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: 1710858
Sex: M
Age:
State: FL

Vax Date: 06/28/2021
Onset Date: 07/26/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: states that he feels sometimes the nausea, but he doesn't get it every day, gets it once on a while; it made him feel sick, but it wasn't as bad as the first one; the first day was fine but that night he was super cold as ice; had 3 blankets on because he was shivering; fever; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS, FEELING COLD, CHILLS, PYREXIA, and NAUSEA in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included COVID-19 (He had Covid19 in January). Concomitant products included ESCITALOPRAM for an unknown indication. On 28-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Jul-2021, the patient experienced ILLNESS and PYREXIA. 26-Jul-2021, the patient experienced FEELING COLD and CHILLS. On an unknown date, the patient experienced NAUSEA. At the time of the report, ILLNESS, FEELING COLD, CHILLS, PYREXIA, and NAUSEA outcome was unknown. No Treatment mediation were reported. This case was linked to MOD-2021-281448 (Patient Link).

Other Meds: ESCITALOPRAM

Current Illness:

ID: 1710859
Sex: F
Age: 70
State: PA

Vax Date: 07/17/2021
Onset Date:
Rec V Date: 09/18/2021
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: She had a sore arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (She had a sore arm) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 091D2-1A) for COVID-19 vaccination. The patient's past medical history included Breast cancer. Concomitant products included MONTELUKAST SODIUM (SINGULAIR) for an unknown indication. On 17-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE PAIN (She had a sore arm). At the time of the report, VACCINATION SITE PAIN (She had a sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Reported stated she received vaccine in the left arm as her doctor stated not to do it on her right arm because of breast cancer. No Treatment medications provided. This case was linked to MOD-2021-287461 (Patient Link).

Other Meds: SINGULAIR

Current Illness:

ID: 1710860
Sex: F
Age:
State: NY

Vax Date: 05/07/2021
Onset Date:
Rec V Date: 09/18/2021
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: She got scared; Did not get her second vaccine; This spontaneous case was reported by a consumer and describes the occurrence of FEAR (She got scared) and PRODUCT DOSE OMISSION ISSUE (Did not get her second vaccine) 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 07-May-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 FEAR (She got scared) and PRODUCT DOSE OMISSION ISSUE (Did not get her second vaccine). At the time of the report, FEAR (She got scared) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (Did not get her second vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment were reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710861
Sex: F
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 09/18/2021
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: experienced the extreme fatigue after second dose vaccination; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (experienced the extreme fatigue after second dose vaccination) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced FATIGUE (experienced the extreme fatigue after second dose vaccination). At the time of the report, FATIGUE (experienced the extreme fatigue after second dose vaccination) outcome was unknown. Concomitant product information was not provided. The cardiologist does not know what it is and could only prove that it wasn't a heart problem. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710862
Sex: M
Age: 72
State: CA

Vax Date: 08/12/2021
Onset Date:
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: my skin started itching: I have red dots in the area where the shot was given; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (my skin started itching) and VACCINATION SITE ERYTHEMA (I have red dots in the area where the shot was given) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 12-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRURITUS (my skin started itching) and VACCINATION SITE ERYTHEMA (I have red dots in the area where the shot was given). At the time of the report, PRURITUS (my skin started itching) and VACCINATION SITE ERYTHEMA (I have red dots in the area where the shot was given) outcome was unknown. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710863
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/18/2021
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: Test Name: Rapid and PCR Covid tests; Test Result: Negative ; Result Unstructured Data: Negative

Allergies:

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

Symptoms: Cold; I'm only still feeling a little tired; This spontaneous case was reported by a consumer and describes the occurrence of NASOPHARYNGITIS (Cold) and FATIGUE (I'm only still feeling a little tired) 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 NASOPHARYNGITIS (Cold) and FATIGUE (I'm only still feeling a little tired). At the time of the report, NASOPHARYNGITIS (Cold) was resolving and FATIGUE (I'm only still feeling a little tired) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication was not reported. Treatment medication was not reported. The patient did not experience fever, coughing or sneezing. Patient was supposed to get 2nd Moderna shot in the morning Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710864
Sex: U
Age:
State: TN

