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: 1706444
Sex: F
Age: 31
State: WA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/17/2021
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: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Abdominal Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fever-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Additional Details: Within 5 min of admin, patient spiked a fever, w/ HR > 90, coughing, trouble breathing, stomach pains (had prev hx of hernia surgery/condition). Had patient lie down, elevated feet, take 3 deep breaths. Brought epipen next to me in case, however, within 2-3 minutes, patients HR was lowering to baseline and fever was going down with a cold compress. Offered water and she was able to drink/swallow water. Told patient to stay as long as she needed - she later was sitting up and drinking water.

Other Meds:

Current Illness:

ID: 1706445
Sex: M
Age: 25
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Mild, Additional Details: I did not witness the event but girlfriend started yelling for help saying that patient was seizing and when I got to him he was alert and sweating.

Other Meds:

Current Illness:

ID: 1706446
Sex: F
Age: 88
State: NC

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: Site: Bruising at Injection Site-Mild, Additional Details: pt came to pharmacy on 09/12/2021 after receiving pfizer vaccine on 09/10/2021 -- very large bruise on arm starting upper arm extending to elbow. pt stated that bruise was spreading. very dark and edges defined with dark areas. advised to seek immediate treatment but was reluctant because no pain. stated on eliquis. said would contact her doctor monday. said normal her pharmacy told her not to worry about it

Other Meds:

Current Illness:

ID: 1706447
Sex: M
Age: 32
State: PA

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Mild

Other Meds:

Current Illness:

ID: 1706448
Sex: F
Age: 80
State: FL

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
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: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe

Other Meds:

Current Illness:

ID: 1706449
Sex: F
Age: 58
State: CA

Vax Date: 08/14/2021
Onset Date: 08/15/2021
Rec V Date: 09/17/2021
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: Site: Pain at Injection Site-Severe, Systemic: Bell's Palsy-Medium, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium

Other Meds:

Current Illness:

ID: 1706450
Sex: F
Age: 61
State: OH

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 09/17/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1706451
Sex: F
Age: 73
State: CA

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 09/17/2021
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: low grade fever, malaise, myalgias, arthralgias for 3-4 days after vaccination and mild malaise myalgias arthralgias continue now one month later

Other Meds:

Current Illness:

ID: 1706452
Sex: F
Age: 33
State: MD

Vax Date: 08/31/2021
Onset Date: 09/06/2021
Rec V Date: 09/17/2021
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: Systemic: Body Aches Generalized-Severe, Additional Details: UPPER LEFT ARM PAIN STARTED 9/6. NOT IT HURS LIKE A POOLED MUSCLE SPREADING ACROSS THE RIGHT BACK AND SWALLEN. PAIN SEVERITY IS SEVERE. ADVISED TO CONTACT HER PRIMARY CARE PHYSICIAN TOMORROW.

Other Meds:

Current Illness:

ID: 1706453
Sex: F
Age: 50
State:

Vax Date: 09/11/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Joint pain, headache, rash, trouble breathing, and unexpected period with heavy flow and pain. (Menopausal woman without period for almost a year now.)

Other Meds: None

Current Illness: None

ID: 1706454
Sex: M
Age: 51
State: GA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/17/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1706455
Sex: M
Age: 15
State: TX

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Severe, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Severe, Additional Details: Patient became extremely lethargic while sitting on the chair 2 to 3 mins after receive first dose of pfizer covid-19 vaccination. Alert and oriented x3, c/o intermitent blurry vision, Bp 73/28 HR 108. Asked for water, given above 5oz. No s/s allergic reaction. Taken to ER by ambulance 4 to 5mins later while still extremely lethargic.

Other Meds:

Current Illness:

ID: 1706456
Sex: F
Age: 55
State: TX

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
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: Site: Pain at Injection Site-Mild, Systemic: Chills-Mild, Additional Details: patient felt chills, pharmacist follow up on sunday patient feeling better a little sore on the arm but nothing else

Other Meds:

Current Illness:

ID: 1706457
Sex: F
Age: 15
State: TX

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Additional Details: SEVERE NOSE BLEED THAT LASTED ABOUT 5-10 MINUTES

Other Meds:

Current Illness:

ID: 1706458
Sex: F
Age: 26
State: WV

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Visual Changes/Disturbances-Severe

Other Meds:

Current Illness:

ID: 1706459
Sex: F
Age: 35
State: OR

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

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

Lab Data: 9/14/21- Ekg showed sinus tachycardia

Allergies: Tamiflu, morphine, amoxicillin

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

Symptoms: Vaccine at 4pm. At 5pm started having a sharp, shooting, electrical shock sensation under Left side of tongue. Around 7:30 I had localized redness and swelling under the left side of my tongue and a weird tingling sensation throughout my body. The next day the swelling increased with difficulty eating and drinking that lasted through 9/14/21. The following day 9/9/21 I had swelling of my left tonsil and left side of throat, bilateral nasal turbinate swelling, bilateral ear pressure and 99.5.F temp. The following day, 9/10/21, I had red blotches in my throat and on my tonsils, my swallowing felt different/weird/a little more difficult, my throat and tonsil swelling worsened, the nasal turbinate swelling worsened where I could barely breath through nose, I had nerve pain and sensitivity behind My left ear that radiates down my neck and to My left shoulder, I had midline upper back pain/pressure, and at 3pm had sharp stabbing pain to my right lower quadrant of abdomen/uterus/ovary (this resolved after an hour). All symptoms have continued through 9/14/21. 9/13/21 I felt very fatigued, unable to do much of anything, barely ate much due to fatigue. I woke up at 1pm on 9/14/21 with A heart rate of 148 just standing and 125 resting which continued for the past 8-9 hrs. Chest discomfort toward the 7 hour mark, slightly winded with some dizziness and HA. My nerve pain behind my left ear had moved up into my l face, forehead, and behind my left eye. Had ekg that showed just tachycardia. All other Vital signs were normal. My nasal turbinate, throat and tonsil swelling was beginning to improve but not resolved and the tongue swelling and pain had resolved. I had fluids to help with the heart rate. And Sudafed and Afrin to try to help with the nasal turbinate swelling. Continue to nave some nasal turbinate swelling and congestion, left tonsil swelling with blotches in the throat and ear pressure as well as fatigue.

Other Meds: Xyzal, vitamin c, folate, biotin, vitamin d3

Current Illness: None

ID: 1706460
Sex: M
Age: 56
State: OR

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 09/17/2021
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: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1706461
Sex: F
Age: 30
State: TX

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 09/17/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1706462
Sex: F
Age: 56
State: DC

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
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: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1706463
Sex: F
Age: 30
State: NC

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
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: Error: Wrong Route (SC, IM, etc.)-

Other Meds:

Current Illness:

ID: 1706464
Sex: F
Age: 35
State: TX

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 09/17/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1706465
Sex: M
Age: 24
State: PA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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: Systemic: Confusion-Mild, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Additional Details: Over the course of about 1 minute, the patient felt sweaty and clammy. He then fainted/passed out in his chair. A customer noticed and said, "I think he's passed out." A technician responded and asked the patient if he was alright. After awakening, patient was given water and juice. The patient was given time to recuperate for about 10 minutes. Patient then reported feeling better and was able to leave on his own. Patient was encouraged to follow up with pharmacy should anything change.

Other Meds:

Current Illness:

ID: 1706466
Sex: M
Age: 18
State: OH

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
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: Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1706467
Sex: F
Age: 36
State: NC

Vax Date: 05/27/2021
Onset Date: 06/05/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Dentist checked for TMJ, and the Opthamologist found no issues with her eyes. Around late June, PCP then suggested POTS as a potential diagnosis; however, subsequent visit to Cardiologist in late July determined no POTS and that her heart is in good health. In August, Oncologist/Hematologist found no signs of cancer, noted a narrow right carotid on CT scan. Neurologist noted a narrow right carotid on MRI. No signs of circulatory problems or stroke observed in either scan. Doppler ultrasound of carotid arteries found no problems with blood-flow, no blockage, and she was told it should not be contributing to her symptoms. Changed PCPs at about the three month point after symptom onset, new PCP had her tested for thyroid function which appeared normal, lyme disease (negative), and no signs of auto-immune disorders identifiable by blood test.

Allergies: Sulfa Drugs

Symptom List: Injection site pain, Pain

Symptoms: Nine days after vaccination, she started having periodic dizziness, tightness/soreness around front and sides of neck, chest and shoulders, and feeling of racing/pounding heart. Symptoms grew worse and came to include difficulty with concentration and focus, muscles spasms in arms, lethargy, and weight loss, peaking around 6-8 weeks after onset of symptoms. During the peak of symptoms, she found it nearly impossible to read and struggled to comprehend simple written instructions. She started missing work and had to stop work entirely about two months after symptoms started. Since the peak of symptoms around 8 weeks, racing/pounding heart has resolved and energy level has partially rebounded, weight loss has ceased. Periodic dizziness still occurs multiple times per day, generally it is less common and occurs for shorter durations than at the peak of her symptoms. Three months after symptoms started, she has been able to resume reading and working, though with some difficulty, only working a few hours per week. Looking at computer screens, and other things that move quickly in her near field of vision is disorienting and seems to bring on symptoms as does being in low-light conditions such as dusk/dawn, or performing rapid movements. Treatment: About 1 week after symptoms, treated as ear-infection by primary care provider (pcp) based on initial report of dizziness. Symptoms did not improve with antibiotics and subsequent trip to ENT showed now signs of ear-infection. ENT has proposed a problem with the Vestibular system, suggesting "mal-disembarkment syndrome" and prescribed Vestibular PT which she is attending weekly while performing daily exercises at-home as directed by the therapist. She has spoken with mental health professionals who do not believe this to be the result of a mental health issue. Doctors say they cannot confirm one way or another if this is related to the vaccine, but the consensus is that she should avoid a second dose until a cause is identified or symptoms fully resolve.

Other Meds: Multi-vitamin

Current Illness: Cold lasting from about April 30 to May 9th.

