body aches; Headache; Heart beat increased to 80-100 beats per minute; This spontaneous case was reported by a nurse and describes the occurrence of PAIN IN EXTREMITY (Soreness of arm), HEART RATE INCREASED (Heart beat increased to 80-100 beats per minute), PYREXIA (Fever), MYALGIA (Body aches) and HEADACHE (Headache) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) for COVID-19 vaccination. Concomitant products included BIOTIN for an unknown indication. On 17-Aug-2021 at 11:30 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Aug-2021, the patient experienced HEART RATE INCREASED (Heart beat increased to 80-100 beats per minute). On 18-Aug-2021, the patient experienced PAIN IN EXTREMITY (Soreness of arm), PYREXIA (Fever), MYALGIA (Body aches) and HEADACHE (Headache). At the time of the report, PAIN IN EXTREMITY (Soreness of arm), HEART RATE INCREASED (Heart beat increased to 80-100 beats per minute), PYREXIA (Fever), MYALGIA (Body aches) and HEADACHE (Headache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 17-Aug-2021, Heart rate: 80-100 (High) Fast heart beat around 6-7 PM 80-100 beats per minute. On an unknown date, Heart rate: 75-80 (normal) 75-80 beats per minute. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant drugs includes Birth Control No Treatment information was reported.

Other Meds: BIOTIN

Current Illness:

ID: 1672491
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: very painful; swelling of the lymphoid; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (very painful) and LYMPHADENOPATHY (swelling of the lymphoid) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN (very painful) and LYMPHADENOPATHY (swelling of the lymphoid). At the time of the report, PAIN (very painful) and LYMPHADENOPATHY (swelling of the lymphoid) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1672492
Sex: U
Age:
State:

Vax Date: 02/01/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Never received the second dose and it's been more than 36 days since the first; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Never received the second dose and it's been more than 36 days since the first) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In February 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Never received the second dose and it's been more than 36 days since the first). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Never received the second dose and it's been more than 36 days since the first) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication of the patient was not reported. No treatment information was provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 18-Aug-2021: Follow-up information included update of reporter details.

Other Meds:

Current Illness:

ID: 1672493
Sex: U
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 2nd dose not received between day 25-35 of the 1st dose/COVID 19 vaccine about 3 months ago/ Patient didn't receive 2nd dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (2nd dose not received between day 25-35 of the 1st dose/COVID 19 vaccine about 3 months ago/ Patient didn't receive 2nd dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (2nd dose not received between day 25-35 of the 1st dose/COVID 19 vaccine about 3 months ago/ Patient didn't receive 2nd dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (2nd dose not received between day 25-35 of the 1st dose/COVID 19 vaccine about 3 months ago/ Patient didn't receive 2nd dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The concomitant medications were not reported. The treatment information was not provided. It was reported that patient wanted to get the second dose now. And the first dose was received two to three months before. Most recent FOLLOW-UP information incorporated above includes: On 20-Aug-2021: Follow-up information included addition of additional reporter. On 23-Aug-2021: Follow-up received included additional reported details.

Other Meds:

Current Illness:

ID: 1672494
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Do you expect the Moderna booster to have side effects similar to the second dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Do you expect the Moderna booster to have side effects similar to the second dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Do you expect the Moderna booster to have side effects similar to the second dose). At the time of the report, VACCINATION COMPLICATION (Do you expect the Moderna booster to have side effects similar to the second dose) outcome was unknown. the treatment history was not reported. The concomitant medication was not reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1672495
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I have completed your on-line reporting form.; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of ADVERSE EVENT in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ADVERSE EVENT. At the time of the report, ADVERSE EVENT outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. No concomitant medications were reported. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1672496
Sex: F
Age:
State: CT

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Reactions were even more significant than the first two doses; Bone pain; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Reactions were even more significant than the first two doses) and BONE PAIN (Bone pain) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised (Severely immunocompromised). On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Reactions were even more significant than the first two doses) and BONE PAIN (Bone pain). At the time of the report, VACCINATION COMPLICATION (Reactions were even more significant than the first two doses) and BONE PAIN (Bone pain) outcome was unknown. No concomitant medications provided. No treatment medications provided. Patient was severely immunocompromised who received 3rd dose of Moderna COVID-19 vaccine. The reactions were even more significant than first two doses as patient has bone pain now. Reporter did not allow further contact