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 3 expired doses administered as 1st dose; 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 EXPIRED PRODUCT ADMINISTERED (3 expired doses administered as 1st dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 020B21A) 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) (Intramuscular) 1 dosage form. On 16-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (3 expired doses administered as 1st dose). At the time of the report, EXPIRED PRODUCT ADMINISTERED (3 expired doses administered as 1st dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported No Treatment medication was reported

Other Meds:

Current Illness:

ID: 1710865
Sex: F
Age: 34
State: WA

Vax Date: 07/14/2021
Onset Date: 08/14/2021
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:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: It started itching; Now, she feels as if her bones hurt; She also has swelling in her ankles; It's black in color.; As of now it's peeling at injection site; When she extend her fingers, they hurt at joints/complaining of joint pain; She started with tendered injection site for 4 days after receiving 2nd dose; She noticed some rash on injection site 3 days after receiving 2nd dose; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (It started itching), BONE PAIN (Now, she feels as if her bones hurt), JOINT SWELLING (She also has swelling in her ankles), VACCINATION SITE DISCOLOURATION (It's black in color.) and INJECTION SITE EXFOLIATION (As of now it's peeling at injection site) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 078C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 14-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INJECTION SITE RASH (She noticed some rash on injection site 3 days after receiving 2nd dose). On 15-Aug-2021, the patient experienced INJECTION SITE PAIN (She started with tendered injection site for 4 days after receiving 2nd dose). On an unknown date, the patient experienced PRURITUS (It started itching), BONE PAIN (Now, she feels as if her bones hurt), JOINT SWELLING (She also has swelling in her ankles), VACCINATION SITE DISCOLOURATION (It's black in color.), INJECTION SITE EXFOLIATION (As of now it's peeling at injection site) and ARTHRALGIA (When she extend her fingers, they hurt at joints/complaining of joint pain). The patient was treated with ALOE VERA for Adverse event, at a dose of Unknown and HAMAMELIS SPP. (WITCH HAZEL [HAMAMELIS SPP.]) for Adverse event, at a dose of Unknown. At the time of the report, PRURITUS (It started itching), BONE PAIN (Now, she feels as if her bones hurt), JOINT SWELLING (She also has swelling in her ankles), VACCINATION SITE DISCOLOURATION (It's black in color.), INJECTION SITE EXFOLIATION (As of now it's peeling at injection site), INJECTION SITE RASH (She noticed some rash on injection site 3 days after receiving 2nd dose), INJECTION SITE PAIN (She started with tendered injection site for 4 days after receiving 2nd dose) and ARTHRALGIA (When she extend her fingers, they hurt at joints/complaining of joint pain) outcome was unknown. No concomitant medications were reported. Treatment medication includes Pain relievers. This case was linked to MOD-2021-288025 (Patient Link).

Other Meds:

Current Illness:

ID: 1710866
Sex: U
Age:
State:

Vax Date: 01/01/2021
Onset Date:
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Became ill; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Became ill) 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 January 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 ILLNESS (Became ill). At the time of the report, ILLNESS (Became ill) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications information was reported. No treatment medications were provided.

Other Meds:

Current Illness:

ID: 1710867
Sex: M
Age:
State: FL

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Did not get the second dose, "first dose early this year: he was unable to go get the second dose"; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Did not get the second dose, "first dose early this year: he was unable to go get the second dose") in a 24-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Did not get the second dose, "first dose early this year: he was unable to go get the second dose"). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Did not get the second dose, "first dose early this year: he was unable to go get the second dose") outcome was unknown. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710868
Sex: U
Age:
State:

Vax Date: 02/01/2021
Onset Date:
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:

Allergies:

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

Symptoms: had some mild symptoms after the shot that were constitutional in nature; It has now been 6 months since their first dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a physician and describes the occurrence of VACCINATION COMPLICATION (had some mild symptoms after the shot that were constitutional in nature) and PRODUCT DOSE OMISSION ISSUE (It has now been 6 months since their 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 was reported. In February 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (had some mild symptoms after the shot that were constitutional in nature) and PRODUCT DOSE OMISSION ISSUE (It has now been 6 months since their first dose). At the time of the report, VACCINATION COMPLICATION (had some mild symptoms after the shot that were constitutional in nature) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (It has now been 6 months since their first dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment was reported. It was reported that, patient subsequently received steroids & was told to delay 2nd dose further. It had now been 6 months since their first dose. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710869
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/18/2021
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: Missed his second vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Missed his second vaccine) 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, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed his second vaccine). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Missed his second vaccine) had resolved. No concomitant medication information was provided. No treatment medication were provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710870
Sex: F
Age: 50
State: MO

