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: 1707207
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
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: 9 doses administered out of a vial that has a particulate; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT CONTAMINATION PHYSICAL (9 doses administered out of a vial that has a particulate) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002F21A) 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 PRODUCT CONTAMINATION PHYSICAL (9 doses administered out of a vial that has a particulate). At the time of the report, PRODUCT CONTAMINATION PHYSICAL (9 doses administered out of a vial that has a particulate) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported

Other Meds:

Current Illness:

ID: 1707208
Sex: U
Age:
State:

Vax Date: 03/01/2021
Onset Date:
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: Incomplete vaccination schedule since march/No second dose since march; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Incomplete vaccination schedule since march/No second dose since march) 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 March 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 (Incomplete vaccination schedule since march/No second dose since march). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Incomplete vaccination schedule since march/No second dose since march) had resolved. Treatment medication was not reported. Relevant concomitant medications were not provided by the reporter. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1707209
Sex: M
Age: 29
State: CA

Vax Date: 08/16/2021
Onset Date: 09/03/2021
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: sharp needle pain in chest with standing up and laying down; 1st dose of the Moderna vaccine on 16-Aug-2021 & 2nd dose of the Moderna vaccine on 03-Sep-2021; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (sharp needle pain in chest with standing up and laying down) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose of the Moderna vaccine on 16-Aug-2021 & 2nd dose of the Moderna vaccine on 03-Sep-2021) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 049E21A and 033D21A) 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 03-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Sep-2021, the patient experienced CHEST PAIN (sharp needle pain in chest with standing up and laying down) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose of the Moderna vaccine on 16-Aug-2021 & 2nd dose of the Moderna vaccine on 03-Sep-2021). The patient was treated with PARACETAMOL (TYLENOL) for Chest pain, at an unspecified dose and frequency and NAPROXEN SODIUM (ALEVE) for Chest pain, at an unspecified dose and frequency. On 03-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose of the Moderna vaccine on 16-Aug-2021 & 2nd dose of the Moderna vaccine on 03-Sep-2021) had resolved. At the time of the report, CHEST PAIN (sharp needle pain in chest with standing up and laying down) outcome was unknown. Concomitant product use was not provided by the reporter

Other Meds:

Current Illness:

ID: 1707210
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: Still sick a week after I got the first dose; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Still sick a week after I got the first 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) (unknown route) 1 dosage form. On an unknown date, the patient experienced ILLNESS (Still sick a week after I got the first dose). At the time of the report, ILLNESS (Still sick a week after I got the first dose) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Relevant concomitant medications were not reported. The treatment information was not provided.

Other Meds:

Current Illness:

ID: 1707211
Sex: U
Age: 50
State:

Vax Date: 09/01/2021
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: 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: Blister on stomach; It was itchy.; This spontaneous case was reported by a consumer and describes the occurrence of BLISTER (Blister on stomach) and PRURITUS (It was itchy.) in a 50-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026D21A) for COVID-19 vaccination. Concomitant products included INSULIN for an unknown indication. On 01-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Sep-2021, the patient experienced BLISTER (Blister on stomach) and PRURITUS (It was itchy.). At the time of the report, BLISTER (Blister on stomach) and PRURITUS (It was itchy.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No treatment medication was reported by patient.

Other Meds: INSULIN.

Current Illness:

ID: 1707212
Sex: U
Age:
State:

Vax Date: 08/15/2021
Onset Date:
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: Each day I'm more fatigue; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Each day I'm more fatigue) 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 15-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced FATIGUE (Each day I'm more fatigue). At the time of the report, FATIGUE (Each day I'm more fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was given by reporter. No treatment medication was given by reporter

Other Meds:

Current Illness:

ID: 1707213
Sex: F
Age: 64
State: LA

Vax Date: 05/02/2021
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: Pyrexia, White blood cell count decreased

Symptoms: 2nd dose >35 days; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (2nd dose >35 days) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 02-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (2nd dose >35 days). At the time of the report, PRODUCT DOSE OMISSION ISSUE (2nd dose >35 days) outcome was unknown. No concomitant medication was reported. No treatment medication was reported. Patient stated that patient was disabled and wanted to be vaccinated with the second dose. Patient's daughter got sick, and then Patient grandchild got sick and had not been provided with the second dose due to personal problems Most recent FOLLOW-UP information incorporated above includes: On 06-Sep-2021: Follow-up document received contains no new information(NNI) On 06-Sep-2021: Follow-up document received contains no new information(NNI)

Other Meds:

Current Illness:

ID: 1707214
Sex: F
Age: 29
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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: Became dehydrated; fever; chills; body aches; Diarrhea; Fever; Chills; Body aches; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DIARRHEA (Diarrhea), DEHYDRATION (Became dehydrated), PYREXIA (Fever), CHILLS (Chills) and MYALGIA (Body aches) in a 29-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 020F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Aug-2021, the patient experienced PYREXIA (Fever), CHILLS (Chills) and MYALGIA (Body aches). On 03-Sep-2021, the patient experienced DIARRHEA (Diarrhea), PYREXIA (fever), CHILLS (chills) and MYALGIA (body aches). On an unknown date, the patient experienced DEHYDRATION (Became dehydrated). At the time of the report, DIARRHEA (Diarrhea), DEHYDRATION (Became dehydrated), PYREXIA (fever), CHILLS (chills) and MYALGIA (body aches) outcome was unknown and PYREXIA (Fever), CHILLS (Chills) and MYALGIA (Body aches) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication was not provided. Treatment information include over the counter medicine for Diarrhea. On 27-Aug-2021 in the evening, the patient had typical side effects of fever, chills, body aches. Patient's side effects improved, however on 03-Sep-2021 about a week from original vaccination date patient had diarrhea. Then the fever, chills and body aches also returned on 03-Sep-2021. On 05-Sep-2021, the patient went to the emergency room (ER). They performed several tests and the tests came back normal. The ER doctor concluded that patient had become dehydrated because of her side effects. ER gave patient different medicines to stabilize her.

