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: 1710070
Sex: F
Age: 42
State: AZ

Vax Date: 09/03/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa

Symptom List: Dysphagia, Epiglottitis

Symptoms: 10 days after - Developed bumps at injection site. Itchy, red, swollen, warm to touch. The itching went away but arm still swollen, red, warm. Today 9-17-21 noticed it grew much larger and has a red ring around it

Other Meds: Vitamins, anxiety medication (nightly ambien, blood pressure medicine, and anxiety medication, medical marijuana

Current Illness: Cough

ID: 1710071
Sex: M
Age: 58
State: SC

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

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: light headed- unsure if related to vaccine since he stated he had that before because of sciatica pain which he currently had as well

Other Meds:

Current Illness:

ID: 1710072
Sex: F
Age: 56
State: NV

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: N/A

Allergies: NKDA

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

Symptoms: Administered 1st covid 19 vaccine to pt (pfizer), while pt was in post vaccination waiting area pt informed us that she was feeling light headed and not right. I placed pt in supine position with legs elevated and monitered her her vital signs, which remained stable throughout incident. Also placed ice packs behind neck and on forehead while she was laying down, and provided her with bottle of water. Patient stated that she suffers from anxiety and had not eaten anything since the morning time, states not diabetic. Patient never lost consciousness during entire time. Patient didn't want us to call ambulance, her husband was notified and he came to the store to get her and take her home.

Other Meds: N/A

Current Illness: N/A

ID: 1710073
Sex: M
Age: 12
State: LA

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

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

Lab Data: None yet

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Next day after 2nd dose of Pfizer vaccine, the school nurse called me to report my son had "red, irritated" eyes. I had just dropped him off at school not even an hour before. The nurse stated, "He told me he had allergies, but I just wanted you to know. I'l send him back to class and tell him to come back if it gets worse." I honestly blew it off because we had all woken up late and I thought he possibly was still sleepy. He stayed at school and the afternoon he came in and went to sleep, which I expected. He woke up about 2 hours after school and both eyes were bloodshot and he was squinting. He said his eyes were bothering him. This has never happened before. He does wear glasses but has never had irritated eyes before. I gave him Ibuprofen and used saline eye drops. He appeared to have some light sensitivity and described having floaters in last hour at school during the day. It is now 10 pm at night approximately 18 hours post the 2nd Pfizer vaccine, and his eyes are still reddened and irritated. If it persists tomorrow after he wakes up, I will take him in to be seen by a doctor.

Other Meds: None

Current Illness: None

ID: 1710074
Sex: F
Age: 0
State:

Vax Date: 10/16/2020
Onset Date: 10/16/2020
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: Stool culture Hemoglobin Fecal occult blood test

Allergies: NA

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

Symptoms: Vomiting, copious green diarrhea, significant rotavirus infection leading to sudden onset intense immune response that resulted in months of bloody green mucous diarrhea, weight loss, proctocolitis, poor weight gain, and sudden onset food protein induced enterocolitis

Other Meds: NA

Current Illness: NA

ID: 1710075
Sex: F
Age: 101
State: OH

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: sulfa

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

Symptoms: I don't believe the adverse reaction was due to the flu shot my mother received but due to the unusual bandaid that was put on the injection site. It was a circular bandaid that was cushioned on the outer ring and had a clear plastic(?) coating in the center of the bandaid. It seemed to act like a suction cup drawing the blood up to the surface. My mother left the bandaid on for 2 days before discovering it and as you can imagine it was very red and it bruised. This had never happened with any other flu shot but they had never used this kind of bandaid on her before either. I would let all medical personnel know to never use this type of bandaid, especially on the elderly who have overly sensitive and tender skin in the first place. There wasn't even any gauze on the bandaid to absorb any drop of blood from the injection. These bandaids are horrible to use since they cause this type of reaction! I'd write the company about them but don't know who makes them. They suck! Literally!

Other Meds: 10 MG Norvasc 1x a day

Current Illness: injury on R. leg

ID: 1710180
Sex: F
Age: 26
State: CA

Vax Date: 08/13/2021
Onset Date: 08/23/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Frequent muscle spasm in the left arm (site of vaccine injection). Estimated to last 60% of the day. Weakness of muscles in left arm. Severe headache. Severe muscle cramps and pain in both legs.

Other Meds:

Current Illness:

ID: 1710181
Sex: F
Age: 43
State:

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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: Next day began heavy vaginal bleeding, abdominal cramping & pain. Was not normal menstrual cycle, occurred nearly 2 weeks prior to anticipated period.