Vax Date: 01/04/2021
Onset Date: 02/01/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Extremely Weak after the second dose; Extremely Sick after the second dose; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (Extremely Weak after the second dose) and ILLNESS (Extremely Sick after the second dose) in a 50-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030L20A) for COVID-19 vaccination. No specified medical history has been reported. On 04-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Feb-2021, the patient experienced ASTHENIA (Extremely Weak after the second dose) and ILLNESS (Extremely Sick after the second dose). In February 2021, ASTHENIA (Extremely Weak after the second dose) and ILLNESS (Extremely Sick after the second dose) outcome was unknown. Concomitant medications were not provided. Treatment information was not provided. She was researching as to what to expect from a third dose of the vaccine. She was immune compromised and she would like to know what to expect prior to getting a third shot. This case was linked to MOD-2021-005642 (Patient Link).

Other Meds:

Current Illness:

ID: 1710871
Sex: F
Age: 66
State: FL

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: left injection site arm was sore; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (left injection site arm was sore) in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. No Medical History information was reported. On 29-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Dec-2020, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced VACCINATION SITE PAIN (left injection site arm was sore). On 29-Dec-2020, VACCINATION SITE PAIN (left injection site arm was sore) had resolved. No concomitant medications were provided by the reporter. Treatment information was not provided. This case was linked to MOD-2021-288149 (Patient Link).

Other Meds:

Current Illness:

ID: 1710872
Sex: F
Age:
State:

Vax Date: 08/11/2021
Onset Date:
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:

Allergies:

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

Symptoms: Got period two days ago but today a little heavier; Tiredness; Soreness; This spontaneous case was reported by a consumer and describes the occurrence of HEAVY MENSTRUAL BLEEDING (Got period two days ago but today a little heavier), FATIGUE (Tiredness) and MYALGIA (Soreness) 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 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced HEAVY MENSTRUAL BLEEDING (Got period two days ago but today a little heavier), FATIGUE (Tiredness) and MYALGIA (Soreness). At the time of the report, HEAVY MENSTRUAL BLEEDING (Got period two days ago but today a little heavier), FATIGUE (Tiredness) and MYALGIA (Soreness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication was reported.

Other Meds:

Current Illness:

ID: 1710873
Sex: U
Age:
State:

Vax Date: 04/01/2021
Onset Date:
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:

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

Symptoms: very painful arm that lasted weeks; Stomach ache; Diarrhea; Headache; Chills; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (very painful arm that lasted weeks), ABDOMINAL PAIN UPPER (Stomach ache), DIARRHOEA (Diarrhea), HEADACHE (Headache) and CHILLS (Chills) 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 April 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 PAIN IN EXTREMITY (very painful arm that lasted weeks), ABDOMINAL PAIN UPPER (Stomach ache), DIARRHOEA (Diarrhea), HEADACHE (Headache) and CHILLS (Chills). At the time of the report, PAIN IN EXTREMITY (very painful arm that lasted weeks) had resolved and ABDOMINAL PAIN UPPER (Stomach ache), DIARRHOEA (Diarrhea), HEADACHE (Headache) and CHILLS (Chills) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication were provided.

Other Meds:

Current Illness:

ID: 1710874
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
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:

Allergies:

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

Symptoms: headache; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 16-Aug-2021 and was forwarded to Moderna on 16-Aug-2021. Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (headache) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced HEADACHE (headache). At the time of the report, HEADACHE (headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. Treatment medications were not provided by the reporter. Action taken with mRNA-1273 in response to the events were not Applicable. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710875
Sex: U
Age:
State: PA

Vax Date: 06/23/2021
Onset Date:
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Received 1st dose of Moderna COVID-19 vaccine and not received the 2nd dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of Received 1st dose of Moderna COVID-19 vaccine and not received the 2nd dose in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Jun-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 Received 1st dose of Moderna COVID-19 vaccine and not received the 2nd dose. At the time of the report, Received 1st dose of Moderna COVID-19 vaccine and not received the 2nd dose had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Administrator of a healthcare facility did not think that any of the patients got COVID after vaccination. The corporate office or someone in the protocol office made a decision to stop the vaccination.