ID: 1706469
Sex: U
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: EXPIRED PRODUCT ADMINISTERED; This spontaneous report received from a pharmacist concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 207A21A, and 1808986 expiry: UNKNOWN) dose, start therapy date were not reported for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient experienced expired product administered. The action taken with covid-19 vaccine was not applicable. The outcome of expired product administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210915852, 20210915731, 20210916228, 20210916312, 20210916455, 20210916553, 20210915748, 20210916658, 20210915719, 20210916910, 20210915661, 20210917226, 20210917160, 20210916465, 20210916697, 20210915646, 20210916808, 20210916715, 20210917163, 20210916768, 20210917515, 20210916965, 20210915623, 20210916300, 20210916584, 20210916811 and 20210918425.; Sender's Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non-serious.

Other Meds:

Current Illness:

ID: 1706470
Sex: M
Age:
State: NJ

Vax Date:
Onset Date: 06/28/2021
Rec V Date: 09/17/2021
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: VACCINE STORED IN TEMPERATURE EXCURSION; EXPIRED PRODUCT ADMINISTERED; This spontaneous report received from a pharmacist concerned a 20 year old male. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A expiry: 21-SEP-2021) dose was not reported, administered on 28-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-JUN-2021, the patient experienced expired product administered. On an unspecified date, the patient experienced vaccine stored in temperature excursion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the expired product administered and vaccine stored in temperature excursion was not reported. This report was non-serious. This case, from the same reporter is linked to 20210916965, 20210915719, 20210916300, 20210916129, 20210916465, 20210916498, 20210916455, 20210916715, 20210917160, 20210915646, 20210916697, 20210915731, 20210916520, 20210915852, 20210916312, 20210916228, 20210915661, 20210916415, 20210916401, 20210916584, 20210916811, 20210915748, 20210915623, 20210916768, 20210916849, 20210916907, 20210916910, 20210916959, 20210917074, 20210917163, 20210913164, 20210916553, 20210917515, 20210917226, 20210916658, 20210917500 and 20210918425.; Sender's Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non serious.

Other Meds:

Current Illness:

ID: 1706471
Sex: F
Age:
State: TX

Vax Date:
Onset Date: 09/07/2021
Rec V Date: 09/17/2021
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: Test Date: 20210907; Test Name: Blood test; Result Unstructured Data: No result; Test Date: 20210907; Test Name: Chest X-ray; Result Unstructured Data: No result; Test Date: 20210908; Test Name: Blood test; Result Unstructured Data: No result; Test Date: 20210908; Test Name: Chest X-ray; Result Unstructured Data: No result; Test Date: 20210909; Test Name: Blood test; Result Unstructured Data: No result; Test Date: 20210909; Test Name: Cardiac function test; Result Unstructured Data: cardiac lab change and she has a cardiac damaged and retaining

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: CARDIAC DAMAGED; UNABLE TO SLEEP; PAIN ALL OVER HER BODY; FEELING UNWELL; NAUSEA; VOMITTING; EDEMA ON BOTH LUNG; FEELING VERY SLEEPY; UNABLE TO EAT AND DRINK; SHE PASSED OUT; CHEST TIGHTENING; THROAT TIGHTENING; This spontaneous report received from a patient concerned a 35 year old female. The patient's height, and weight were not reported. The patient's concurrent conditions included: allergy to eggs, mustard and avocado, allergy and environmental allergens and the patient's pre-existing medical conditions included: The patient was very healthy before getting vaccinated, all her lab test was normal and did not have a history of the same medical condition. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 264A21A) dose was not reported, 1 total, administered on 07-SEP-2021 on right deltoid for prophylactic vaccination. Concomitant medications included diphenhydramine hydrochloride for allergy, epinephrine for allergy, loratadine for allergy, and corticosteroids for allergy. On 07-SEP-2021, few minutes post vaccination, the patient was unable to breath, her chest and throat was tightening. The patient used epi (epinephrine) pen to alleviate the allergic reaction and passed out on the pharmacy floor. On the same day, once the patient gained her strength and went to hospital and had series of blood works and Chest X-ray. The patient was given IV fluids. On 08-SEP-2021, the patient felt unwell, unable to get up all day, felt very sleepy, tiredness, nausea, vomiting, unable to eat and drink without throwing up. At the evening, she went to the ER again, did a series of blood works, chest x-ray and was given IV fluids, anti-nausea and anti-inflammatory. On 09-SEP-2021, the patient experienced chest pain which was worsening and experienced pain all over her body and the patient was unable to sleep. Therefore, patient went to ER again, gave her another IV fluids and performed a Pulmonary Embolism protocol and another blood works. The attending physician informed her that her cardiac lab change so much and she has a cardiac damaged and retaining too much fluids. She was referred to a cardiologist for echo and stress test. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from she passed out on 07-SEP-2021, was recovering from throat tightening, had not recovered from chest tightening, feeling unwell, feeling very sleepy, unable to eat and drink, nausea, vomiting, unable to sleep, pain all over her body, edema on both lung and the outcome of cardiac damaged was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0:20210920683-covid-19 vaccine ad26.cov2.s-Pulmonary oedema,Loss of consciousness.This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds: DIPHENHYDRAMINE HYDROCHLORIDE; CLARITINE; EPINEPHRINE