Other Meds:

Current Illness:

ID: 1710182
Sex: F
Age: 71
State: TX

Vax Date: 02/05/2021
Onset Date: 02/01/2021
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: positive urine tests for uti, bladder, yeast. Diagnosis of rosacea by opthamoligst and dermatologist. Psoriasis diagnosed by dermatologist

Allergies: None known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Multi inflammation- 4 UTI's, 1 bladder inf, 1 yeast inf, bursitus, swollen ankles, rosacea on face/ eyelids,/in eye, psoriasis, from lifelong oily skin to extremely dry, dizziness, chest pressure, fatigue, vomiting, bloated stomach, constipation, brain fog, poor concentration, hair loss

Other Meds: Doxycycline 100 mg 2/day Spironolactone 100 mg Super Boron Bone Collagen Preservision Arends 2 Omega 3 Salmon Oik Culturelle Probiotic

Current Illness: None

ID: 1710183
Sex: M
Age: 55
State: MD

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: fever (100.5 degrees), fatigue --- 36 hours

Other Meds: Norvasc, tumeric, D3, men's multi-vitamin

Current Illness: none

ID: 1710184
Sex: F
Age: 42
State: TX

Vax Date: 04/23/2021
Onset Date: 04/28/2021
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: 2 Hearing tests conducted by audiologist and 1 hearing test conducted

Allergies: None

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

Symptoms: Developed hearing loss eventually resulting in tinnitus. Visited audiologist 2 weeks after symptoms began. The audiologist referred me to an ENT specialist, I saw Dr. 2 weeks later. He administered a steroid shot. Some hearing regained but tinnitus has persisted.

Other Meds: None

Current Illness: None

ID: 1710185
Sex: M
Age: 59
State: OR

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: Patient received Pfizer 1st dose and was instructed to wait at the pt observation area at 6:56pm. Shortly after at 7:05pm, pharmacist observed from pharmacy bench that patient was wiping his forehead with his shirt and starting to fan himself with his T-shirt. Pharmacist immediately ran out to aid patient, pt reported hot flashes and a spike in fever but no loss of consciousness. Pharmacist provided pt with cool pack that he applied to forehead and neck. Pt denied offer to lay down and said he had no symptoms of dizziness or lightheadedness at this time. Pt was offered ambulance/emergency response services but denied them. Patient stated that he had called his daughter and she was on her way. When daughter arrived, she stated that patient does have a history of anxiety disorder and this is most likely a psychosomatic reaction to the vaccine. RPH and store management witnessed patient return to normal body temperature and back to non-anxious feeling until 7:33pm. Patient was driven home accompanied by his daughter and had no further complaints.

Other Meds: none

Current Illness: none

ID: 1710186
Sex: M
Age: 43
State: CA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: none

Allergies: None

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

Symptoms: 102f fever

Other Meds: None

Current Illness: None

ID: 1710187
Sex: F
Age: 36
State: WA

Vax Date: 08/16/2021
Onset Date: 08/22/2021
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: I went to my September 3rd doctor and she couldn't find any reason for me to be having such a huge turn of events, I am having a vaginal ultrasound done of Sept 20th and a blood screen panel.

Allergies: Sulpha, oral Allergy syndrome

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

Symptoms: I received the vaccine . Since I received the vaccine I have had the most painful ovulation, and menstruation cycle in my whole life I am mid thirty?s, I know my cycle and body extremely well. Nothing else in my life has changed except the vaccine. I also visited my doctor this week and she has no explanation for my Sudden changes. A week after my initial shot I was near the end of my ovulation I was incapacitated for 4 hours unable to move and felt like my insides were cramping and stabbed, a heating pad helped to reduce the pain to a dull roar. I never fully recovered to a normal stomach there has been slight pain in my whole abdomen for over 2 weeks. I received my second dose (Tuesday) and then started menstruating Wednesday, my entire abdomen is extremely painful it goes through my whole body to my back from the pelvis to my mid back. It is like someone has punched me in abdomen 40 times and put knives in my back, like I said i have never experienced anything remotely close before my vaccine status changed.