Other Meds:

Current Illness:

ID: 1710876
Sex: M
Age:
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than; administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than) and PRODUCT STORAGE ERROR (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Aug-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 16-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than) and PRODUCT STORAGE ERROR (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than). On 16-Aug-2021, EXPIRED PRODUCT ADMINISTERED (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than) and PRODUCT STORAGE ERROR (administered a dose to a male patient on 16Aug2021 from a vial that was first punctured on 13Aug2021 and was kept at room temperature since than) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710877
Sex: M
Age: 40
State: NY

Vax Date: 01/25/2021
Onset Date:
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: hives; itching; patient never went back to get the second dose; This case was received via a Regulatory Authority (Reference number: MOD21-131443) on 16-Aug-2021 and was forwarded to Moderna on 16-Aug-2021. This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (hives), PRURITUS (itching) and PRODUCT DOSE OMISSION ISSUE (patient never went back to get the second dose) in a 40-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided by reporter. No concomitant medication reported. Treatment medication for hives include Steroids. On 25-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1. On an unknown date, the patient experienced URTICARIA (hives), PRURITUS (itching) and PRODUCT DOSE OMISSION ISSUE (patient never went back to get the second dose). At the time of the report, URTICARIA (hives) and PRURITUS (itching) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (patient never went back to get the second dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical history was provided by reporter. No concomitant medication reported. Treatment medication for hives include Steroids. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710878
Sex: F
Age: 51
State: AL

Vax Date: 01/20/2021
Onset Date:
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:

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

Symptoms: I never got my second/got first dose in month of jan; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (I never got my second/got first dose in month of jan) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037K20A) for COVID-19 vaccination. The patient's past medical history included COVID-19 (Patient tested positive for COVID-19.) in August 2020. On 20-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (I never got my second/got first dose in month of jan). At the time of the report, PRODUCT DOSE OMISSION ISSUE (I never got my second/got first dose in month of jan) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication information was provided. No treatment medication were provided. Most recent FOLLOW-UP information incorporated above includes: On 16-Aug-2021: follow up document received on 16-AUG-2021 contains Reporter information updated, patient demographics added and batch/lot number added.

Other Meds:

Current Illness:

ID: 1710879
Sex: F
Age:
State:

Vax Date: 08/14/2021
Onset Date:
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: underarm swelling; pain in the arm; blue marks on the swelling; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (underarm swelling), PAIN IN EXTREMITY (pain in the arm) and SKIN DISCOLOURATION (blue marks on the swelling) 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 14-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PERIPHERAL SWELLING (underarm swelling), PAIN IN EXTREMITY (pain in the arm) and SKIN DISCOLOURATION (blue marks on the swelling). At the time of the report, PERIPHERAL SWELLING (underarm swelling), PAIN IN EXTREMITY (pain in the arm) and SKIN DISCOLOURATION (blue marks on the swelling) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710880
Sex: F
Age: 61
State: MD

Vax Date: 08/16/2021
Onset Date: 08/12/2021
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:

Allergies:

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

Symptoms: felt like injection was given too high on her arm too close to shoulder joint; This spontaneous case was reported by a consumer and describes the occurrence of INCORRECT ROUTE OF PRODUCT ADMINISTRATION (felt like injection was given too high on her arm too close to shoulder joint) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 054C21A) 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) (Intramuscular) 1 dosage form. On 12-Aug-2021, the patient experienced INCORRECT ROUTE OF PRODUCT ADMINISTRATION (felt like injection was given too high on her arm too close to shoulder joint). At the time of the report, INCORRECT ROUTE OF PRODUCT ADMINISTRATION (felt like injection was given too high on her arm too close to shoulder joint) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication were provided by the reporter. No treatment medication were provided by the reporter.