Current Illness: Allergy; Environmental allergy; Food allergy

ID: 1706472
Sex: M
Age:
State: NY

Vax Date:
Onset Date: 09/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Test Name: COVID-19 rapid POC test; Result Unstructured Data: Negative; Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: Negative; Test Name: CT scan; Result Unstructured Data: Normal; Test Name: CT scan; Result Unstructured Data: results awaiting; Test Name: Electrocardiogram; Result Unstructured Data: Normal; Test Name: Blood test NOS; Result Unstructured Data: Normal; Test Name: COVID-19 rapid POC test; Result Unstructured Data: Negative; Test Name: Chest scan; Result Unstructured Data: Normal

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: INFLAMMATION; FLU LIKE SYMPTOMS; FEELS LIKE NOT BALANCED EVERY ONCE IN A WHILE; HEADACHE (BECOMES WORSE LIKE A MIGRAINE); NAUSEA/FEEL LIKE I WANT TO THROW UP; FATIGUE COMES AND GOES; INJECTION SITE PAIN; THREW UP 2 OR 3 TIMES; TINGLING OF THE WHOLE FOOT/LEFT FINGERS/RIGHT FINGERS; FEELING EVERY THING IS HEAVY FOR THE FEET; This spontaneous report received from a patient concerned a 36 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: seasonal allergies, and other pre-existing medical conditions included: Patient had no medical conditions. The patient was previously treated with loratadine for seasonal allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 07-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On SEP-2021, the patient experienced feeling every thing is heavy for the feet. On SEP-2021, the patient experienced tingling of the whole foot/left fingers/right fingers. On an unspecified date, the patient experienced inflammation, flu like symptoms, feels like not balanced every once in a while, headache (becomes worse like a migraine), nausea/feel like i want to throw up, fatigue comes and goes, injection site pain, and threw up 2 or 3 times. Laboratory data (dates unspecified) included: Blood test NOS (NR: not provided) Normal, COVID-19 rapid POC test (NR: not provided) Negative, Negative, CT scan (NR: not provided) results awaiting, Normal, Chest scan (NR: not provided) Normal, Electrocardiogram (NR: not provided) Normal, and SARS-CoV-2 RT-PCR test (NR: not provided) Negative. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from flu like symptoms, and injection site pain, and feeling every thing is heavy for the feet on SEP-2021, had not recovered from headache (becomes worse like a migraine), nausea/feel like i want to throw up, fatigue comes and goes, tingling of the whole foot/left fingers/right fingers, inflammation, and threw up 2 or 3 times, and the outcome of feels like not balanced every once in a while was not reported. This report was non-serious.

Other Meds:

Current Illness: Seasonal allergy

ID: 1706473
Sex: U
Age:
State:

Vax Date:
Onset Date: 09/01/2021
Rec V Date: 09/17/2021
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: HEAVY ARM; PAIN OF LEFT ARM; NUMBNESS OF LEFT ARM; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 09-SEP-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On SEP-2021, the patient experienced heavy arm. On SEP-2021, the patient experienced pain of left arm. On SEP-2021, the patient experienced numbness of left arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from heavy, pain of left arm, and numbness of left arm on 12-SEP-2021. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706474
Sex: F
Age:
State: LA

Vax Date:
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
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: SWELLING OF FACE; SWELLING OF TOP LIP/UPPER LIP; FEELING LIKE THERE IS A FEVER WITHOUT A FEVER (FEELING ICKY); MALAISE; MILD HEADACHE; WHEEZING IN BREATHING; HANDS WERE SWOLLEN/SWELLING OF HANDS; VERY LITTLE SORENESS ON THE INJECTION SITE/MILD SORENESS ON THE INJECTION SITE; This spontaneous report received from a patient concerned a 62 year old female. The patient's height, and weight were not reported. The patient's past medical history included: shingles, and concurrent conditions included: undifferentiated connective tissue disease, severe osteoarthritis, iodine allergy, alcohol user, non-smoker, and antibiotic allergy, and other pre-existing medical conditions included: The patient was not pregnant at the time of reporting. The patient was on an antiviral drug that patient cannot remember but given for shingles and had no history of drug abuse or illicit drug use. The patient reported that she had fillers on her face. The patient took pain medicine (an OTC). The patient experienced drug allergy when treated with codeine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982 and expiry: UNKNOWN) dose was not reported, administered on 09-SEP-2021 for prophylactic vaccination on left deltoid. No concomitant medications were reported. On 09-SEP-2021, the patient experienced very little soreness on the injection site/mild soreness on the injection site. On 11-SEP-2021, the patient experienced hands were swollen/swelling of hands and wheezing in breathing. On 12-SEP-2021, the patient experienced swelling of face, swelling of top lip/upper lip, feeling like there is a fever without a fever (feeling icky), malaise and mild headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from wheezing in breathing on 11-SEP-2021, and had not recovered from very little soreness on the injection site/mild soreness on the injection site, mild headache, malaise, feeling like there is a fever without a fever (feeling icky), hands were swollen/swelling of hands, swelling of face, and swelling of top lip/upper lip. This report was non-serious.