Other Meds: Lion's mane mushroom, Cetirizine Hydrochloride, Vitamin D

Current Illness: na

ID: 1710188
Sex: M
Age: 65
State: WA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient was vaccinated in left deltoid with 0.5 mL of Janssen COVID-19 Vaccine Lot 204A21A. Pt reported immediate and persisting sharp pain exactly where the needle went when he was vaccinated. Patient was very uncomfortable, grimacing, eyes squinted apparently from pain. We had him lay down on a cot and applied an ice pack to the site. BP 132/78, HR 84, PWD, PERRL, A&O, injection site looked normal. Pt stated he had sort of thing happen after an influenza vaccine, and that the pain lasted 6 months. Patient reported his current pain as 2/10 compared to worst pain in life, and 2 or 3/10 compared to his previous experience(s?) of this. Pt had a sharp pain down his back (pt denied chest pains) that went away after about 20 seconds. A wrapped cold pack on the injection site seemed to help slightly, and he seemed to feel best when supporting his left arm with his right arm, and keeping his left arm still, adducted, and flexed with his left fist at his midline. Patient brought back to sitting upright on cot. He expressed pain when lifting his left arm upward. After a brief rest, he had less pain and could raise his left arm further before feeling significant pain. Pt has history of shingles and has a gabapentin prescription. Pt works. After 15 minutes pt felt a bit better, got up, and stated he didn't want to wait any longer and wanted to leave. MD on site suggested he switch from cold to applying heat this evening, to keep his arm moving though its full range, and that Tylenol or ibuprofen may help. Pt left with spouse.

Other Meds: Gabapentin prescription.

Current Illness:

ID: 1710189
Sex: M
Age: 48
State: PA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
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: Hospital has not contacted me yet after I made them aware of the adverse effect. I am currently waiting for additional steps and instructions.

Allergies: No

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

Symptoms: I had a "heavy" burning sensation in my throat, chest and lower back. I had "sharp" pains in my chest and lower back. I also had a "heavy" feeling on my chest feeling similar to compressions (cpr) and my throat felt like someone was physically strangling me. My throat felt very tight. This event woke me out of my sleep at 3:38am on Saturday, 11, 2021. The first 30 minutes was the worse. It was close call to driving to the E.R. or calling 911. (I reported this to The Occupational Health Dept. where I received the vaccine).

Other Meds: Nature Made Vitamin C Vitamin D

Current Illness: No

ID: 1710191
Sex: F
Age: 73
State: OH

Vax Date: 06/06/2021
Onset Date: 06/01/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None back yet

Allergies: None

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

Symptoms: Trouble breathing even on oxygen, sleeping 12 to 18 hours straight, brain fog, headaches, coughing that wakes me up, fatigue, legs swelling, sore throat on and off, and fever and chills at different times after 16 months of complete quarantine, having everything delivered to porch, nobody in or out of house!

Other Meds: enalapril, clonazepam, and effixer

Current Illness: none

ID: 1710192
Sex: M
Age: 44
State: GA

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Around 8PM I started having chills. Within an hour I was achy and the chills were terrible. I wore freezing winter weather clothing under 4 blankets and was still freezing. I experienced shortness of breath and started using my CPAP even when awake about half the time. I walked with a hunch very slowly and my knees and feet crunched. I couldn't sleep for more than about 30 minutes at a time and it took a lot of energy to roll over or get up. By 6AM, I couldn't even try to sleep anymore and started drinking constant hot black tea with a splash of milk. I had lost my appetite and only ate small amounts until Tuesday, July 31. The extreme chills started alternating between bad chills and burning up for about 12 hours but most of the time I was chilly and wore layers. My joints and bones felt loose and I still walked with a hunch and around 4PM on Aug 27 I was walking on a hardwood floor when I felt a crunch in the instep of my right foot and it started hurting bad. To this day (Sept 17) it still hurts although not as bad but occasionally I'll be walking normally and I'll feel a pop and it hurts like crazy for a few seconds. The chills started to die down slowly and the hot flashes became less often for the next two days and by dinner time on Sunday, Aug 29 I was only slightly chilly and no longer walked with a hunch but did walk slightly slower than normal. Normally I feel fine in temperatures between about 60 and 80 degrees Fahrenheit but by this point I wasn't comfortable outside of about 70-75. Over the past 3 weeks my comfortable temperature range has widened a bit and as I write this my house is 68 degrees and I'm slightly cold when I normally wouldn't be. My appetite restored by Tuesday and the only night I had a hard time sleeping thru was the first night. As of Wednesday, Sept 15 I'd say I felt close enough to my pre-vaccination self to say I've fully recovered. I'm not achy anymore but my energy level is only about 85%-90% of what it was pre-vaccination and my right foot still hurts sometimes when I walk. I've noticed that I still get winded quicker than I did pre-vaccination and fatigue quicker when walking but I'm no longer shallow breathing and haven't since the day after my vaccination. I think that's about as thorough as I can be.