Other Meds:

Current Illness: Immunocompromised (Severely immunocompromised)

ID: 1672497
Sex: F
Age: 77
State: CA

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: 101; Test Date: 20210816; Test Name: Heart rate; Result Unstructured Data: Increased

Allergies:

Symptom List: Injection site pain

Symptoms: Extra dose administered; Started with bruise that now has become much larger; She is also feeling dizzy; She has headache; It is itchy.; On same day at night, she started with little fever; She had nausea.; Her left arm started hurting at injection site; Injection site is swollen; It is red; She had stomach cramps; She started with bruise that now has become much larger.; She hasn't been eating much.; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (She is also feeling dizzy), EXTRA DOSE ADMINISTERED (Extra dose administered), ABDOMINAL PAIN UPPER (She had stomach cramps), CONTUSION (She started with bruise that now has become much larger.) and FEEDING DISORDER (She hasn't been eating much.) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Atrial fibrillation. Concomitant products included FAMOTIDINE, LOSARTAN, METOPROLOL SUCCINATE (TOPROL), ERGOCALCIFEROL (VITAMIN D [ERGOCALCIFEROL]), EZETIMIBE (ZETIA), CELECOXIB (CELEBREX), KETAMINE and CLOPIDOGREL BISULFATE (PLAVIX) for an unknown indication. On 14-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 14-Aug-2021, the patient experienced ABDOMINAL PAIN UPPER (She had stomach cramps), CONTUSION (She started with bruise that now has become much larger.), FEEDING DISORDER (She hasn't been eating much.), VACCINATION SITE PRURITUS (It is itchy.), PYREXIA (On same day at night, she started with little fever), NAUSEA (She had nausea.), VACCINATION SITE PAIN (Her left arm started hurting at injection site), VACCINATION SITE SWELLING (Injection site is swollen) and VACCINATION SITE ERYTHEMA (It is red). On 16-Aug-2021, the patient experienced DIZZINESS (She is also feeling dizzy), VACCINATION SITE BRUISING (Started with bruise that now has become much larger) and HEADACHE (She has headache). On an unknown date, the patient experienced EXTRA DOSE ADMINISTERED (Extra dose administered). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, DIZZINESS (She is also feeling dizzy), ABDOMINAL PAIN UPPER (She had stomach cramps), CONTUSION (She started with bruise that now has become much larger.), FEEDING DISORDER (She hasn't been eating much.), VACCINATION SITE BRUISING (Started with bruise that now has become much larger), VACCINATION SITE PRURITUS (It is itchy.), PYREXIA (On same day at night, she started with little fever), NAUSEA (She had nausea.), VACCINATION SITE PAIN (Her left arm started hurting at injection site), VACCINATION SITE SWELLING (Injection site is swollen), VACCINATION SITE ERYTHEMA (It is red) and HEADACHE (She has headache) outcome was unknown and EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 16-Aug-2021, Heart rate: increased (High) Increased. On an unknown date, Body temperature: 101 (High) 101.

Other Meds: FAMOTIDINE; LOSARTAN; TOPROL; VITAMIN D [ERGOCALCIFEROL]; ZETIA; CELEBREX; KETAMINE; PLAVIX

Current Illness: Atrial fibrillation

ID: 1672498
Sex: F
Age: 80
State: MD

Vax Date: 02/04/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: General feelings of malaise and spent a day in bed; Patient had taken 3rd dose of the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (General feelings of malaise and spent a day in bed) and EXTRA DOSE ADMINISTERED (Patient had taken 3rd dose of the vaccine) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012M20A and 054C21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced MALAISE (General feelings of malaise and spent a day in bed) and EXTRA DOSE ADMINISTERED (Patient had taken 3rd dose of the vaccine). At the time of the report, MALAISE (General feelings of malaise and spent a day in bed) outcome was unknown and EXTRA DOSE ADMINISTERED (Patient had taken 3rd dose of the vaccine) had resolved. No concomitant medications are reported by reporter. No treatment medications are reported by reporter. This case was linked to MOD-2021-290368.