Other Meds:

Current Illness:

ID: 1707215
Sex: F
Age: 66
State: OH

Vax Date: 03/10/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: pressure in her head; sinus pressure; couldn't walk very good with her legs; epileptic reaction; swollen rash on left arm; swollen rash on left arm; really bad headache; This spontaneous case was reported by a consumer and describes the occurrence of EPILEPSY (epileptic reaction) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040C21, 046A21A and 003A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Allergy to antibiotic (Amoxicillin-rash), Sulfonamide allergy (rash), Cancer and Diabetes (Not taking any Diabetic medication.). Concomitant products included MONTELUKAST SODIUM (SINGULAIR) and LEVOCETIRIZINE DIHYDROCHLORIDE (XYZAL) for Allergy. On 10-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Aug-2021, the patient experienced HEADACHE (really bad headache). On 30-Aug-2021, the patient experienced PERIPHERAL SWELLING (swollen rash on left arm) and RASH (swollen rash on left arm). On an unknown date, the patient experienced EPILEPSY (epileptic reaction) (seriousness criterion medically significant), HEAD DISCOMFORT (pressure in her head), PARANASAL SINUS DISCOMFORT (sinus pressure) and GAIT DISTURBANCE (couldn't walk very good with her legs). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) at a dose of 2 dosage form every four hours. At the time of the report, EPILEPSY (epileptic reaction), PERIPHERAL SWELLING (swollen rash on left arm), HEAD DISCOMFORT (pressure in her head), PARANASAL SINUS DISCOMFORT (sinus pressure), GAIT DISTURBANCE (couldn't walk very good with her legs), RASH (swollen rash on left arm) and HEADACHE (really bad headache) outcome was unknown. Patient reported that she tried to go to urgent care for her rash and the doctor told her to take Benadryl (high doses) 2 tablets every 4 hours which she took for a week. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, underlying medical history of diabetes and cancer are cofounder. The event was downgrade to non-serious, due the patient did not seek medical attention for the epileptic reaction, but she sought for medical attention for the rash.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, underlying medical history of diabetes and cancer are cofounder. The event was downgrade to non-serious, due the patient did not seek medical attention for the epileptic reaction, but she sought for medical attention for the rash.

Other Meds: SINGULAIR; XYZAL

Current Illness: Allergy to antibiotic (Amoxicillin-rash); Cancer; Diabetes (Not taking any Diabetic medication.); Sulfonamide allergy (rash)

ID: 1707216
Sex: F
Age: 69
State: NY

Vax Date: 01/26/2021
Onset Date:
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: Test Date: 2021; Test Name: antibody test; Test Result: Negative ; Result Unstructured Data: doctor reported did not have antibodies

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: tiredness at injection site; soreness at injection site; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (tiredness at injection site) and VACCINATION SITE PAIN (soreness at injection site) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 011A21A and 012M20A) for COVID-19 vaccination. Concurrent medical conditions included Chronic lymphocytic leukemia. Concomitant products included IBRUTINIB (IMBRUVICA) and GAMMA GLOBULIN for an unknown indication. On 26-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Feb-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 FATIGUE (tiredness at injection site) and VACCINATION SITE PAIN (soreness at injection site). At the time of the report, FATIGUE (tiredness at injection site) and VACCINATION SITE PAIN (soreness at injection site) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Antibody test: negative (Negative) doctor reported did not have antibodies. Treatment information not reported. This case was linked to MOD-2021-308895 (Patient Link).

Other Meds: IMBRUVICA; GAMMA GLOBULIN

Current Illness: Chronic lymphocytic leukemia

ID: 1707217
Sex: M
Age: 67
State: TX

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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: This spontaneous case was reported by a consumer and describes the occurrence of PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062D21A) for COVID-19 vaccination. The patient's past medical history included Stroke in 2015 and Atrial fibrillation. Concomitant products included BUSPIRONE, ATORVASTATIN, METOPROLOL and APIXABAN for an unknown indication. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated). At the time of the report, PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication use was reported.

Other Meds: BUSPIRONE; ATORVASTATIN; METOPROLOL; APIXABAN

Current Illness:

ID: 1707218
Sex: F
Age: 37
State: AZ

Vax Date: 07/27/2021
Onset Date: 08/03/2021
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: Swelling in right arm 8 inch by 5 inch patch around bicep; Swelling from armpit to occipital bone with lymph node swelling; Fatigue and headache took three days to go away; Headache; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Swelling in right arm 8 inch by 5 inch patch around bicep), LYMPHADENOPATHY (Swelling from armpit to occipital bone with lymph node swelling), FATIGUE (Fatigue and headache took three days to go away) and HEADACHE (Headache) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 059E21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Aug-2021, the patient experienced PERIPHERAL SWELLING (Swelling in right arm 8 inch by 5 inch patch around bicep), LYMPHADENOPATHY (Swelling from armpit to occipital bone with lymph node swelling), FATIGUE (Fatigue and headache took three days to go away) and HEADACHE (Headache). In August 2021, FATIGUE (Fatigue and headache took three days to go away) and HEADACHE (Headache) had resolved. At the time of the report, PERIPHERAL SWELLING (Swelling in right arm 8 inch by 5 inch patch around bicep) and LYMPHADENOPATHY (Swelling from armpit to occipital bone with lymph node swelling) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) dosing remained unchanged. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment medication was not reported. Relevant concomitant medications were not provided by the reporter. This case was linked to MOD-2021-309088 (Patient Link).

Other Meds:

Current Illness:

ID: 1707219
Sex: U
Age:
State:

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: congestion; dry cough; sore throat; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 04-Sep-2021 and was forwarded to Moderna on 06-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of NASAL CONGESTION (congestion), COUGH (dry cough) and OROPHARYNGEAL PAIN (sore throat) 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 NASAL CONGESTION (congestion), COUGH (dry cough) and OROPHARYNGEAL PAIN (sore throat). At the time of the report, NASAL CONGESTION (congestion), COUGH (dry cough) and OROPHARYNGEAL PAIN (sore throat) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medication was reported No treatment Drug was reported

Other Meds:

Current Illness:

ID: 1707220
Sex: M
Age: 51
State: PA

Vax Date: 03/07/2021
Onset Date: 09/06/2021
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: Test Date: 20210906; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Result : Patient tested positive for Covid 19 via rapid test

Allergies:

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

Symptoms: back and joints pain; cough; headache; back and joints pain; lack of efficacy; Positive for Covid; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (back and joints pain), COUGH (cough), DRUG INEFFECTIVE (lack of efficacy), SARS-COV-2 TEST POSITIVE (Positive for Covid) and HEADACHE (headache) in a 52-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 030A21A and 019B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 07-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Sep-2021, the patient experienced DRUG INEFFECTIVE (lack of efficacy) and SARS-COV-2 TEST POSITIVE (Positive for Covid). On an unknown date, the patient experienced BACK PAIN (back and joints pain), COUGH (cough), HEADACHE (headache) and ARTHRALGIA (back and joints pain). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, BACK PAIN (back and joints pain), COUGH (cough), DRUG INEFFECTIVE (lack of efficacy), SARS-COV-2 TEST POSITIVE (Positive for Covid), HEADACHE (headache) and ARTHRALGIA (back and joints pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 06-Sep-2021, SARS-CoV-2 test: positive (Positive) Result : Patient tested positive for Covid 19 via rapid test. No Concomitant medications were reported.; Sender's Comments: Covid infection following vaccination has a causality assessment of "not applicable" by convention. Other events captured are likely symptoms of the Covid infection but a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1707221
Sex: U
Age:
State: TN

Vax Date: 07/26/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: This spontaneous case was reported by a consumer and describes the occurrence of SARS-COV-2 TEST POSITIVE (Tested positive for Covid 10 days after 1st dose) and PRODUCT DOSE OMISSION ISSUE (had to wait 90 days before I can receive the second dose of Moderna) 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 Cancer. On 26-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced SARS-COV-2 TEST POSITIVE (Tested positive for Covid 10 days after 1st dose) and PRODUCT DOSE OMISSION ISSUE (had to wait 90 days before I can receive the second dose of Moderna). At the time of the report, SARS-COV-2 TEST POSITIVE (Tested positive for Covid 10 days after 1st dose) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (had to wait 90 days before I can receive the second dose of Moderna) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication provided. patient received antibody infusion on 5-Aug-2021 and the patient was under the targeted treatment for cancer.

Other Meds:

Current Illness: Cancer

ID: 1707222
Sex: F
Age: 70
State: NY

Vax Date: 08/18/2021
Onset Date: 08/01/2021
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: Test Name: Antibody Test; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: Weight; Result Unstructured Data: Lost 5 lbs; Test Name: Blood pressure; Result Unstructured Data: Low blood pressure.

Allergies:

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

Symptoms: Inappropriate schedule of vaccine administered; Is sick as a dog/very sick; Reoccurring Fever/fevers; Threw up( this was triggered by wine); Headaches; Nausea; chills; Exhausted; Shakes; no appetite; No energy; Sleeping a lot; Depressed; No quality of life can't do any of her normal activities; irritable/cranky; Sinus infection; can't sleep well; feels like she has been poisoned; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Shakes), DECREASED APPETITE (no appetite), ASTHENIA (No energy), SOMNOLENCE (Sleeping a lot) and DEPRESSION (Depressed) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Chronic lymphocytic leukemia. Concomitant products included IBRUTINIB (IMBRUVICA) and GAMMA GLOBULIN for an unknown indication. On 18-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In August 2021, the patient experienced TREMOR (Shakes), DECREASED APPETITE (no appetite), ASTHENIA (No energy), SOMNOLENCE (Sleeping a lot), DEPRESSION (Depressed), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (No quality of life can't do any of her normal activities), IRRITABILITY (irritable/cranky), SINUSITIS (Sinus infection), INSOMNIA (can't sleep well), FEELING ABNORMAL (feels like she has been poisoned), ILLNESS (Is sick as a dog/very sick), PYREXIA (Reoccurring Fever/fevers), VOMITING (Threw up( this was triggered by wine)), HEADACHE (Headaches), NAUSEA (Nausea), CHILLS (chills) and FATIGUE (Exhausted). On 18-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). The patient was treated with AZITHROMYCIN (ZITHROMAX) for Sinus infection, at an unspecified dose and frequency. On 18-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. At the time of the report, TREMOR (Shakes), DECREASED APPETITE (no appetite), ASTHENIA (No energy), SOMNOLENCE (Sleeping a lot), DEPRESSION (Depressed), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (No quality of life can't do any of her normal activities), IRRITABILITY (irritable/cranky), SINUSITIS (Sinus infection), INSOMNIA (can't sleep well), FEELING ABNORMAL (feels like she has been poisoned), ILLNESS (Is sick as a dog/very sick), PYREXIA (Reoccurring Fever/fevers), VOMITING (Threw up( this was triggered by wine)), HEADACHE (Headaches), NAUSEA (Nausea), CHILLS (chills) and FATIGUE (Exhausted) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: 99/60 (Low) Low blood pressure.. On an unknown date, SARS-CoV-2 antibody test: negative (Negative) Negative. On an unknown date, Weight: decreased (abnormal) Lost 5 lbs. It was reported that Hydration treatment given for sinus infection. This case was linked to MOD-2021-308835 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Significant Follow up: new events (difficulty sleeping and irritable) added.

Other Meds: IMBRUVICA; GAMMA GLOBULIN

Current Illness: Chronic lymphocytic leukemia

ID: 1707223
Sex: F
Age:
State: FL

Vax Date: 08/29/2021
Onset Date: 08/29/2021
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: Pain at armpit on the same injection site; This spontaneous case was reported by a consumer and describes the occurrence of APPLICATION SITE PAIN (Pain at armpit on the same injection site) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 29-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Aug-2021, the patient experienced APPLICATION SITE PAIN (Pain at armpit on the same injection site). At the time of the report, APPLICATION SITE PAIN (Pain at armpit on the same injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1707224
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: This spontaneous case was reported by a consumer and describes the occurrence of DYSPEPSIA (Horrible heartburn) 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 DYSPEPSIA (Horrible heartburn). At the time of the report, DYSPEPSIA (Horrible heartburn) outcome was unknown. Relevant concomitant medications were not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1707225
Sex: M
Age: 34
State: WA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: Test Date: 20210903; Test Name: Body temperature; Result Unstructured Data: Had a slight fever of 100 degree Fahrenheit.