Other Meds:

Current Illness: Alcohol use (Occasionally drinks); Allergy to antibiotic; Iodine allergy (had really bad reaction); Non-smoker; Osteoarthritis (rapidly progressing moving too fast); Undifferentiated connective tissue disease (causes a lot of problems)

ID: 1706475
Sex: F
Age:
State: PA

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: FEELING HEAVY ON THE RIGHT ARM; PINS AND NEEDLES TYPE OF PAIN ON THE RIGHT ARM THAT RADIATING TO SHOULDER AND BACK; BURNING PAIN ON THE RIGHT ARM; This spontaneous report received from a patient concerned a 37 year old female. The patient's height, and weight were not reported. The patient's concurrent conditions included: latex allergy. The patient experienced drug allergy when treated with erythromycin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 202AZ1A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 10-SEP-2021, the patient experienced burning pain on the right arm. On 11-SEP-2021, the patient experienced feeling heavy on the right arm. On 11-SEP-2021, the patient experienced pins and needles type of pain on the right arm that radiating to shoulder and back. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from burning pain on the right arm, feeling heavy on the right arm, and pins and needles type of pain on the right arm that radiating to shoulder and back. This report was non-serious.

Other Meds:

Current Illness: Latex allergy

ID: 1706476
Sex: F
Age:
State: IN

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: VOMITING (BLACK IN COLOR); PANIC ATTACK; BODY ACHES; HEADACHE; NAUSEA; FEVER; This spontaneous report received from a patient concerned a 21 year old female. The patient's height, and weight were not reported. The patient's past medical history included: stroke and concurrent conditions included: seasonal allergies, and panic attacks. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 10:00 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid, ademetionine, fluvoxamine, and loratadine. On 10-SEP-2021, the patient experienced panic attack. On 10-SEP-2021, the patient experienced body aches. On 10-SEP-2021, the patient experienced headache. On 10-SEP-2021, the patient experienced nausea. On 10-SEP-2021, the patient experienced fever. On 11-SEP-2021, the patient experienced vomiting (black in color). The action taken with covid-19 vaccine was not applicable. The patient had not recovered from vomiting (black in color), headache, body aches, nausea, and fever, and the outcome of panic attack was not reported. This report was non-serious.

Other Meds: FLUVOXAMINE; ASPRIN; LORATADINE; SAM-E

Current Illness: Panic attacks; Seasonal allergy

ID: 1706477
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: FEELING HOT; FEVER; This spontaneous report received from a parent concerned a 32 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 10-SEP-2021, the patient experienced feeling hot. On 10-SEP-2021, the patient experienced fever. The action taken with covid-19 vaccine was not applicable. The outcome of the fever and feeling hot was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706478
Sex: F
Age:
State: WV

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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 Date: 20210911; Test Name: Pain scale; Result Unstructured Data: pain over 10/10

Allergies:

Symptom List: Tremor

Symptoms: HEART FLUTTERING; PAIN EVERYWHERE/ACHY FROM HEAD TO TOES; DID NOT FEEL GOOD; EXTREMELY TIRED; This spontaneous report received from a consumer concerned a female of unspecified age. The patient's weight was 260 pounds, and height was 64 inches. The patient's past medical history included: liver transplant and blood clot. The patient experienced cellulitis when treated with levofloxacin (Lovenox), and oxycodone hydrochloride/paracetamol (Percocet). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: UNKNOWN) dose was not reported, 1 total, administered to left arm on 09-SEP-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid, amlodipine besilate, bupropion hydrochloride, empagliflozin, ergocalciferol, ezetimibe, levothyroxine sodium, losartan, metoprolol, mycophenolate sodium, pioglitazone, calcium and tacrolimus. On 10-SEP-2021, the patient felt extremely tired and did not feel good. The patient went to bed around 9 pm and on 11-SEP-2021, she woke up at 4 am and felt like somebody beat her and she had pain everywhere, also her hair hurt. The patient was achy from head to toes, and her pain was over 10/10 on the pain scale. The patient took 2 Tylenols and felt no relief. On the same day, the patient felt like her heart was fluttering a couple of times. Laboratory data included: Pain scale (NR: not provided) pain over 10/10. Treatment medications included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain everywhere/achy from head to toes, and heart fluttering, and the outcome of extremely tired and did not feel good was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0 20210921278-COVID-19 VACCINE AD26.COV2.S- heart fluttering. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds: LOSARTAN; MYFORTIC; JARDIANCE; WELLBUTRIN; PIOGLITAZONE; SYNTHROID; PROGRAF; EZETIMIBE; VITAMIN D [ERGOCALCIFEROL]; ASPRIN; METOPROLOL; NORVASC; CALCIUM

Current Illness:

ID: 1706479
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: FAIRLY SIGNIFICANT LETHARGY; BODY ACHES; HAVE NOT FELT WELL; DAILY HEADACHES; TINGLING IN VARIOUS REGIONS WHICH STARTED ON THE RIGHT SIDE OF BODY AND MOVED TO BOTH FEET/LEGS; This spontaneous report received from a patient concerned a male of unspecified age. The patient's height, and weight were not reported. The patient's pre-existing medical conditions included: The patient reported that the patent was previously very healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced fairly significant lethargy, body aches, have not felt well, daily headaches, and tingling in various regions which started on the right side of body and moved to both feet/legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from body aches, and the outcome of have not felt well, daily headaches, tingling in various regions which started on the right side of body and moved to both feet/legs and fairly significant lethargy was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706480
Sex: U
Age:
State: PA