Other Meds:

Current Illness:

ID: 1672499
Sex: U
Age:
State: WV

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Getting infected with COVID; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Getting infected with COVID) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (Getting infected with COVID). At the time of the report, COVID-19 (Getting infected with COVID) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. No treatment medication were reported. The reporter states that people who have received the COVID-19 vaccine in her area are getting infected with COVID-19.

Other Meds:

Current Illness:

ID: 1672500
Sex: M
Age: 69
State: AL

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Name: antibody testing; Test Result: Positive; Result Unstructured Data: positive antibodies test for covid-19

Allergies:

Symptom List: Tremor

Symptoms: Bitterness; Runny nose; Joint pain; muscle pain; This spontaneous case was reported by a consumer and describes the occurrence of DYSGEUSIA, RHINORRHOEA, ARTHRALGIA, and MYALGIA in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031A211A and 001C21A) for COVID-19 vaccination. The patient's past medical history included Sleep apnea. Concurrent medical conditions included Type 2 diabetes mellitus, Blood pressure high, and Allergy. Concomitant products included METFORMIN, OMEPRAZOLE, METOPROLOL, ATORVASTATIN, GLIPIZIDE, and LOSARTAN/HYDROCHLOORTHIAZIDE for an unknown indication. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DYSGEUSIA, RHINORRHOEA, ARTHRALGIA, and MYALGIA. At the time of the report, DYSGEUSIA, RHINORRHOEA, ARTHRALGIA, and MYALGIA outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 antibody test positive antibodies test for covid-19. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No treatment medication was reported by patient. Patient reported that he got the Moderna covid-19 vaccine and some time later he got a positive antibodies test for covid-19, doctor suggested that might need to change the statin because it might be the culprit.

Other Meds: METFORMIN; OMEPRAZOLE; METOPROLOL; ATORVASTATIN; GLIPIZIDE; LOSARTAN/HYDROCHLOORTHIAZIDE

Current Illness: Allergy; Blood pressure high; Type 2 diabetes mellitus

ID: 1672501
Sex: F
Age:
State: OK

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Sickness; Tachycardia; Pain; Dizziness; Fever; Chills; a lot of muscle pain after the second dose of the vaccine; Arthralgia; This spontaneous case was reported by a pharmacist and describes the occurrence of ILLNESS (Sickness), TACHYCARDIA (Tachycardia), PAIN (Pain), DIZZINESS (Dizziness) and PYREXIA (Fever) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ILLNESS (Sickness), TACHYCARDIA (Tachycardia), PAIN (Pain), DIZZINESS (Dizziness), PYREXIA (Fever), CHILLS (Chills), MYALGIA (a lot of muscle pain after the second dose of the vaccine) and ARTHRALGIA (Arthralgia). At the time of the report, ILLNESS (Sickness), TACHYCARDIA (Tachycardia), PAIN (Pain), DIZZINESS (Dizziness), PYREXIA (Fever), CHILLS (Chills), MYALGIA (a lot of muscle pain after the second dose of the vaccine) and ARTHRALGIA (Arthralgia) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment medication reported. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 18-Aug-2021: Follow-up received on 18 Aug 2021, Added events.

Other Meds:

Current Illness:

ID: 1672502
Sex: M
Age: 16
State: MD

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

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: cannot get the 2nd shot; 17 year old patient was given the 1st shot of the Moderna vaccine in April/erroneously given the first shot of the Moderna vaccine/under 18 child was erroneously given the first shot of; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (17 year old patient was given the 1st shot of the Moderna vaccine in April/erroneously given the first shot of the Moderna vaccine/under 18 child was erroneously given the first shot of) and PRODUCT DOSE OMISSION ISSUE (cannot get the 2nd shot) in a 17-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (17 year old patient was given the 1st shot of the Moderna vaccine in April/erroneously given the first shot of the Moderna vaccine/under 18 child was erroneously given the first shot of). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (cannot get the 2nd shot). On 03-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (17 year old patient was given the 1st shot of the Moderna vaccine in April/erroneously given the first shot of the Moderna vaccine/under 18 child was erroneously given the first shot of) had resolved. At the time of the report, PRODUCT DOSE OMISSION ISSUE (cannot get the 2nd shot) had resolved. Caller says her underage son received 1st dose and now cannot get his 2nd dose . She enquires what are the options at this point. She also states he does not take any medication regularly. Most recent FOLLOW-UP information incorporated above includes: On 18-Aug-2021: Non-Significant Follow up appended On 18-Aug-2021: Non significant Follow-up appended On 18-Aug-2021: Significant followup ; outcome of event updated to recovered and added reporters address