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Missed two days of work; Pain; Slight fever of 100?F; Right foot had a gout attack; Felt sick; Right foot hurts really bad/Right foot hurts like crazy; Could not sleep; Sweat like crazy; Messed them up; This spontaneous case was reported by a consumer and describes the occurrence of GOUT (Right foot had a gout attack), ILLNESS (Felt sick), PAIN IN EXTREMITY (Right foot hurts really bad/Right foot hurts like crazy), INSOMNIA (Could not sleep) and HYPERHIDROSIS (Sweat like crazy) in a 34-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Gout (Gout once 6 years ago and since then the patient had to modify his diet.) in 2015. On 02-Sep-2021 at 1:26 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Sep-2021, the patient experienced FEELING ABNORMAL (Messed them up). On 03-Sep-2021, the patient experienced GOUT (Right foot had a gout attack), ILLNESS (Felt sick), PAIN IN EXTREMITY (Right foot hurts really bad/Right foot hurts like crazy), INSOMNIA (Could not sleep), HYPERHIDROSIS (Sweat like crazy) and PYREXIA (Slight fever of 100?F). On an unknown date, the patient experienced LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Missed two days of work) and PAIN (Pain). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at an unspecified dose and frequency. On 03-Sep-2021, HYPERHIDROSIS (Sweat like crazy) and PYREXIA (Slight fever of 100?F) had resolved. At the time of the report, GOUT (Right foot had a gout attack) was resolving and ILLNESS (Felt sick), PAIN IN EXTREMITY (Right foot hurts really bad/Right foot hurts like crazy), INSOMNIA (Could not sleep), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Missed two days of work), FEELING ABNORMAL (Messed them up) and PAIN (Pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Sep-2021, Body temperature: 100 (High) Had a slight fever of 100 degree Fahrenheit.. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. Most recent FOLLOW-UP information incorporated above includes: On 09-Sep-2021: Additional information received included patient demographic details, suspect vaccine details, reported adverse event outcome and causality.

Other Meds:

Current Illness:

ID: 1707226
Sex: F
Age: 63
State: PR

Vax Date: 08/06/2021
Onset Date: 09/03/2021
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: redness of the site of the injection; a horrible, very large swelling of the injection site/swelling of the injection site, extending downwards, about 5 inches long.; fever for 48 hours; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE ERYTHEMA (redness of the site of the injection), VACCINATION SITE SWELLING (a horrible, very large swelling of the injection site/swelling of the injection site, extending downwards, about 5 inches long.) and PYREXIA (fever for 48 hours) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 006D21A) for COVID-19 vaccination. Concurrent medical conditions included Rheumatoid arthritis. Concomitant products included IBUPROFEN for Rheumatoid arthritis. On 06-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Sep-2021, the patient experienced PYREXIA (fever for 48 hours). On an unknown date, the patient experienced VACCINATION SITE ERYTHEMA (redness of the site of the injection) and VACCINATION SITE SWELLING (a horrible, very large swelling of the injection site/swelling of the injection site, extending downwards, about 5 inches long.). The patient was treated with HYDROCORTISONE for Adverse event, at a dose of 1 dosage form and ACETAMINOPHEN for Fever, at a dose of 1 dosage form. On 05-Sep-2021, PYREXIA (fever for 48 hours) had resolved. At the time of the report, VACCINATION SITE ERYTHEMA (redness of the site of the injection) and VACCINATION SITE SWELLING (a horrible, very large swelling of the injection site/swelling of the injection site, extending downwards, about 5 inches long.) outcome was unknown. Patient report no side effects after the first dose.

Other Meds: IBUPROFEN

Current Illness: Rheumatoid arthritis

ID: 1707227
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: 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: Area around the injection site started to get itchy, red & hot to the touch; Area around the injection site started to get itchy, red & hot to the touch; Area around the injection site started to get itchy, red & hot to the touch; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Area around the injection site started to get itchy, red & hot to the touch), VACCINATION SITE PRURITUS (Area around the injection site started to get itchy, red & hot to the touch) and VACCINATION SITE ERYTHEMA (Area around the injection site started to get itchy, red & hot to the touch) 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 WARMTH (Area around the injection site started to get itchy, red & hot to the touch), VACCINATION SITE PRURITUS (Area around the injection site started to get itchy, red & hot to the touch) and VACCINATION SITE ERYTHEMA (Area around the injection site started to get itchy, red & hot to the touch). At the time of the report, VACCINATION SITE WARMTH (Area around the injection site started to get itchy, red & hot to the touch), VACCINATION SITE PRURITUS (Area around the injection site started to get itchy, red & hot to the touch) and VACCINATION SITE ERYTHEMA (Area around the injection site started to get itchy, red & hot to the touch) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided. Treatment product information was not provided.

Other Meds:

Current Illness:

ID: 1707228
Sex: F
Age: 62
State: WV

Vax Date: 02/28/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Experience body ache; Nausea; Fever; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Experience body ache), NAUSEA (Nausea) and PYREXIA (Fever) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022M20A) for COVID-19 vaccination. No Medical History information was reported. Concomitant products included THYROID (ARMOUR THYROID), CIMETIDINE, SULFAMETHOXAZOLE, TRIMETHOPRIM (BACTRIM), OXYBUTYNIN, PHENTERMINE, TOPIRAMATE, HYDROXYZINE, PREDNISONE, SPIRONOLACTONE, ESZOPICLONE (LUNESTA), LEVOCETIRIZINE DIHYDROCHLORIDE (XYZAL), FEXOFENADINE HYDROCHLORIDE (ALLEGRA), FLUTICASONE and METHENAMINE for an unknown indication. On 28-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 MYALGIA (Experience body ache), NAUSEA (Nausea) and PYREXIA (Fever). The patient was treated with SUMATRIPTAN (IMITREX [SUMATRIPTAN]) at an unspecified dose and frequency. At the time of the report, MYALGIA (Experience body ache), NAUSEA (Nausea) and PYREXIA (Fever) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. This case was linked to MOD-2021-309664 (Patient Link).