Other Meds:

Current Illness:

ID: 1710881
Sex: M
Age: 49
State: FL

Vax Date: 02/13/2021
Onset Date: 08/11/2021
Rec V Date: 09/18/2021
Hospital:

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

Lab Data: Test Date: 20210811; Test Name: COVID-19 Test; Test Result: Positive ; Result Unstructured Data: COVID-19 positive

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: He developed cough; Fatigue; Headache; body ache; Fever; Lack of drug ineffective; tested positive for COVID 19; Rhinitis; This spontaneous case was reported by an other health care professional and describes the occurrence of COVID-19 (tested positive for COVID 19), RHINITIS (Rhinitis), COUGH (He developed cough), FATIGUE (Fatigue) and HEADACHE (Headache) in a 50-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 015M20A and 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Aug-2021, the patient experienced COVID-19 (tested positive for COVID 19), RHINITIS (Rhinitis), FATIGUE (Fatigue), HEADACHE (Headache), MYALGIA (body ache), PYREXIA (Fever) and DRUG INEFFECTIVE (Lack of drug ineffective). On an unknown date, the patient experienced COUGH (He developed cough). In August 2021, COVID-19 (tested positive for COVID 19), RHINITIS (Rhinitis), FATIGUE (Fatigue), HEADACHE (Headache), MYALGIA (body ache) and PYREXIA (Fever) had resolved. At the time of the report, COUGH (He developed cough) had not resolved and DRUG INEFFECTIVE (Lack of drug ineffective) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Aug-2021, COVID-19: positive (Positive) COVID-19 positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were provided by reporter. The patient was treated by his doctor

Other Meds:

Current Illness:

ID: 1710882
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Unspecific Adverse event; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Unspecific Adverse event) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No specified medical history has been reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Unspecific Adverse event). At the time of the report, VACCINATION COMPLICATION (Unspecific Adverse event) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not provided. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710883
Sex: F
Age: 57
State: IN

Vax Date: 05/10/2021
Onset Date: 06/08/2021
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:

Allergies:

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

Symptoms: intense pain; migraine became more severe; affects vision/she can't read printed writing like a book unless she takes medication; nausea worsens; head hurts so bad even in the dark; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (intense pain), MIGRAINE (migraine became more severe), VISUAL IMPAIRMENT (affects vision/she can't read printed writing like a book unless she takes medication), NAUSEA (nausea worsens) and HEADACHE (head hurts so bad even in the dark) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 041C21A and 004C21A) for COVID-19 vaccination. Concurrent medical conditions included Insulin-dependent diabetes mellitus. Concomitant products included INSULIN for Insulin-dependent diabetes mellitus, ONDANSETRON (ZOFRAN [ONDANSETRON]), HYDROCODONE and ASPIRIN [ACETYLSALICYLIC ACID] for an unknown indication. On 10-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Jun-2021, the patient experienced PAIN (intense pain), MIGRAINE (migraine became more severe), VISUAL IMPAIRMENT (affects vision/she can't read printed writing like a book unless she takes medication), NAUSEA (nausea worsens) and HEADACHE (head hurts so bad even in the dark). The patient was treated with UBROGEPANT (UBRELVY) for Migraine, at an unspecified dose and frequency and CLONAZEPAM for Nausea, at an unspecified dose and frequency. At the time of the report, PAIN (intense pain), MIGRAINE (migraine became more severe), VISUAL IMPAIRMENT (affects vision/she can't read printed writing like a book unless she takes medication), NAUSEA (nausea worsens) and HEADACHE (head hurts so bad even in the dark) outcome was unknown. Patient reported that, she had been taking a double dose of Zofran and when that doesn't work she takes clonazepam for her nausea. She also reports that, she doesn't eat until late sometimes because the migraines and that it affects her insulin dependent diabetes. She said that, she has breaks for 3 or 4 days without headache. She said, she has to keep the left eye closed and right eye open because her head hurts so bad even in the dark. She reports getting 24 Botox shots in the head last month by her neurologist. This case was linked to MOD-2021-288701 (Patient Link).