Other Meds: Men's one a day vitamin, zinc supplement and turmeric with black pepper supplement

Current Illness: None

ID: 1710193
Sex: F
Age: 58
State: CA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None

Allergies: Neomycin topical? contact dermatitis

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Itchy hives around injection site, myalgias, temp elevation to 99.6 degrees F

Other Meds: Sertraline, valacyclovir, nortriptyline, alprazolam

Current Illness: None

ID: 1710194
Sex: F
Age: 71
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Client received 1st Pfizer vaccine and received 2nd Moderna vaccine. Monitored client and educated client on possible side effects after vaccine.

Other Meds:

Current Illness:

ID: 1710195
Sex: F
Age: 24
State: CA

Vax Date: 09/01/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Penicillin

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

Symptoms: I got my first shot at 3:54 Sept. 17th 2021 (today) & only about a minute after i started having pain in the left side of my chest. I was a little light headed about 5-10 minutes after the shot. But by the time the 15 minutes were up symptoms seemed to have subsided a little bit, so i thought it would just go away & be fine. So i didnt bother the staff with this. But the pain didnt go away until later in the evening. From the time the pain started to late evening the pain slowly worked its way down the left side of my rib cage to my low stomach. My stomach started hurting with some nausea the same evening, with some minor shortness of breath but that seems to be getting better by 9pm.

Other Meds: Birth control & hormone creams (progesterone & testosterone)

Current Illness:

ID: 1710197
Sex: F
Age: 53
State: HI

Vax Date: 01/12/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Covid vaccinated and covid positive

Other Meds:

Current Illness:

ID: 1710198
Sex: M
Age: 17
State: WA

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 09/18/2021
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: N/A

Allergies: N/A

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

Symptoms: Swelling in the arm pit lymph node

Other Meds: N/A

Current Illness: N/A

ID: 1710199
Sex: F
Age: 38
State: OR

Vax Date: 03/24/2021
Onset Date: 04/12/2021
Rec V Date: 09/18/2021
Hospital: Y

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

Lab Data: the doctors did find cocksackie b virus titers in my blood tests. i believe the vaccine and this virus caused my immune system to overreact which caused the inflammation of my heart and percardium.

Allergies: macrobid

Symptom List: Injection site pain, Pain

Symptoms: I developed acute myopercarditis. I was hospitalized for two weeks. cardiologist inserted a drain into my pericardium. later in the week i developed the myocarditis. i was treated with diuretic and heart meds

Other Meds: none

Current Illness: titers present for cocksackie b

ID: 1710200
Sex: F
Age: 37
State: OH

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: labs(blood and urine test order 9/16/2017). ultrasound for left arm axilla scheduled for 10/28/2021. X-ray scheduled for 9/17/2021

Allergies: no

Symptom List: Injection site pain, Menorrhagia

Symptoms: severe nausea and headache at 7pm when i returned home. Vomiting the day after the vaccination, fever and chills. Friday of that week lymph node swelled under left armpit. Numbing and burning in arm and hands and side of left breast. Rash onknees and continued left arm tingling and neck pain. Irregular menstrual cycle.

Other Meds: benefiber pakets and hair skin and nails gummies

Current Illness: no

ID: 1710201
Sex: F
Age: 56
State: OK

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: na

Allergies: na

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

Symptoms: after injection - injection site instantly started to raise , I notified pt of the site reaction and got immediately got a cold compress to apply to site while holding compress to site I had the patient self administer 50mg or diphenhydramine solution. after cold compress removed swelling and redness would come back. pt complained of heat at site with cold compress. I switched to frozen compress and after 10 minutes swelling did not come back as fast when frozen compress removed. pt decided to leave sent diphenhydramine and frozen pack with patient to use as needed and with instructions to seek medical care if needed. Patient returned on 9/17/21 a bruise at injection site was only remaining issue.

Other Meds: na

Current Illness: liver , past covid infection , smoker

ID: 1710202
Sex: F
Age: 55
State: TN

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 09/18/2021
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: CT Scan of chest and neck 5/2021-cannot remember actual date-1 set of xrays US and Mammogram done at on 5/20/2021 Stress test 8/5/2021- mildly abnormal Repeat CT scan of chest and neck on 8/25/2021 to see if lymph nodes and swelling have improve Repeat Stress test with thallium 9/7/2021 Echo is being schedule now once approval from insurance

Allergies: Nubain, toradol, stadol, nitroglycerin SL, some PCN, an provera

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I started having an reaction after about 6 hours from injection and ended up in the ER. I saw the doctor the same or next morning after dose two with swelling of my left side of neck and shoulder area with headache and nausea. Some heart palpitations. I went to see the doctor who reviewed the CT neck and chest and it showed swollen nodes from injection site to neck to left upper chest and under left axillary in chain like appearance. . The symptoms remained for several weeks with on and off headaches. He finally prescribe medication for headache and recently repeat CT scans. I also had to get an US and Mammogram to see if it went into my breast tissue. I had to see the Cardiologist who has done two stress tests thus far and now as of today has notice a new heart murmur and is setting me up for an Echo. No previous history of any heart murmur.