Other Meds: ARMOUR THYROID; CIMETIDINE; BACTRIM; OXYBUTYNIN; PHENTERMINE; TOPIRAMATE; HYDROXYZINE; PREDNISONE; SPIRONOLACTONE; LUNESTA; XYZAL; ALLEGRA; FLUTICASONE; METHENAMINE

Current Illness:

ID: 1707229
Sex: F
Age:
State: WA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: This spontaneous case was reported by a pharmacist and describes the occurrence of DYSMENORRHOEA (It occurred within a week of getting the vaccine, vaginal bleeding and cramping) and VAGINAL HAEMORRHAGE (She got vaginal bleeding after both doses, It stopped on its own lasting no more than 3 days of heavy period then spotting) 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DYSMENORRHOEA (It occurred within a week of getting the vaccine, vaginal bleeding and cramping) and VAGINAL HAEMORRHAGE (She got vaginal bleeding after both doses, It stopped on its own lasting no more than 3 days of heavy period then spotting). At the time of the report, DYSMENORRHOEA (It occurred within a week of getting the vaccine, vaginal bleeding and cramping) outcome was unknown and VAGINAL HAEMORRHAGE (She got vaginal bleeding after both doses, It stopped on its own lasting no more than 3 days of heavy period then spotting) 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 medication was not provided Treatment information was not reported It was reported that the symptoms included cramping and vaginal bleeding were more severe after the first dose than the second dose. The bleeding stopped on its own, lasting no more than 3 days

Other Meds:

Current Illness:

ID: 1707230
Sex: M
Age: 41
State: MI

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient received expired 2nd dose of the Moderna vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received expired 2nd dose of the Moderna vaccine) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036A21A) for COVID-19 vaccination. No Medical History information was reported. On 31-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received expired 2nd dose of the Moderna vaccine). On 31-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Patient received expired 2nd dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Relevant concomitant medications were not provided. Treatment information was not provided. Expired doses of the Moderna vaccine were administered to three patients.

Other Meds:

Current Illness:

ID: 1707231
Sex: F
Age:
State: PA

Vax Date: 07/28/2021
Onset Date: 07/28/2021
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: Injection site pain, Menorrhagia

Symptoms: Patient did not receive the second dose of the Moderna COVID-19 vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Patient did not receive the second dose of the Moderna COVID-19 vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 28-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Jul-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Patient did not receive the second dose of the Moderna COVID-19 vaccine). On 28-Jul-2021, PRODUCT DOSE OMISSION ISSUE (Patient did not receive the second dose of the Moderna COVID-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided. Treatment information was not provided. The pharmacist wanted to know if the patient can receive a second dose of the Moderna COVID-19 vaccine or if they need to restart the series. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1707232
Sex: F
Age: 49
State: CT

Vax Date: 08/08/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Bleeding heavier than normal during period; This spontaneous case was reported by a pharmacist and describes the occurrence of HEAVY MENSTRUAL BLEEDING (Bleeding heavier than normal during period) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040C21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced HEAVY MENSTRUAL BLEEDING (Bleeding heavier than normal during period). At the time of the report, HEAVY MENSTRUAL BLEEDING (Bleeding heavier than normal during period) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment history was reported.

Other Meds:

Current Illness:

ID: 1707233
Sex: F
Age: 37
State: AZ

Vax Date: 07/27/2021
Onset Date: 08/31/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: I had shortness of breath, palpitation heaviness and pounding in chest, I had shortness of breath when walking feel like getting hit in center of chest; I had shortness of breath, palpitation heaviness and pounding in chest; heaviness and pounding in chest, Pounding feeling when walking; Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch; Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch; Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch; Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch; This spontaneous case was reported by a consumer and describes the occurrence of BURNING SENSATION (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), INJECTION SITE WARMTH (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), DYSPNOEA (I had shortness of breath, palpitation heaviness and pounding in chest, I had shortness of breath when walking feel like getting hit in center of chest), ERYTHEMA (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch) and PAIN (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004F21A and 059E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 31-Aug-2021, the patient experienced BURNING SENSATION (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), INJECTION SITE WARMTH (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), ERYTHEMA (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch) and PAIN (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch). On 03-Sep-2021, the patient experienced DYSPNOEA (I had shortness of breath, palpitation heaviness and pounding in chest, I had shortness of breath when walking feel like getting hit in center of chest), PALPITATIONS (I had shortness of breath, palpitation heaviness and pounding in chest) and CHEST DISCOMFORT (heaviness and pounding in chest, Pounding feeling when walking). At the time of the report, BURNING SENSATION (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), INJECTION SITE WARMTH (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), DYSPNOEA (I had shortness of breath, palpitation heaviness and pounding in chest, I had shortness of breath when walking feel like getting hit in center of chest), ERYTHEMA (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), PAIN (Two hours after second dose I had burning sensation with an 3 by 6 inch patch massively red and in pain hot to touch), PALPITATIONS (I had shortness of breath, palpitation heaviness and pounding in chest) and CHEST DISCOMFORT (heaviness and pounding in chest, Pounding feeling when walking) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. This case was linked to MOD-2021-308841.

Other Meds:

Current Illness:

ID: 1707234
Sex: M
Age: 39
State: CA

Vax Date: 07/28/2021
Onset Date: 08/25/2021
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:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Very painful that he cannot sleep comfortably; Fever; Chills; Headache; Pain on the left arm,After that, he will still have intermittent moderate to severe arm pain. the arm pain started to be severe; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Pain on the left arm,After that, he will still have intermittent moderate to severe arm pain. the arm pain started to be severe), INSOMNIA (Very painful that he cannot sleep comfortably), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Headache) in a 40-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 0056021A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 25-Aug-2021, the patient experienced PAIN IN EXTREMITY (Pain on the left arm,After that, he will still have intermittent moderate to severe arm pain. the arm pain started to be severe), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Headache). On 03-Sep-2021, the patient experienced INSOMNIA (Very painful that he cannot sleep comfortably). At the time of the report, PAIN IN EXTREMITY (Pain on the left arm,After that, he will still have intermittent moderate to severe arm pain. the arm pain started to be severe), INSOMNIA (Very painful that he cannot sleep comfortably), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Headache) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications reported. No treatment information was reported by reporter.

Other Meds:

Current Illness:

ID: 1707235
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: 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: Headache; Fever; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (Headache) and PYREXIA (Fever) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced HEADACHE (Headache) and PYREXIA (Fever). At the time of the report, HEADACHE (Headache) and PYREXIA (Fever) outcome was unknown. No concomitant medications were provided. Treatment information was not provided. Patient had no side effects from the first dose.

Other Meds:

Current Illness:

ID: 1707236
Sex: M
Age: 54
State: VA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
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: Headache; Fever; Sore arm; This spontaneous case was reported by a non-health professional and describes the occurrence of HEADACHE (Headache), PYREXIA (Fever) and VACCINATION SITE PAIN (Sore arm) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) 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) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Feb-2021, the patient experienced HEADACHE (Headache), PYREXIA (Fever) and VACCINATION SITE PAIN (Sore arm). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) at a dose of 1 dosage form. On 07-Feb-2021, HEADACHE (Headache), PYREXIA (Fever) and VACCINATION SITE PAIN (Sore arm) had resolved. No relevant concomitant medications reported. This case was linked to MOD-2021-309111 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: Follow-up received contains additional Include no new significant information.