Other Meds:

Current Illness:

ID: 1672503
Sex: F
Age: 34
State: WA

Vax Date: 12/27/2020
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pregnant when vaccinated,Are you still looking for pregnant women who have been vaccinated; This spontaneous prospective pregnancy case was reported by an other health care professional and describes the occurrence of EXPOSURE DURING PREGNANCY (Pregnant when vaccinated,Are you still looking for pregnant women who have been vaccinated) in a 35-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 042L20A and 037K20A) for COVID-19 vaccination. No Medical History information was reported. On 27-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On an unknown date, the patient experienced EXPOSURE DURING PREGNANCY (Pregnant when vaccinated,Are you still looking for pregnant women who have been vaccinated). At the time of the report, EXPOSURE DURING PREGNANCY (Pregnant when vaccinated,Are you still looking for pregnant women who have been vaccinated) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient's last cycle was in November. No relevant concomitant medications were reported. No treatment information was provided. Most recent FOLLOW-UP information incorporated above includes: On 18-Aug-2021: Follow-up received on 18 Aug 2021 included no new information.

Other Meds:

Current Illness:

ID: 1672504
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Eight days after I received my first Moderna shot my arm started itching at the shot ssite; Get red where you got the shot eight days later; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Eight days after I received my first Moderna shot my arm started itching at the shot ssite) and VACCINATION SITE ERYTHEMA (Get red where you got the shot eight days later) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE PRURITUS (Eight days after I received my first Moderna shot my arm started itching at the shot ssite) and VACCINATION SITE ERYTHEMA (Get red where you got the shot eight days later). At the time of the report, VACCINATION SITE PRURITUS (Eight days after I received my first Moderna shot my arm started itching at the shot ssite) and VACCINATION SITE ERYTHEMA (Get red where you got the shot eight days later) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant product use was provided by the reporter. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1672505
Sex: F
Age:
State: FL

Vax Date: 07/29/2021
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Test Name: Blood pressure; Result Unstructured Data: very high

Allergies:

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

Symptoms: the itching is uncontrollable, it is all over her body, Uncontrollable itching; welts all over her body/welts got big, red and raised/still getting hives; throat started constricting/throat gets tight like she can't breathe; face swelled up, she was unrecognizable; still has shortness of breath; continuing to get allergies; Blood pressure was crazy high, very high; welts got big, red and raised; welts got big, red and raised; aside from pain at the injection site for a prolonged period of time she did not have any reactions till 15AUG2021, and she is still suffering with it; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (the itching is uncontrollable, it is all over her body, Uncontrollable itching), URTICARIA (welts all over her body/welts got big, red and raised/still getting hives), THROAT TIGHTNESS (throat started constricting/throat gets tight like she can't breathe), SWELLING FACE (face swelled up, she was unrecognizable) and DYSPNOEA (still has shortness of breath) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included DIPHENHYDRAMINE HYDROCHLORIDE, PARACETAMOL (TYLENOL PM) for an unknown indication. On 29-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRURITUS (the itching is uncontrollable, it is all over her body, Uncontrollable itching), URTICARIA (welts all over her body/welts got big, red and raised/still getting hives), THROAT TIGHTNESS (throat started constricting/throat gets tight like she can't breathe), SWELLING FACE (face swelled up, she was unrecognizable), DYSPNOEA (still has shortness of breath), HYPERSENSITIVITY (continuing to get allergies), HYPERTENSION (Blood pressure was crazy high, very high), ERYTHEMA (welts got big, red and raised), SWELLING (welts got big, red and raised) and VACCINATION SITE PAIN (aside from pain at the injection site for a prolonged period of time she did not have any reactions till 15AUG2021, and she is still suffering with it). The patient was treated with EPINEPHRINE on 16-Aug-2021 at a dose of 1 dosage form; PREDNISONE at a dose of 1 dosage form; HYDROXYZINE HCL at a dose of 25 microgram and EPINEPHRINE (EPIPEN) at a dose of 1 dosage form. At the time of the report, PRURITUS (the itching is uncontrollable, it is all over her body, Uncontrollable itching), URTICARIA (welts all over her body/welts got big, red and raised/still getting hives), THROAT TIGHTNESS (throat started constricting/throat gets tight like she can't breathe), SWELLING FACE (face swelled up, she was unrecognizable), DYSPNOEA (still has shortness of breath), HYPERSENSITIVITY (continuing to get allergies), HYPERTENSION (Blood pressure was crazy high, very high), ERYTHEMA (welts got big, red and raised), SWELLING (welts got big, red and raised) and VACCINATION SITE PAIN (aside from pain at the injection site for a prolonged period of time she did not have any reactions till 15AUG2021, and she is still suffering with it) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: high (High) very high. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. On 15-AUG-2021, the patient went to the ER at about 5 am. Treatment medication also includes Benadryl.