Other Meds: Prescription medication, vitamins taken hours after the vaccine was given. No medication taken that morning of the second dose of Pfizer. Vit D, Vit C, protonix, lozol, bystolic daily. Miralax as needed, Linzess twice a week if constipated.

Current Illness: None

ID: 1710203
Sex: M
Age: 28
State:

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Ringing ears approx. 9 hours post-vaccination lasting about 30-45 minutes

Other Meds:

Current Illness:

ID: 1710204
Sex: F
Age: 21
State: CA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Fever, body pain, trouble breathing, pain in the back by the lungs.

Other Meds: TYLENOL

Current Illness:

ID: 1710205
Sex: F
Age: 47
State: CA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: N/A

Allergies: NONE

Symptom List: Nausea

Symptoms: My symptoms after my second shot were temperature, chills, headache, body aches and fatigue.

Other Meds: NONE

Current Illness: NONE

ID: 1710206
Sex: M
Age: 27
State: TX

Vax Date: 09/01/2021
Onset Date: 09/07/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: ENT CONSULT AFTER URGENT CARE VISIT; HEAD CT ON 09/17/2021

Allergies: NONE

Symptom List: Injection site pain

Symptoms: ONSET OF HEADACHES X7 DAYS AFTER VACCINE, HEADACHES PERSIST ON (09/17/2021)

Other Meds: NONE

Current Illness: FATTY LIVER DISEASE

ID: 1710207
Sex: F
Age: 38
State: RI

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/18/2021
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: Janssen COVID-19 Vaccine EUA Pain at injection site Headache nausea feeling very tired body aches

Other Meds:

Current Illness:

ID: 1710208
Sex: F
Age: 60
State: WA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: strawberries

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

Symptoms: My arms were itching before I left the pharmacy. Within one hour I had hives on both arms and a few blotches in other spots on my legs. My throat tightened and I started to wheeze on the exhale. I called the advice nurse who suggested I go to the ER. I did not want to do that on a Friday night. I took 2 Benadryl and the wheezing stopped. Throat loosened, but still didn't feel quite normal. The hives have lightened, but I am still itchy. I am now 6 hours post vaccine with hives.

Other Meds: mirtrazpine

Current Illness: sensorineural hearing loss

ID: 1710210
Sex: M
Age: 14
State: MT

Vax Date: 05/01/2021
Onset Date: 09/10/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: So many now. 9/12 heart pain 9/13 elevated Troponin 147 and EKG ECG--review with cardiologist 9/14 blood draw and elevated Troponin 112 9/14 blood draw and elevated Troponin 112 9/16 blood draw and elevated Troponin 62 9/16 at 11 pm pain again.

Allergies: Allergic to finned fish

Symptom List: Tremor

Symptoms: My son has myopericarditis. With troponin levels of 147, this indicates heart muscle damage. My son is a runner, hiker, skiing athelete. This is so out of the blue.

Other Meds: none

Current Illness: none

ID: 1710211
Sex: F
Age: 44
State: HI

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/18/2021
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: none

Symptom List: Erythema, Pruritus

Symptoms: As described by pt- Monday got the shot. In the first 5 mins I felt uncomfortable throbbing/pulsing in my vein (artery?) at the base of left clavicle. I said 'it's not pain,' but nurse said: "muscle pain is to be expected." Felt hot, w/same skin-crawl sensation on my head. Face was tingling, but that and vein subsided after about 10 mins. Tip of left thumb was "asleep" but back normal on Tuesday w/o peeling this time. Awoke Monday. night w/pain in my rt index knuckle, red lump, sore to the touch, w/a very strange indentation there. Fingertips all cold, but now ok. Leg twitching came back on Tuesday, still twitching. And felt confused all of Tuesday. Had a larger amount of spotting this time, only Tue and Wed. Mild leg pain, rt foot burning Wednesday, but ok now. Still with some muscle twitches.

Other Meds: none

Current Illness:

ID: 1710212
Sex: F
Age: 55
State: CA

Vax Date: 05/21/2021
Onset Date: 08/01/2021
Rec V Date: 09/18/2021
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: August 17, 2021: labs to test blood levels of Vitamin B12, magnesium, and electrolytes all yielded normal results.