Other Meds:

Current Illness:

ID: 1707237
Sex: M
Age: 46
State: IL

Vax Date: 02/02/2021
Onset Date:
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: Tired; Slight fever; Headache; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Tired), PYREXIA (Slight fever) and HEADACHE (Headache) in a 46-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052E21A, 031M20A and 010M20A) for COVID-19 vaccination. The patient's past medical history included Cancer (25 years ago). On 02-Feb-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 28-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 FATIGUE (Tired), PYREXIA (Slight fever) and HEADACHE (Headache). On 28-Aug-2021, FATIGUE (Tired), PYREXIA (Slight fever) and HEADACHE (Headache) had resolved. No concomitant medications reported. No treatment information was reported by reporter. This case was linked to MOD-2021-265490, MOD-2021-265483 (Patient Link).

Other Meds:

Current Illness:

ID: 1707238
Sex: U
Age:
State:

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Had a red spot where didn't get the shot; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 05-Sep-2021 and was forwarded to Moderna on 06-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of ERYTHEMA (Had a red spot where didn't get the shot) 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 ERYTHEMA (Had a red spot where didn't get the shot). At the time of the report, ERYTHEMA (Had a red spot where didn't get the shot) 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: 1707239
Sex: M
Age: 80
State: TX

Vax Date: 02/11/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Shortness of breath; Tightness in chest; Soreness in arm; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 05-Sep-2021 and was forwarded to Moderna on 05-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Shortness of breath), CHEST DISCOMFORT (Tightness in chest) and MYALGIA (Soreness in arm) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 030M20A, 031A21A and 939902) for COVID-19 vaccination. Concomitant products included FINASTERIDE, ALFUZOSIN and ALLOPURINOL for an unknown indication. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-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 DYSPNOEA (Shortness of breath), CHEST DISCOMFORT (Tightness in chest) and MYALGIA (Soreness in arm). At the time of the report, DYSPNOEA (Shortness of breath), CHEST DISCOMFORT (Tightness in chest) and MYALGIA (Soreness in arm) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.

Other Meds: FINASTERIDE; ALFUZOSIN; ALLOPURINOL

Current Illness:

ID: 1707240
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: Tremor

Symptoms: haven't felt good all day; I woke up this morning chilling; have a fever of 101; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (haven't felt good all day), CHILLS (I woke up this morning chilling) and PYREXIA (have a fever of 101) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced MALAISE (haven't felt good all day), CHILLS (I woke up this morning chilling) and PYREXIA (have a fever of 101). At the time of the report, MALAISE (haven't felt good all day), CHILLS (I woke up this morning chilling) and PYREXIA (have a fever of 101) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was not applicable No concomitant medications reported. No treatment reported.

Other Meds:

Current Illness:

ID: 1707241
Sex: U
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: Mild L arm edema; L axillary tenderness; This spontaneous case was reported by a consumer and describes the occurrence of OEDEMA PERIPHERAL (Mild L arm edema) and AXILLARY PAIN (L axillary tenderness) 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 OEDEMA PERIPHERAL (Mild L arm edema) and AXILLARY PAIN (L axillary tenderness). At the time of the report, OEDEMA PERIPHERAL (Mild L arm edema) and AXILLARY PAIN (L axillary tenderness) had resolved. Not Provided No Concomitant medication details were provided. No Treatment medication details were provided.

Other Meds:

Current Illness:

ID: 1707242
Sex: M
Age:
State:

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: Test Name: COVID- 19 test; Test Result: Positive ; Result Unstructured Data: Positive

Allergies:

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

Symptoms: My husband has Covid right now; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (My husband has Covid right now) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, 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 COVID-19 (My husband has Covid right now). At the time of the report, COVID-19 (My husband has Covid right now) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. No relevant concomitant medications were not reported by reporter. Treatment information was not reported by reporter.

Other Meds:

Current Illness:

ID: 1707243
Sex: U
Age: 65
State: CA

Vax Date: 02/17/2021
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: This spontaneous case was reported by a patient and describes the occurrence of INFLAMMATION (Inflammation in the upper arm), DIZZINESS (dizziness), BALANCE DISORDER (loss of equilibrium and fall in two instances), HYPOAESTHESIA (Sleeping foot) and ARTHRITIS (Inflammation in the elbow) in a 66-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.No Medical History information was reported. On 17-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced INFLAMMATION (Inflammation in the upper arm), DIZZINESS (dizziness), BALANCE DISORDER (loss of equilibrium and fall in two instances), HYPOAESTHESIA (Sleeping foot), ARTHRITIS (Inflammation in the elbow), PAIN IN EXTREMITY (pain in the left hand is increasing), ARTHRALGIA (left shoulder blade hurts) and MYALGIA (body aches). At the time of the report, INFLAMMATION (Inflammation in the upper arm), DIZZINESS (dizziness), BALANCE DISORDER (loss of equilibrium and fall in two instances), HYPOAESTHESIA (Sleeping foot), ARTHRITIS (Inflammation in the elbow), PAIN IN EXTREMITY (pain in the left hand is increasing), ARTHRALGIA (left shoulder blade hurts) and MYALGIA (body aches) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were not reported. On an unknown date, the patient underwent some laboratory tests like blood test, urine test and x-rays and revealed to be normal, except that they had a little blood in urine. HCP prescribed treatment medication. This case was linked to MOD-2021-309675 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 06-Sep-2021: significant follow up appended. Translation document updated the events. Which includes Inflammation, Dizziness, balance disorder, hypoaesthesia, arthritis, pain in extremity, arthralgia, myalgia.

Other Meds:

Current Illness:

ID: 1707244
Sex: F
Age: 23
State:

Vax Date: 08/07/2021
Onset Date: 09/04/2021
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: Extremely vivid dreams about killing herself; Panic attacks; Extreme pain on injection site; This spontaneous case was reported by a consumer and describes the occurrence of ABNORMAL DREAMS (Extremely vivid dreams about killing herself) and PANIC ATTACK (Panic attacks) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Drug allergy (Prozac). On 07-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Sep-2021, the patient experienced ABNORMAL DREAMS (Extremely vivid dreams about killing herself) (seriousness criterion life threatening), PANIC ATTACK (Panic attacks) (seriousness criterion life threatening) and VACCINATION SITE PAIN (Extreme pain on injection site). At the time of the report, ABNORMAL DREAMS (Extremely vivid dreams about killing herself), PANIC ATTACK (Panic attacks) and VACCINATION SITE PAIN (Extreme pain on injection site) outcome was unknown. Concomitant products were not provided. Treatment information was not reported. Company Comment: Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender's Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.