Other Meds: TYLENOL PM

Current Illness:

ID: 1672506
Sex: F
Age: 68
State:

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Joint Pain; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (Joint Pain) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 001C21A and 031A211A) for COVID-19 vaccination. Concurrent medical conditions included Immunosuppression. Concomitant products included METFORMIN, OMEPRAZOLE (OMEPRAZOLE ABBOTT), HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM (LOSARTAN + HIDROCLOROTIAZIDA), METOPROLOL, ATORVASTATIN and GLIPIZIDE for an unknown indication. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ARTHRALGIA (Joint Pain). At the time of the report, ARTHRALGIA (Joint Pain) outcome was unknown. Treatment information was not provided. This case was linked to MOD-2021-292622 (Patient Link).

Other Meds: METFORMIN; OMEPRAZOLE ABBOTT; LOSARTAN + HIDROCLOROTIAZIDA; METOPROLOL; ATORVASTATIN; GLIPIZIDE

Current Illness: Immunosuppression

ID: 1672507
Sex: F
Age: 61
State: VA

Vax Date: 01/11/2021
Onset Date: 02/10/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: had a fever of 99 F that lasted the rest of the day; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (had a fever of 99 F that lasted the rest of the day) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. # 010M20A and 026L20A) for COVID-19 vaccination. No Medical History information was reported. On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 10-Feb-2021, the patient experienced PYREXIA (had a fever of 99 F that lasted the rest of the day). At the time of the report, PYREXIA (had a fever of 99 F that lasted the rest of the day) had resolved. No concomitant medications were provided by reporter. No treatment details were provided by reporter. This case was linked to MOD-2021-290618 (Patient Link).

Other Meds:

Current Illness:

ID: 1672508
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: rash /more red; Rashes are more like a little pimples; arm kind of hurts; This spontaneous case was reported by an other health care professional and describes the occurrence of RASH ERYTHEMATOUS (rash /more red), DERMATITIS ACNEIFORM (Rashes are more like a little pimples) and MYALGIA (arm kind of hurts) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH ERYTHEMATOUS (rash /more red), DERMATITIS ACNEIFORM (Rashes are more like a little pimples) and MYALGIA (arm kind of hurts). At the time of the report, RASH ERYTHEMATOUS (rash /more red), DERMATITIS ACNEIFORM (Rashes are more like a little pimples) and MYALGIA (arm kind of hurts) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. concomitant medication was not provided treatment information was not provided

Other Meds:

Current Illness:

ID: 1672509
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: fully vaccinated but contracted Covid about 1 week ago; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (fully vaccinated but contracted Covid about 1 week ago) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced COVID-19 (fully vaccinated but contracted Covid about 1 week ago). At the time of the report, COVID-19 (fully vaccinated but contracted Covid about 1 week ago) outcome was unknown. No Concomitant medications were provided. No treatment medications were provided. Most recent FOLLOW-UP information incorporated above includes: On 18-Aug-2021: Follow-up information included no new information.