Allergies: n/a

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

Symptoms: Tingling/numbness in fingertips and toes; ongoing since late July/early August 2021. I was advised to drink electrolyte-based liquids in case I was dehydrated, but the drinks had no apparent effect.

Other Meds: Keppra, Paxil, Zyprexa, SAM-e, algal oil, turmeric, vitamin D3, Emergen-C multivitamin

Current Illness: n/a

ID: 1710213
Sex: F
Age: 65
State: MN

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: none

Allergies: Cephalosporines Xylocaine Seafood

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

Symptoms: Vision issues: floaters, bilateral, right visual fields, both eyes, in form of yellow crystals. Unable to read, lasting 20 minutes

Other Meds: none

Current Illness: none

ID: 1710214
Sex: M
Age: 33
State: HI

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Not yet. I'm waiting for my insurance to kick in through work.

Allergies: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I have not seen a doctor yet. Just to be clear, I do occasionally get head aches but they've been noticeably worse and more frequent since the day after the second dose, though not nearly as bad as that day. I developed a persistent cough on the 2nd day after the 2nd dose and it's been getting a little worse every day since (this is currently the end of day 5). It's not so bad yet that I can't control it so I can resist coughing when I'm at work usually but this definitely doesn't feel normal. Last night, after a particularly bad bout of coughing I got a few very strange, burning body aches on my neck, shoulders, and stomach but they went away after a few minutes. I've had coughs before but not that.

Other Meds: No

Current Illness: No

ID: 1710215
Sex: M
Age: 42
State:

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Syncope approximately 5 minutes after dose given. Pt recovered on floor 1-2 minutes after. Family requested 911 called. Pt taken to hospital.

Other Meds:

Current Illness:

ID: 1710216
Sex: F
Age: 37
State: WV

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 09/18/2021
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: -none-

Allergies: PCN, Sulfa, Codeine, garlic, dust, Erythromycin, Augmentin

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

Symptoms: Hives, SOB, severe abdominal pain, vomiting, diarrhea, weakness, numbness/ tingling in hands and feet, unable to walk. Since vaccine I have been unable to eat a normal diet and can only tolerate bland foods and broth. Multiple episodes have occurred since.

Other Meds: Vitamin-D, Wellbutryn, Adderall, Estrogen, Atripla

Current Illness: -none-

Date Died:

ID: 1710217
Sex: M
Age: 69
State: HI

Vax Date: 02/23/2021
Onset Date: 03/22/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: none

Allergies: Paroxetine

Symptom List: Pain in extremity

Symptoms: Death

Other Meds: furosemide rifaximin aspirin hydromorphone

Current Illness: none

ID: 1710218
Sex: F
Age: 14
State: IL

Vax Date: 07/03/2021
Onset Date: 07/24/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: none

Allergies: no known allergies

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

Symptoms: Rash on face that lasted 1 week, then rash on thigh that lasted one week, then rash on face came back. Rash is macular erythematous forming circles and lines., not pruritic or painful, not vesicular.

Other Meds: none

Current Illness: none

ID: 1710219
Sex: M
Age: 21
State: PR

Vax Date: 04/06/2021
Onset Date: 04/14/2021
Rec V Date: 09/18/2021
Hospital: Y

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

Lab Data: Laboratory came out negative. April 16, 2021. Holter cardiac studies August 23, 2021. Echocardiogram September 8, 2021

Allergies: Tuberculin

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

Symptoms: April 14, 2021 at 5 in the morning, I woke up with a racing heart and pain in my chest. I took my blood pressure at home, and it was very high , as was my pulse at 130. I went to the hospital, they did a laboratory and it came out negative. Then an electrocardiogram and it came out with tachycardia. They gave me a serum and a pill. I was asleep until I was discharged from the emergency room. Then the next day I had the same thing.

Other Meds: Not taking any medications

Current Illness: None

ID: 1710220
Sex: F
Age: 30
State: FL

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: None

Allergies: Clindamycin

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

Symptoms: Alteration in the menstrual period, a lot of pain in the arm, itching in the arm, redness, brain fog, tiredness, sleepy.

Other Meds: None

Current Illness: None

ID: 1710221
Sex: F
Age: 34
State: NY

Vax Date: 01/24/2021
Onset Date: 04/01/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Pending approval w MD

Allergies: No

Symptom List: Vomiting

Symptoms: Never have had abnormal periods. Always lasting 28-32 days. They are now 17-20 days since April

Other Meds: None

Current Illness: No

ID: 1710222
Sex: F
Age: 41
State: LA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/18/2021
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: Soon after taking first dose, i noticed a change in my heart rate. It started beating rapidly and I am feeling sick.