Other Meds: ZOFRAN [ONDANSETRON]; HYDROCODONE; INSULIN; ASPIRIN [ACETYLSALICYLIC ACID]

Current Illness: Insulin-dependent diabetes mellitus

ID: 1710884
Sex: F
Age:
State: FL

Vax Date: 05/04/2021
Onset Date: 05/04/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received doses from two different manufactures / first dose 04May2021 which was a Moderna / on 27July2021 and received a dose of Pfizer; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 17-Aug-2021 and was forwarded to Moderna on 17-Aug-2021. This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Patient received doses from two different manufactures / first dose 04May2021 which was a Moderna / on 27July2021 and received a dose of Pfizer) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 04-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Jul-2021, the patient received first dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 04-May-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Patient received doses from two different manufactures / first dose 04May2021 which was a Moderna / on 27July2021 and received a dose of Pfizer). On 04-May-2021, INTERCHANGE OF VACCINE PRODUCTS (Patient received doses from two different manufactures / first dose 04May2021 which was a Moderna / on 27July2021 and received a dose of Pfizer) 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. No concomitant medication were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1710885
Sex: F
Age:
State: FL

Vax Date: 08/09/2021
Onset Date: 08/09/2021
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: rash in the area, it is red; A barely perceptible/slight swelling; The reaction is localized; Every time she extended the arm it would hurt; This spontaneous case was reported by a consumer and describes the occurrence of RASH ERYTHEMATOUS (rash in the area, it is red), SWELLING (A barely perceptible/slight swelling), SKIN REACTION (The reaction is localized) and PAIN IN EXTREMITY (Every time she extended the arm it would hurt) 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 09-Aug-2021 at 11:45 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Aug-2021, the patient experienced PAIN IN EXTREMITY (Every time she extended the arm it would hurt). On 17-Aug-2021, the patient experienced RASH ERYTHEMATOUS (rash in the area, it is red), SWELLING (A barely perceptible/slight swelling) and SKIN REACTION (The reaction is localized). In August 2021, PAIN IN EXTREMITY (Every time she extended the arm it would hurt) had resolved. At the time of the report, RASH ERYTHEMATOUS (rash in the area, it is red), SWELLING (A barely perceptible/slight swelling) and SKIN REACTION (The reaction is localized) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710886
Sex: U
Age:
State: IN

Vax Date: 06/11/2021
Onset Date: 07/02/2021
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: two individuals received the Moderna vaccine dose #2 at day 21; 2 of these 72 individuals who received the expired vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (two individuals received the Moderna vaccine dose #2 at day 21) and EXPIRED PRODUCT ADMINISTERED (2 of these 72 individuals who received the expired vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. No Medical History information was reported. On 11-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 02-Jul-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (two individuals received the Moderna vaccine dose #2 at day 21) and EXPIRED PRODUCT ADMINISTERED (2 of these 72 individuals who received the expired vaccine). On 02-Jul-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (two individuals received the Moderna vaccine dose #2 at day 21) and EXPIRED PRODUCT ADMINISTERED (2 of these 72 individuals who received the expired vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710887
Sex: U
Age:
State: KY

Vax Date: 08/19/2021
Onset Date: 08/19/2021
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:

Allergies:

Symptom List: Nausea

Symptoms: 3 vials that were punctured and stayed at room temperature for longer than 12 hours; There were 3 doses given to patients out of expired vial; 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 EXPIRED PRODUCT ADMINISTERED (There were 3 doses given to patients out of expired vial) and PRODUCT STORAGE ERROR (3 vials that were punctured and stayed at room temperature for longer than 12 hours) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (There were 3 doses given to patients out of expired vial). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (3 vials that were punctured and stayed at room temperature for longer than 12 hours). On 19-Aug-2021, EXPIRED PRODUCT ADMINISTERED (There were 3 doses given to patients out of expired vial) had resolved. At the time of the report, PRODUCT STORAGE ERROR (3 vials that were punctured and stayed at room temperature for longer than 12 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710888
Sex: F
Age: 29
State: CO

Vax Date: 04/03/2021
Onset Date:
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:

Allergies:

Symptom List: Injection site pain

Symptoms: The nurse messed up the dates and she didn't get her 2nd dose; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (The nurse messed up the dates and she didn't get her 2nd dose) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030B21A) for COVID-19 vaccination. No Medical History information was reported. On 03-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (The nurse messed up the dates and she didn't get her 2nd dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (The nurse messed up the dates and she didn't get her 2nd dose) had resolved. Concomitant product information was not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1710889
Sex: M
Age:
State:

Vax Date:
Onset Date: 08/21/2021
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: fever; chills; headache; fatigue; severe pain; body aches; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (severe pain), PAIN (body aches), PYREXIA (fever), CHILLS (chills) and HEADACHE (headache) in a 20-year-old male patient 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Aug-2021, the patient experienced PAIN (severe pain), PAIN (body aches), CHILLS (chills), HEADACHE (headache) and FATIGUE (fatigue). On an unknown date, the patient experienced PYREXIA (fever). At the time of the report, PAIN (severe pain), PAIN (body aches), PYREXIA (fever), CHILLS (chills), HEADACHE (headache) and FATIGUE (fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Patient called and said she and her other two sons already got the vaccine. Her youngest son side effects included fever chills, severe pain, trebles, headache. No Concomitant drugs were reported. No Treatment information was reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1710890
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

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

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

Other Meds:

Current Illness:

ID: 1710891
Sex: M
Age:
State: WI

Vax Date:
Onset Date:
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: Test Name: Coronarycomputed tomography angiogram; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: BNP; Result Unstructured Data: 38 pg/ml; Test Name: 12-lead ECG; Result Unstructured Data: Nonspecific T-wave abnormality anterolateral leads, RSR' pattern in V1; Test Name: Pulmonary Magnetic Resonance Angiogram; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 2021; Test Name: Cardiac MRI; Result Unstructured Data: Late Gadolinium Enhancement (LGE): epicardial left ventricular(LV) inferior basal wall, lateral wall mid ventricle, anterolateral wall apical.T2w signal abnormality in corresponding locations as LGE. Pericardial enhancement and borderline effusion. Left Ventricular Ejection Fraction(LVEF) was 57%, Right Ventricular Ejection Fraction (RVEF) was 54%. Ipsilateral axillary lymphadenopathy.; Test Name: Troponin-I at peak; Result Unstructured Data: Troponin-I at peak was 4.00ng/ml

Allergies:

Symptom List: Tremor

Symptoms: Myocarditis; This literature-study case was reported in a literature article and describes the occurrence of MYOCARDITIS (Myocarditis) in an 18-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. LITERATURE REFERENCE: Myocarditis associated with mRNA COVID-19 vaccination. Radiology. 2021:211430 No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced MYOCARDITIS (Myocarditis) (seriousness criteria hospitalization and medically significant). At the time of the report, MYOCARDITIS (Myocarditis) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Magnetic resonance imaging heart: abnormal (abnormal) Late Gadolinium Enhancement (LGE): epicardial left ventricular(LV) inferior basal wall, lateral wall mid ventricle, anterolateral wall apical.T2w signal abnormality in corresponding locations as LGE. Pericardial enhancement and borderline effusion. Left Ventricular Ejection Fraction(LVEF) was 57%, Right Ventricular Ejection Fraction (RVEF) was 54%. Ipsilateral axillary lymphadenopathy.. On an unknown date, Angiocardiogram: negative (Negative) Negative. On an unknown date, Brain natriuretic peptide: 38 pg/ml (normal) 38 pg/ml. On an unknown date, Electrocardiogram: abnormal (abnormal) Nonspecific T-wave abnormality anterolateral leads, RSR' pattern in V1. On an unknown date, Magnetic resonance imaging: negative (Negative) Negative. On an unknown date, Troponin I: 4.00ng/ml (abnormal) Troponin-I at peak was 4.00ng/ml. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered MYOCARDITIS (Myocarditis) to be possibly related. No concomitant medication was provided by the reporter. Patients was hospitalized due to acute onset of chest pain with diagnosis of acute myocarditis. Patient had received their second dose of mRNA-1273 three days before onset of chest pain. Patient had following symptoms after vaccination subjective mild fever, chills, malaise, chest pain and dyspnea. COVID-19 test was negative for 4 patients out of 5 patients. No treatment medication information was provided by the reporter. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This case was linked to MOD-2021-293277 (Patient Link).; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1710892
Sex: F
Age: 83
State: NM