Other Meds:

Current Illness:

ID: 1672510
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Side effects; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Side effects) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Side effects). At the time of the report, VACCINATION COMPLICATION (Side effects) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. The treatment information was unknown. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1672511
Sex: F
Age:
State: NH

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Test Name: X-ray; Result Unstructured Data: did not reveal anything.

Allergies:

Symptom List: Vomiting

Symptoms: inflammatory response to the vaccine; pain radiating from her thigh to her knee; excruciating pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (pain radiating from her thigh to her knee) and PAIN (excruciating pain) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Pain in thigh (this pain had been ongoing since a couple of months before ) and Pain in knee (this pain had been ongoing since a couple of months before ). On 10-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, the patient experienced PAIN (pain radiating from her thigh to her knee) (seriousness criterion medically significant) and PAIN (excruciating pain) (seriousness criterion medically significant). On an unknown date, the patient experienced VACCINATION COMPLICATION (inflammatory response to the vaccine). The patient was treated with Surgery (spinal cord operation) for Pain and Surgery (spinal surgery) for Pain. At the time of the report, PAIN (pain radiating from her thigh to her knee), PAIN (excruciating pain) and VACCINATION COMPLICATION (inflammatory response to the vaccine) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, X-ray: did not reveal anything (normal) did not reveal anything. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was withdrawn on an unknown date. Patient got the first dose of the Moderna COVID-19 vaccine in 10Mar2021 (she does not have the vaccination card now). Within 4 hours she experienced pain radiating from her thigh to her knee, this pain had been ongoing since a couple of months before but after the vaccine the pain magnified. Earlier the day of the shot she had had an X-ray that day did not reveal anything. But 4 hours after the shot she had excruciating pain that went on for several days. Her doctor felt she was having an inflammatory response to the vaccine. She tried steroids that did not work, it progressed and in 10Apr2021 she ended up with spinal surgery. Her neurologist did not want her to get second dose because of this reaction. She's feeling much better now. She never got the second shot and wants to know if she can take it or if the booster shot could take place of the second dose. Her husband got the dose right before her, from the same lot and he was fine. She does not take any concomitant medications. Consent for Safety to follow up provided. Company comment: Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. However patient?s medical history of pain in thigh could be a confounder for the events. No further information is available for this case. The event were upgraded to serious by medical judgment because the need of surgery.; Sender's Comments: Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. However patient?s medical history of pain in thigh could be a confounder for the events.No further information is available for this case. The event were upgraded to serious by medical judgment because the need of surgery.

Other Meds:

Current Illness: Pain in knee (this pain had been ongoing since a couple of months before); Pain in thigh (this pain had been ongoing since a couple of months before).

ID: 1672512
Sex: F
Age: 50
State: PA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (left arm hurt), PAIN (pain spread across the chest, mostly over the left breast area), INFLAMMATION (pain feels muscular and inflamed) and MYALGIA (the pain feels muscular) in a 50-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027C21A and 046B21A) for COVID-19 vaccination. Concomitant products included HYDROXYCHLOROQUINE SULFATE (PLAQUENIL S), PREGABALIN, PREDNISONE, MYCOPHENOLATE MOFETIL HYDROCHLORIDE (CELLCEPT [MYCOPHENOLATE MOFETIL HYDROCHLORIDE]), CELECOXIB (CELEBREX), CYANOCOBALAMINE, BELIMUMAB, LANSOPRAZOLE, IRON and RIBOFLAVIN for an unknown indication. On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (left arm hurt), PAIN (pain spread across the chest, mostly over the left breast area), INFLAMMATION (pain feels muscular and inflamed) and MYALGIA (the pain feels muscular). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (left arm hurt) had resolved and PAIN (pain spread across the chest, mostly over the left breast area), INFLAMMATION (pain feels muscular and inflamed) and MYALGIA (the pain feels muscular) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. The patient described the pain feels muscular and inflamed and has spread across the chest, mostly over the left breast area. The patient explained they have Lupus and are on a lot of immunosuppressing medications. This case was linked to MOD-2021-290995.