Other Meds:

Current Illness:

ID: 1710223
Sex: F
Age: 30
State: PA

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 09/18/2021
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: N/a

Allergies: N/a

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

Symptoms: Persistent tingling/ partial numbness was noted town the left arm and left side of chest with warmth noted in the left hand and fingers, mild muscle soreness at the injection site

Other Meds: Prenatal vitamins, iron supplement

Current Illness: N/a

ID: 1710224
Sex: F
Age: 46
State: MO

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 09/18/2021
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: Severe allergic reaction shortly after vaccine. Hives and swollen face. Started itching. Was given an Epipen injection and given multiple oral medications. The Doctor on site observed me and informed me that if I was not better within 15 minutes I would have to be taken to the hospital by ambulance.

Other Meds:

Current Illness:

ID: 1710419
Sex: F
Age:
State: NE

Vax Date: 06/26/2021
Onset Date: 07/24/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Test Date: 20210724; Test Name: Body temperature; Result Unstructured Data: fever 99-101

Allergies:

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

Symptoms: Her arm was also fairly sore/Body is bad; fever went up to 99 to a 100, or 101; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Her arm was also fairly sore/Body is bad) and PYREXIA (fever went up to 99 to a 100, or 101) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939893 and X51621A) for COVID-19 vaccination. No Medical History information was reported. On 26-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 24-Jul-2021, the patient experienced MYALGIA (Her arm was also fairly sore/Body is bad) and PYREXIA (fever went up to 99 to a 100, or 101). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] for Fever, at a dose of 1 dosage form every four hours. On 26-Jul-2021, PYREXIA (fever went up to 99 to a 100, or 101) had resolved. At the time of the report, MYALGIA (Her arm was also fairly sore/Body is bad) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 24-Jul-2021, Body temperature: 99-101 (High) fever 99-101. No concomitant medications were provided. This case was linked to MOD-2021-244794 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: Follow up received contained: Updated event outcome

Other Meds:

Current Illness:

ID: 1710568
Sex: F
Age:
State: PR

Vax Date:
Onset Date: 08/01/2021
Rec V Date: 09/18/2021
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: This is a solicited report from a non-Pfizer sponsored program from a contactable consumer, based on information received by Pfizer from (manufacturer control number: PR-AMGEN-PRISL2021131589), license party for etanercept (ENBREL). This non-serious solicited report (PRISL2021131589) was reported to Health Authority on 23/AUG/2021 by a consumer from a commercial program (PSP00086) and involves a 37 year old female patient who experienced black and blue, at the injection site [PT: injection site discolouration] and while she got the injection it burned a little [PT: injection site pain] while receiving Enbrel, Single Dose Prefilled Autoinjector.No historical medical condition was reported. The patient's current medical condition included rheumatoid arthritis. No concomitant medications were provided. No co-suspect medications were reported.The patient began Enbrel with Single Dose Prefilled Autoinjector on an unknown date. On Saturday, 21/AUG/2021, the patient injected the injection and stated while she got the injection it burned a little. On an unknown date in AUG/2021, the patient developed black and blue, at the injection site.No treatment information was received. The outcome of the events injection site discolouration and injection site pain was reported as unknown. Action taken with Enbrel and Single Dose Prefilled Autoinjector was reported as unknown for the events injection site discolouration and injection site pain.The causal relationship between the events injection site discolouration, injection site pain and Enbrel with Single Dose Prefilled Autoinjector was not provided by the consumer.The reporter declined consent for follow up. No follow up attempts are possible. No further information is expected. The reporter's assessment of the causal relationship of the events Injection site discoloration and Injection site burning with the suspect product, Enbrel, was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. Health Authority's Causality Assessment: The events Injection site discoloration and Injection site burning were assessed as non-serious and related to etanercept (ENBREL). Follow-up (25Aug2021): This is a follow-up solicited report from a non-Pfizer sponsored program (marketing program name not available) from a contactable consumer, based on information received by Pfizer from Health Authority (manufacturer control number: PR-AMGEN-PRISL2021131589), license party for etanercept (ENBREL). ADDITIONAL INFORMATION RECEIVED ON 25/AUG/2021 AND 30/AUG/2021: In this follow up, the patient reported she got itching all over her body with some rash on her body [PT: rash pruritic], unable to sleep/insomnia [PT: insomnia], was nauseous/not able to eat [PT: nausea], and experienced anxiety/felt uneasy [PT: anxiety], while receiving Enbrel with Single Dose Prefilled Autoinjector. on an unknown date in AUG/2021, the patient experienced itching all over her body with some rash on her body. She also reported anxiety and insomnia. The patient felt uneasy, was unable to sleep, nauseous, and not able to eat. The patient did not inject Enbrel on Saturday 28/AUG/2021, due to these side effects she experienced after her previous dose. The outcome of the event rash pruritic, insomnia, nausea, and anxiety was reported as unknown. Action taken with Enbrel and Single Dose Prefilled Autoinjector was reported as temporarily withheld for the events rash pruritic, insomnia, nausea and anxiety. The causal relationship between the events rash pruritic, insomnia, nausea, anxiety and Enbrel with Single Dose Prefilled Autoinjector was not provided by the consumer. No further information is expected. No follow up required. Case PRISL2021132676 was identified as duplicate of PRISL2021131589. Source document from PRISL2021132676 has been copied over to case PRISL2021131589 which will be the case of record. PRISL2021132676 will be deleted. The reporter's assessment of the causal relationship of the events Injection site discoloration, Injection site burning, Itchy rash, Insomnia, Nausea, and Anxiety with the suspect product, Enbrel, was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. Health Authority's Causality Assessment: The events Injection site discoloration and Injection site burning were assessed as non-serious and related to etanercept (ENBREL). The events Itchy rash, Insomnia, Nausea, and Anxiety were assessed as non-serious and unrelated to etanercept (ENBREL). Follow-up (25Aug2021): This is a follow-up solicited report from a non-Pfizer sponsored program (marketing program name not available) from a contactable consumer, based on information received by Pfizer from Health Authority (manufacturer control number: PR-AMGEN-PRISL2021132676), license party for etanercept (ENBREL). This non-serious solicited report (PRISL2021132676) was reported to Health Authority on 25/AUG/2021 by a consumer from a commercial program (PSP00086) and involves a 37 year old, female patient who got itching all over her body with some rash on her body [PT: rash pruritic], unable to sleep/insomnia [PT: insomnia], nausea/not able to eat [PT: nausea], anxiety/feels uneasy [PT: anxiety] while receiving Enbrel with Single Dose Prefilled Autoinjector. No historical medical condition was reported. The patient's current medical condition included rheumatoid arthritis. No concomitant medications were provided. No co-suspect medications were reported. The patient began Enbrel with Single Dose Prefilled Autoinjector on an unknown date. On an unknown date, the patient experienced itching all over her body with some rash on her body. She also reported anxiety and insomnia. The patient felt uneasy, unable to sleep, nausea, and not able to eat. No treatment information was received. The outcome of the events rash pruritic, anxiety, insomnia and nausea was reported as unknown. Action taken with Enbrel and Single Dose Prefilled Autoinjector was reported as unknown for the events rash pruritic, anxiety, insomnia and nausea. The causal relationship between the events rash pruritic, anxiety, insomnia, nausea and Enbrel with Single Dose Prefilled Autoinjector was not provided by the consumer. Follow up has been requested. The reporter's assessment of the causal relationship of the events Itchy rash, Anxiety, Insomnia, and Nausea with the suspect product, Enbrel, was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. Amgen's Causality Assessment: The events Itchy rash, Anxiety, Insomnia, and Nausea were assessed as non-serious and related to etanercept (ENBREL). Follow-up (25Aug2021): This is a follow-up solicited report from a non-Pfizer sponsored program (marketing program name not available), based on information received by Pfizer from Health Authority (Manufacturer control number PR-AMGEN-PRISL2021132676), license party for etanercept (ENBREL). CORRECTION DATED 25/AUG/2021: Case PRISL2021132676 was identified as duplicate of PRISL2021131589. Source document from PRISL2021132676 has been copied over to case PRISL2021131589 which will be the case of record. PRISL2021132676 will be deleted after one last submission. The reporter's assessment of the causal relationship of the events Anxiety, Insomnia, Nausea, and Itchy rash with the suspect product, Enbrel, was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. Health Authority's Causality Assessment: The events Anxiety, Insomnia, Nausea, and Itchy rash were assessed as non-serious and related to etanercept (ENBREL). Follow-up (10Sep2021): New information received from Health Authority in response to query mail sent regarding clarification with action taken of unknown in XML and temporarily withheld in narrative for both drug and device of the retained case PRISL2021131589, while in duplicate case PRISL2021132676, action taken was provided as unknown in

Other Meds: Enbrel

Current Illness: Rheumatoid arthritis

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am