Other Meds:

Current Illness: Drug allergy (Prozac)

ID: 1707245
Sex: M
Age: 53
State: WI

Vax Date: 08/30/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: muscle spasms; feeling fatigue; recurring headaches; sore arm; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE SPASMS (muscle spasms), FATIGUE (feeling fatigue), HEADACHE (recurring headaches) and MYALGIA (sore arm) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 03421A) for COVID-19 vaccination. Concomitant products included ROSUVASTATIN for Hypercholesteraemia, LOSARTAN for Hypertension. On 30-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced MUSCLE SPASMS (muscle spasms), FATIGUE (feeling fatigue), HEADACHE (recurring headaches) and MYALGIA (sore arm). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, MUSCLE SPASMS (muscle spasms), FATIGUE (feeling fatigue), HEADACHE (recurring headaches) and MYALGIA (sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds: LOSARTAN; ROSUVASTATIN

Current Illness:

ID: 1707246
Sex: M
Age:
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
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: arm tender; not being able to sleep well; This spontaneous case was reported by a consumer and describes the occurrence of TENDERNESS (arm tender) and INSOMNIA (not being able to sleep well) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025J20A) for COVID-19 vaccination. No Medical History information was reported. On 26-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Jan-2021, the patient experienced TENDERNESS (arm tender) and INSOMNIA (not being able to sleep well). On 27-Jan-2021, TENDERNESS (arm tender) and INSOMNIA (not being able to sleep well) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. This case was linked to MOD-2021-309642 (Patient Link).

Other Meds:

Current Illness:

ID: 1707247
Sex: M
Age: 47
State:

Vax Date: 06/06/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: did not get second dose in the time period stipulated for the second dose; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (did not get second dose in the time period stipulated for the second dose) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050c21a) for COVID-19 vaccination. No Medical History information was reported. On 06-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (did not get second dose in the time period stipulated for the second dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (did not get second dose in the time period stipulated for the second dose) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication were reported. No treatment information was provided by the reporter.

Other Meds:

Current Illness:

ID: 1707248
Sex: F
Age: 43
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: bad reaction to my first dose of the vaccine; didn't take her second dose; lost the feeling in her hand and feet; heart palpitations; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (lost the feeling in her hand and feet), PALPITATIONS (heart palpitations), VACCINATION COMPLICATION (bad reaction to my first dose of the vaccine) and PRODUCT DOSE OMISSION ISSUE (didn't take her second dose) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Apr-2021, the patient experienced PALPITATIONS (heart palpitations). On 08-Apr-2021, the patient experienced HYPOAESTHESIA (lost the feeling in her hand and feet). On an unknown date, the patient experienced VACCINATION COMPLICATION (bad reaction to my first dose of the vaccine) and PRODUCT DOSE OMISSION ISSUE (didn't take her second dose). The patient was treated with VITAMIN B12 [VITAMIN B12 NOS] ongoing since an unknown date for Hypoaesthesia, at a dose of 1 dosage form. On 20-Apr-2021, PALPITATIONS (heart palpitations) had resolved. At the time of the report, HYPOAESTHESIA (lost the feeling in her hand and feet), VACCINATION COMPLICATION (bad reaction to my first dose of the vaccine) and PRODUCT DOSE OMISSION ISSUE (didn't take her second dose) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 06-Sep-2021: Significant follow-up received on 06 Sep 2021: Added new event

Other Meds:

Current Illness:

ID: 1707249
Sex: U
Age:
State:

Vax Date: 09/03/2021
Onset Date:
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: Full body muscle cramps for the last two hours; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE SPASMS (Full body muscle cramps for the last two hours) 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 03-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MUSCLE SPASMS (Full body muscle cramps for the last two hours). At the time of the report, MUSCLE SPASMS (Full body muscle cramps for the last two hours) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1707250
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: 2 weeks later he was diagnosed from 3rd cranial nerve palsy; sinus infection; This spontaneous case was reported by a consumer and describes the occurrence of IIIRD NERVE PARALYSIS (2 weeks later he was diagnosed from 3rd cranial nerve palsy) in a male 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced IIIRD NERVE PARALYSIS (2 weeks later he was diagnosed from 3rd cranial nerve palsy) (seriousness criterion medically significant) and SINUSITIS (sinus infection). At the time of the report, IIIRD NERVE PARALYSIS (2 weeks later he was diagnosed from 3rd cranial nerve palsy) and SINUSITIS (sinus infection) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Sender's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1707251
Sex: M
Age: 25
State: NY

Vax Date: 08/29/2021
Onset Date: 09/03/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: tingling in their left hand / tingling mostly in their left pinky; numbness in their left hand/ numbness mostly in their left pinky; This spontaneous case was reported by a consumer and describes the occurrence of PARAESTHESIA (tingling in their left hand / tingling mostly in their left pinky) and HYPOAESTHESIA (numbness in their left hand/ numbness mostly in their left pinky) in a 25-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, the patient experienced PARAESTHESIA (tingling in their left hand / tingling mostly in their left pinky) and HYPOAESTHESIA (numbness in their left hand/ numbness mostly in their left pinky). At the time of the report, PARAESTHESIA (tingling in their left hand / tingling mostly in their left pinky) and HYPOAESTHESIA (numbness in their left hand/ numbness mostly in their left pinky) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. The treatment history was not reported. The concomitant medication was not reported.

Other Meds:

Current Illness:

ID: 1707252
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: Tendanitis; Bursitis; In bad pain; This spontaneous case was reported by a consumer and describes the occurrence of TENDONITIS (Tendanitis), BURSITIS (Bursitis) and PAIN (In bad pain) 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 TENDONITIS (Tendanitis), BURSITIS (Bursitis) and PAIN (In bad pain). At the time of the report, TENDONITIS (Tendanitis), BURSITIS (Bursitis) and PAIN (In bad pain) 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 medication was provided.