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: EXTREMELY PAINFUL PAIN IN BOTH KIDNEYS; RINGING IN EARS; SEVERE HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced extremely painful pain in both kidneys, ringing in ears, and severe headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from extremely painful pain in both kidneys, and the outcome of severe headaches and ringing in ears was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706481
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: VERTIGO; CHEST PAIN; PANICKED AT 3 AM; THOUGHT WAS GOING TO DIE; CHILLS; VOMITING; DIARRHEA; FEVER; This spontaneous report received from a parent via a company representative concerned a male of unspecified age. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced vertigo, chest pain, panicked at 3 am, thought was going to die, chills, vomiting, diarrhea, and fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vomiting, diarrhea, chills, vertigo, chest pain, fever, panicked at 3 am and thought was going to die was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706482
Sex: M
Age:
State: AR

Vax Date:
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
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: JOINT PAIN ALL OVER; PINS AND NEEDLES SENSATION; This spontaneous report received from a patient concerned a 20 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: social alcohol user, and non smoker, and other pre-existing medical conditions included: The patient did not have any history of drug abuse or illicit drug use. The patient experienced anaphylaxis to flu vaccine at 6 months of age when treated with influenza vaccine for prophylactic vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-SEP-2021, the patient experienced pins and needles sensation. On 12-SEP-2021, the patient experienced joint pain all over. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from pins and needles sensation on 11-SEP-2021, and had not recovered from joint pain all over. This report was non-serious.

Other Meds:

Current Illness: Non-smoker; Social alcohol drinker (Social not very often)

ID: 1706483
Sex: F
Age:
State: NH

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: NAUSEA; INTERMITTENT TINGLING IN LEFT LEG; INJECTION LEFT ARM NUMBNESS WHICH MADE FEEL LIKE DEAD WEIGHT AND AFFECTED WHOLE HAND; This spontaneous report received from a patient concerned a 46 year old female. The patient's height, and weight were not reported. The patient's concurrent conditions included: asthma, and other pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 10-SEP-2021, the patient experienced injection left arm numbness which made feel like dead weight and affected whole hand. On 11-SEP-2021, the patient experienced nausea. On 11-SEP-2021, the patient experienced intermittent tingling in left leg. The action taken with covid-19 vaccine was not applicable. The patient recovered from nausea on 11-SEP-2021, had not recovered from intermittent tingling in left leg and injection left arm numbness which made feel like dead weight and affected whole hand. This report was non-serious.

Other Meds:

Current Illness: Asthma

ID: 1706484
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: BODY ACHES; SEVERE CHILLS; FEVER; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry: UNKNOWN) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced body aches, severe chills, and fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, severe chills, and fever. This report was non-serious. This case, from the same reporter is linked to 20210921477 and 20210921347.

Other Meds:

Current Illness:

ID: 1706485
Sex: M
Age:
State: FL

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

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

Lab Data: Test Name: Blood test; Result Unstructured Data: results not reported

Allergies:

Symptom List: Pain in extremity

Symptoms: A BASEBALL SIZE LUMP IN THE RIGHT ARM PIT; MILD HEADACHE; MILD FEVER; This spontaneous report received from a patient concerned a 53 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: elevated bp, and other pre-existing medical conditions included: The patient does not have any known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 204B21A expiry: 11-DEC-2021) dose was not reported, administered on 09-SEP-2021 for prophylactic vaccination. Concomitant medications included valsartan for elevated bp. On 09-SEP-2021, the patient experienced mild headache. On 09-SEP-2021, the patient experienced mild fever. On 10-SEP-2021, the patient experienced a baseball size lump in the right arm pit. Laboratory data (dates unspecified) included: Blood test (NR: not provided) results not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from mild headache, and mild fever on 11-SEP-2021, and had not recovered from a baseball size lump in the right arm pit. This report was non-serious.

Other Meds: VALSARTAN

Current Illness: Elevated BP (The patient takes Valsartan 25 mg once daily.)

Date Died:

ID: 1706486
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/17/2021
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: DEATH; This spontaneous report received from a consumer via a company representative through social media concerned 3 patients of unspecified age, sex, race and ethnicity. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: unknown and expiry date: unknown) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. The reporter stated that, "3 patients died from the Janssen vaccine" (date unspecified). The cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal. This report was serious (Death).; Sender's Comments: V0: 20210921454-Covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH

Other Meds:

Current Illness:

ID: 1706487
Sex: F
Age:
State:

Vax Date:
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: UNUSUAL ODOR PRESENT IN URINE; UNUSUAL ODOR PRESENT IN STOOLS; UNUSUAL ODOR PRESENT EVEN ON THE SKIN WHEN SHOWERED; UNUSUAL ORDER PRESENT IN OCULAR TEARS; This spontaneous report received from a patient concerned a female of unspecified age. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 12-SEP-2021, the patient experienced unusual odor present in urine. On 12-SEP-2021, the patient experienced unusual odor present in stools. On 12-SEP-2021, the patient experienced unusual odor present even on the skin when showered. On 12-SEP-2021, the patient experienced unusual order present in ocular tears. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the unusual odor present in urine, unusual odor present in stools, unusual odor present even on the skin when showered and unusual order present in ocular tears was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706488
Sex: U
Age:
State:

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

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

Lab Data: Test Date: 20210808; Test Name: Blood pressure; Result Unstructured Data: 88/50 or 88/60; Test Name: Oxygen saturation; Result Unstructured Data: 98-99 percentage; Test Name: Oxygen saturation; Result Unstructured Data: 60 %; Test Name: Scan with contrast; Result Unstructured Data: vaccine caused heart attack, oxygen drop to 60 from 98-99 percent

Allergies:

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

Symptoms: HEART INFLAMMATION; HEART ATTACK TRIGGERED BRONCHITIS; OXYGEN PLUMMETED TO 60 PERCENT; HEART ATTACK; DEHYDRATION; VOMITING; DIARRHEA; BP WENT TO 88/50 OR 88/60; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. The patient's concurrent condition included: overweight (10-15 pounds overweight). The patient was in excellent health with no pre-existing health issues, nor medication, prior to the vaccine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, 1 total, administered on 31-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. Just after the vaccine was taken, the patient went to urgent care and emergency room (ER) several times for dehydration, caused by vomiting and diarrhea. The first urgent care visit was 02-AUG-2021. On 03-AUG-2021, the patient was in another emergency room. On 06-AUG-2021, the patient went back to urgent care and again on 08-AUG-2021, where patient's blood pressure (BP) went to 88/50 or 88/60. On 09-AUG-2021, the patient had a heart attack, which doctors attributed to the JNJ vaccine. The patient was hospitalized on an unspecified date. The patient was left with heart inflammation, which would pass in late NOV-2021 or early DEC-2021 according to Cardiologist. The heart attack triggered bronchitis and the patient was at the tail end of that. The oxygen plummeted to 60 percent in the emergency room of hospital out of nowhere. The patient was peacefully getting intravenous fluids there and suddenly could not breathe at all. About 2 minutes passed with 60 percent oxygen, where the patient was about to die. Very fortunately, after the patient opened the green curtain in front, the emergency room doctor was standing there right in front and saved patient's life, with many nurses running to patient. The only reason the patient was alive was that the patient went to the ER with no wait and the ER doctor was standing next to patient behind the green curtain. If the ER doctor was down the hall, the patient would have died as patient was told or if patient would have gone to another hospital, which had a very long wait, the patient would have died in the waiting room most likely. The patient was ended up getting stabilized and admitted then taken by ambulance to another hospital at midnight. The patient spent 5 days in the Cardiac Unit there. The CT scan of heart with contrast revealed that vaccine caused the heart attack and oxygen to drop to 60 percent from normal 98-99 percent level. The patient also ended up medical care clinic 2 days after hospital discharge also for several breathing issues and bronchitis. The patient had not recovered from heart inflammation, and the outcome of heart attack, dehydration, heart attack triggered bronchitis, vomiting, diarrhea, BP went to 88/50 or 88/60 and oxygen plummeted to 60 percent was not reported. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition). This case, from the same reporter is linked to 20210923692.; Sender's Comments: V0-20210921562-Covid-19 vaccine ad26.cov2.s- Heart attack, heart inflammation,heart attack triggered bronchitis,oxygen plummeted to 60 percent, BP went to 88/50 or 88/60 .This event(s) is considered unassessable. The event(s) has an compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds:

Current Illness: Overweight

ID: 1706489
Sex: U
Age:
State:

Vax Date:
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Test Date: 20210910; Test Name: Body temperature; Result Unstructured Data: F, 101.7 (Unit unspecified)

Allergies:

Symptom List: Vomiting

Symptoms: SHORTNESS OF BREATH UPON ACTIVITY; UNABLE TO GO TO WORK CALLED OUT SICK; DIZZY ACTIVITY INTOLERANCE; WEAK; FATIGUE; SEVERE NIGHT SWEATS; BODY ACHE; SEVERE FEVER (101.7); SEVERE HEADACHE, WEAK PERSISTENT HEADACHE; RASH ON BOTH ARMS AND LEGS; CHILLS; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 202A21A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 12:20 for prophylactic vaccination. No concomitant medications were reported. On 10-SEP-2021, the patient experienced body ache. On 10-SEP-2021, the patient experienced rash on both arms and legs. On 10-SEP-2021, the patient experienced chills. On 10-SEP-2021, the patient experienced severe fever (101.7). On 10-SEP-2021, the patient experienced severe headache, weak persistent headache. Laboratory data included: Body temperature (NR: not provided). Treatment medications included: paracetamol. On 11-SEP-2021, the patient experienced severe night sweats. On 11-SEP-2021, the patient experienced fatigue. On 12-SEP-2021, the patient experienced shortness of breath upon activity. On 12-SEP-2021, the patient experienced unable to go to work called out sick. On 12-SEP-2021, the patient experienced dizzy activity intolerance. On 12-SEP-2021, the patient experienced weak. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from severe fever (101.7), rash on both arms and legs, chills, severe night sweats, unable to go to work called out sick, dizzy activity intolerance, weak, and shortness of breath upon activity, and the outcome of severe headache, weak persistent headache, body ache and fatigue was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706490
Sex: U
Age:
State: MA