Other Meds: PLAQUENIL S; PREGABALIN; PREDNISONE; CELLCEPT [MYCOPHENOLATE MOFETIL HYDROCHLORIDE]; CELEBREX; CYANOCOBALAMINE; BELIMUMAB; LANSOPRAZOLE; IRON; RIBOFLAVIN

Current Illness:

ID: 1672513
Sex: F
Age: 70
State: SC

Vax Date: 02/16/2021
Onset Date: 03/16/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Test Date: 2021; Test Name: Body temperature; Result Unstructured Data: She also had fever 101 F.

Allergies:

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

Symptoms: COVID Arm (from left Shoulder to elbow); Swollen (from left Shoulder to elbow) after second shot; Red (from left Shoulder to elbow) after second shot; Hot to the touch (from left Shoulder to elbow) after second shot; Rash (from left Shoulder to elbow) after second shot; Fever 101 F after second shot; Chills after second shot; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (COVID Arm (from left Shoulder to elbow)), PERIPHERAL SWELLING (Swollen (from left Shoulder to elbow) after second shot), ERYTHEMA (Red (from left Shoulder to elbow) after second shot), FEELING HOT (Hot to the touch (from left Shoulder to elbow) after second shot) and RASH (Rash (from left Shoulder to elbow) after second shot) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002B21A and 023M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 16-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 16-Mar-2021, the patient experienced PYREXIA (Fever 101 F after second shot) and CHILLS (Chills after second shot). On 17-Mar-2021, the patient experienced VACCINATION COMPLICATION (COVID Arm (from left Shoulder to elbow)), PERIPHERAL SWELLING (Swollen (from left Shoulder to elbow) after second shot), ERYTHEMA (Red (from left Shoulder to elbow) after second shot), FEELING HOT (Hot to the touch (from left Shoulder to elbow) after second shot) and RASH (Rash (from left Shoulder to elbow) after second shot). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. On 17-Mar-2021, PYREXIA (Fever 101 F after second shot) and CHILLS (Chills after second shot) had resolved. On 18-Mar-2021, PERIPHERAL SWELLING (Swollen (from left Shoulder to elbow) after second shot), ERYTHEMA (Red (from left Shoulder to elbow) after second shot) and FEELING HOT (Hot to the touch (from left Shoulder to elbow) after second shot) had resolved. On 31-Mar-2021, VACCINATION COMPLICATION (COVID Arm (from left Shoulder to elbow)) and RASH (Rash (from left Shoulder to elbow) after second shot) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Body temperature: 101 (High) She also had fever 101 F.. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication was provided. She has not reported to VAERS.

Other Meds:

Current Illness:

ID: 1672514
Sex: M
Age: 36
State: CA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: first dose 35 days ago; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (first dose 35 days ago) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027C21A) for COVID-19 vaccination. No Medical History information was reported. On 26-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-May-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (first dose 35 days ago). At the time of the report, PRODUCT DOSE OMISSION ISSUE (first dose 35 days ago) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not reported. Nurse has called that the patient who is trying to get the second dose outside of the recommended time frame.

Other Meds:

Current Illness:

ID: 1672515
Sex: M
Age: 57
State: FL

Vax Date: 07/20/2021
Onset Date: 08/17/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: arm pain; muscle pain; Headache; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (arm pain), MYALGIA (muscle pain) and HEADACHE (Headache) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 053E21A and 006021A) for COVID-19 vaccination. Concomitant products included METFORMIN, ACETYLSALICYLIC ACID (ASPIRIN 1000) and ATORVASTATIN for an unknown indication. On 20-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, the patient experienced PAIN IN EXTREMITY (arm pain), MYALGIA (muscle pain) and HEADACHE (Headache). At the time of the report, PAIN IN EXTREMITY (arm pain), MYALGIA (muscle pain) and HEADACHE (Headache) outcome was unknown. Treatment medications were not provided by the reporter.

Other Meds: METFORMIN; ASPIRIN 1000; ATORVASTATIN

Current Illness:

ID: 1672516
Sex: F
Age:
State: CT

Vax Date: 07/20/2021
Onset Date: 08/09/2021
Rec V Date: 09/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Less than 25 days between the first and second shot; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Less than 25 days between the first and second shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 09-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Less than 25 days between the first and second shot). On 09-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Less than 25 days between the first and second shot) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am