Other Meds:

Current Illness:

ID: 1707253
Sex: F
Age: 57
State: NY

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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 Name: MRI; Result Unstructured Data: inflammation between vertebrae (C1 to C7 and T2 to T3), stenosis

Allergies:

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

Symptoms: Inflammation between her vertebrae; Stenosis; Arthritis; Flattening of the nerve; Weakness; Pain on fingers/Pain on arms; she had pain on her upper body (arms, shoulders, fingers); needle like feeling on her fingers,; ice coldness feeling on her fingers; Pain on shoulders; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (Pain on shoulders), INTERVERTEBRAL DISC DISORDER (Inflammation between her vertebrae), STENOSIS (Stenosis), ARTHRITIS (Arthritis) and NERVE COMPRESSION (Flattening of the nerve) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Hashimoto's disease, Penicillin allergy (Penicillin or any other penicillin derivatives) and Arthritis. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID), LAMOTRIGINE (LAMICTAL), CALCIUM, VITAMIN C [ASCORBIC ACID], ASCORBIC ACID, CALCIUM, MINERALS NOS, RETINOL, TOCOPHERYL ACETATE, VITAMIN B NOS, VITAMINS NOS, ZINC (CENTRUM SILVER [ASCORBIC ACID;CALCIUM;MINERALS NOS;RETINOL;TOCOPHERYL ACETATE;VITAMIN B NOS;VITAMINS NOS;ZINC]) and BIOTIN for an unknown indication. On 24-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Aug-2021, the patient experienced ARTHRALGIA (Pain on shoulders), INTERVERTEBRAL DISC DISORDER (Inflammation between her vertebrae), STENOSIS (Stenosis), ARTHRITIS (Arthritis), NERVE COMPRESSION (Flattening of the nerve), ASTHENIA (Weakness), PAIN IN EXTREMITY (Pain on fingers/Pain on arms), PAIN (she had pain on her upper body (arms, shoulders, fingers)), PARAESTHESIA (needle like feeling on her fingers,) and PERIPHERAL COLDNESS (ice coldness feeling on her fingers). The patient was treated with IBUPROFEN (MOTRIN [IBUPROFEN]) at a dose of 6 Tab once a day and LORAZEPAM (ATIVAN) at a dose of 1 Tab once a day. At the time of the report, ARTHRALGIA (Pain on shoulders), INTERVERTEBRAL DISC DISORDER (Inflammation between her vertebrae), STENOSIS (Stenosis), ARTHRITIS (Arthritis), NERVE COMPRESSION (Flattening of the nerve), ASTHENIA (Weakness), PAIN IN EXTREMITY (Pain on fingers/Pain on arms), PAIN (she had pain on her upper body (arms, shoulders, fingers)), PARAESTHESIA (needle like feeling on her fingers,) and PERIPHERAL COLDNESS (ice coldness feeling on her fingers) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Magnetic resonance imaging: abnormal (abnormal) inflammation between vertebrae (C1 to C7 and T2 to T3), stenosis. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient is allergic to latex, fragrance, aromatic soaps, detergents, furr,. fruits like mangoes and kiwi. Also had high ANA levels and considered to be immunocompromised. This case was linked to MOD-2021-309590.

Other Meds: SYNTHROID; LAMICTAL; CALCIUM; VITAMIN C [ASCORBIC ACID]; CENTRUM SILVER [ASCORBIC ACID;CALCIUM;MINERALS NOS;RETINOL;TOCOPHERYL ACETATE;VITAMIN B NOS;VITAMINS; BIOTIN

Current Illness: Arthritis; Hashimoto's disease; Penicillin allergy (Penicillin or any other penicillin derivatives)

ID: 1707254
Sex: F
Age:
State:

Vax Date:
Onset Date:
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: experienced rash; This spontaneous case was reported by a consumer and describes the occurrence of RASH (experienced rash) 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH (experienced rash). At the time of the report, RASH (experienced rash) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not reported. Treatment medications were not reported.

Other Meds:

Current Illness:

ID: 1707255
Sex: F
Age: 27
State: KY

Vax Date: 08/31/2021
Onset Date: 09/04/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Experiencing side effects 4 days after the first dose; low grade fever; Chills; headache; Side effects make her tired; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Experiencing side effects 4 days after the first dose), PYREXIA (low grade fever), CHILLS (Chills), HEADACHE (headache) and FATIGUE (Side effects make her tired) in a 27-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 0582EZ1A) for COVID-19 vaccination. No Medical History information was reported. On 31-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Sep-2021, the patient experienced VACCINATION COMPLICATION (Experiencing side effects 4 days after the first dose), PYREXIA (low grade fever), CHILLS (Chills), HEADACHE (headache) and FATIGUE (Side effects make her tired). At the time of the report, VACCINATION COMPLICATION (Experiencing side effects 4 days after the first dose), PYREXIA (low grade fever), CHILLS (Chills), HEADACHE (headache) and FATIGUE (Side effects make her tired) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product was not provided by the reporter Treatment information was not provided Most recent FOLLOW-UP information incorporated above includes: On 06-Sep-2021: Follow-up information received included new event (Vaccination complication).

Other Meds:

Current Illness:

ID: 1707256
Sex: F
Age: 57
State: NC

Vax Date: 09/05/2021
Onset Date: 09/06/2021
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: felling itching\got itching again, eyes, nostril, throat, and bottom of the right foot; rush in some spot on the left arm,; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (felling itching\got itching again, eyes, nostril, throat, and bottom of the right foot) and RASH (rush in some spot on the left arm,) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062e21a) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure. Concomitant products included METOPROLOL for Blood pressure, PREDNISONE, COLESEVELAM, LISINOPRIL, ESOMEPRAZOLE and VERAPAMIL for an unknown indication. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced PRURITUS (felling itching\got itching again, eyes, nostril, throat, and bottom of the right foot). 06-Sep-2021, the patient experienced RASH (rush in some spot on the left arm,). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL A) for Itching, at an unspecified dose and frequency. At the time of the report, PRURITUS (felling itching\got itching again, eyes, nostril, throat, and bottom of the right foot) and RASH (rush in some spot on the left arm,) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.

Other Meds: PREDNISONE; COLESEVELAM; LISINOPRIL; ESOMEPRAZOLE; METOPROLOL; VERAPAMIL

Current Illness: Blood pressure

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am