Vax Date:
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: SWELLING UNDERNEATH THE EYE; SKIN UNDER EYE IS LITTLE SENSITIVE; SKIN UNDER EYE IS IRRITATED; This spontaneous report received from a consumer concerned a 60 year old of unspecified sex. The patient's height, and weight were not reported. The patient's past medical history included: dermal filler in cheeks. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 07-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 12-SEP-2021, the patient experienced swelling underneath the eye. On 12-SEP-2021, the patient experienced skin under eye is little sensitive. On 12-SEP-2021, the patient experienced skin under eye is irritated. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from swelling underneath the eye, skin under eye is irritated, and skin under eye is little sensitive. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706491
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 04/10/2021
Rec V Date: 09/17/2021
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: 20210719; Test Name: MRI; Result Unstructured Data: Baby was diagnosed with a fetal stroke; Test Date: 20210719; Test Name: Ultrasound scan; Result Unstructured Data: Baby was diagnosed with a fetal stroke

Allergies:

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

Symptoms: VACCINE EXPOSURE DURING PREGNANCY; This spontaneous pregnancy report received from a patient concerned a 28 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient experienced drug allergy when treated with acetylsalicylic acid, and ibuprofen. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A expiry: 21-SEP-2021) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 10-APR-2021, the patient experienced vaccine exposure during pregnancy. On 19-JUL-2021, Laboratory data included: MRI (NR: not provided) baby was diagnosed with a fetal stroke, and ultrasound scan (NR: not provided) baby was diagnosed with a fetal stroke. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from vaccine exposure during pregnancy. This report was non-serious. This parent/child case is linked to 20210922547.

Other Meds:

Current Illness:

ID: 1706492
Sex: M
Age:
State: OH

Vax Date:
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: SENSE OF TASTE GONE; STRANGE TASTE IN MOUTH; This spontaneous report received from a patient concerned a 60 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: rheumatoid arthritis, non-alcohol use, non-smoker, lupus, high blood pressure, and high cholesterol, and other pre-existing medical conditions included: In youth tried several illicit drug usage, now has medical marijuana and vaporizes marijuana on an as needed bases. The patient was previously treated with memantine hydrochloride for high blood pressure, high cholesterol, omeprazole, ezetimibe, tramadol, folic acid, zinc; and experienced hives and swelling when treated with acetylsalicylic acid. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. Concomitant medications included hydroxychloroquine phosphate for lupus, and prednisone for rheumatoid arthritis. On 12-SEP-2021, the patient experienced sense of taste gone. On 12-SEP-2021, the patient experienced strange taste in mouth. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from sense of taste gone, and strange taste in mouth. This report was non-serious.

Other Meds: PREDNISONE; PLAQUENIL

Current Illness: Abstains from alcohol; Blood pressure high; High cholesterol; Lupus erythematosus; Non-smoker; Rheumatoid arthritis

ID: 1706493
Sex: U
Age:
State:

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

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

Lab Data: Test Date: 20210909; Test Name: Pain scale; Result Unstructured Data: Exceed a 10 on the pain chart

Allergies:

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

Symptoms: LETHARGIC; WEAK; SHOT SIGHT PAIN; SEVERE MUSCLE CRAMPS ALL OVER BODY/COULD NOT TELL IF NERVES WERE ON FIRE OR IF MUSCLES HURT OR IF BONES WERE HURTING; WORST PAIN OF LIFE; SHOT SLIGHT REDNESS; SHOT SLIGHT SWELLING; STARTED RUNNING A FEVER; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 09-SEP-2021 09:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 09-SEP-2021, the patient experienced severe muscle cramps all over body/could not tell if nerves were on fire or if muscles hurt or if bones were hurting. On 09-SEP-2021, the patient experienced worst pain of life. On 09-SEP-2021, the patient experienced shot slight redness. On 09-SEP-2021, the patient experienced shot slight swelling. On 09-SEP-2021, the patient experienced started running a fever. On 09-SEP-2021, the patient experienced shot sight pain. Laboratory data included: Pain scale (NR: not provided) Exceed a 10 on the pain chart. On 10-SEP-2021, the patient experienced lethargic. On 10-SEP-2021, the patient experienced weak. The action taken with covid-19 vaccine was not applicable. The patient recovered from severe muscle cramps all over body/could not tell if nerves were on fire or if muscles hurt or if bones were hurting on 10-SEP-2021, and the outcome of shot sight pain, shot slight swelling, shot slight redness, started running a fever, weak, lethargic and worst pain of life was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1706494
Sex: M
Age:
State: NY

Vax Date:
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
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: HEADACHE; NO SLEEP; BLURRY VISION; CHILLS; This spontaneous report received from a consumer concerned a 21 year old male. The patient's height, and weight were not reported. The patient's pre-existing medical conditions included: The patient had no known drug allergies, no known medical conditions and no known medication usage. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-SEP-2021, the patient experienced no sleep. On 11-SEP-2021, the patient experienced blurry vision. On 11-SEP-2021, the patient experienced chills. On 12-SEP-2021, the patient experienced headache. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from chills, no sleep, blurry vision, and headache. This report was non-serious.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am