Vax Date: 01/20/2021
Onset Date: 08/18/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Her husband states that it looks reddish; when she touches it, it is sensitive to the touch; She states it is also hard; Feels like some type of fibromyalgia; Inappropriate schedule of vaccine administered; She started to feel a lump in the side and top of her head/she reports she still has the lump/the lump is about the size of a quarter; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING (She started to feel a lump in the side and top of her head/she reports she still has the lump/the lump is about the size of a quarter), ERYTHEMA (Her husband states that it looks reddish), HYPERAESTHESIA (when she touches it, it is sensitive to the touch), INDURATION (She states it is also hard) and FIBROMYALGIA (Feels like some type of fibromyalgia) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017E21A, 031M20A and 042L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included LATANOPROST, AMLODIPINE BESYLATE, FAMOTIDINE (PEPCID AC), MULTIVITAMINS [VITAMINS NOS], MAGNESIUM, CALCIUM, VITAMIN D NOS and RABEPRAZOLE SODIUM (ACIPHEX) for an unknown indication. On 20-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Aug-2021, the patient experienced SWELLING (She started to feel a lump in the side and top of her head/she reports she still has the lump/the lump is about the size of a quarter). 18-Aug-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). On 21-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ERYTHEMA (Her husband states that it looks reddish), HYPERAESTHESIA (when she touches it, it is sensitive to the touch), INDURATION (She states it is also hard) and FIBROMYALGIA (Feels like some type of fibromyalgia). On 18-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. At the time of the report, SWELLING (She started to feel a lump in the side and top of her head/she reports she still has the lump/the lump is about the size of a quarter), ERYTHEMA (Her husband states that it looks reddish), HYPERAESTHESIA (when she touches it, it is sensitive to the touch), INDURATION (She states it is also hard) and FIBROMYALGIA (Feels like some type of fibromyalgia) had resolved. Weight of patient reported 111 without units Concomitant medications also include ACIDHEX. No treatment medications were provided. The patient confirmed the symptom they reported having ended up going away in four day and they are doing fine now. Most recent FOLLOW-UP information incorporated above includes: On 31-Aug-2021: follow up received- event outcome updated

Other Meds: LATANOPROST; AMLODIPINE BESYLATE; PEPCID AC; MULTIVITAMINS [VITAMINS NOS]; MAGNESIUM; CALCIUM; VITAMIN D NOS; ACIPHEX

Current Illness:

ID: 1710893
Sex: F
Age: 36
State: IL

Vax Date: 08/03/2021
Onset Date: 08/21/2021
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:

Allergies:

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

Symptoms: nausea; bad headache; sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm), NAUSEA (nausea) and HEADACHE (bad headache) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006021A) for COVID-19 vaccination. No Medical History information was reported. On 03-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced NAUSEA (nausea) and HEADACHE (bad headache). On an unknown date, the patient experienced PAIN IN EXTREMITY (sore arm). The patient was treated with ACETYLSALICYLIC ACID, DIPHENHYDRAMINE CITRATE, PARACETAMOL (EXCEDRIN PM HEADACHE) for Headache, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (sore arm) and NAUSEA (nausea) outcome was unknown and HEADACHE (bad headache) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were reported

Other Meds:

Current Illness:

ID: 1710894
Sex: F
Age:
State: TX

Vax Date:
Onset Date:
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:

Allergies:

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

Symptoms: A 16 year old patient received two doses of the Moderna COVID-19 vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received two doses of the Moderna COVID-19 vaccine) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. 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) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received two doses of the Moderna COVID-19 vaccine). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received two doses of the Moderna COVID-19 vaccine) had resolved. No Concomitant drugs were reported. No Treatment information were reported. The patient is scheduled to receive her third dose of the Moderna COVID-19 vaccine on 22AUG2021. The reporter confirmed that it has been greater than 28 days since the patient received two doses of the Moderna COVID-19 vaccine. Reporter did not allow further contact

Other Meds:

Current Illness: Immunocompromised

ID: 1710895
Sex: F
Age:
State: AZ

Vax Date: 03/14/2021
Onset Date:
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: Test Name: Chloride Levels; Result Unstructured Data: Higher; Test Name: Carbondioxide; Result Unstructured Data: Lower; Test Name: Lipid test; Result Unstructured Data: Got Better

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: after I received both of my Moderna Covid-19 vaccines. My .Rheumatoid Arthritis got better. My lipid panels got better as well. I take Lithium and my Lithium level increased. My Chloride level got higher and my Carbon Dioxide level got lower.; This spontaneous case was reported by a consumer and describes the occurrence of THERAPEUTIC RESPONSE UNEXPECTED (after I received both of my Moderna Covid-19 vaccines. My .Rheumatoid Arthritis got better. My lipid panels got better as well. I take Lithium and my Lithium level increased. My Chloride level got higher and my Carbon Dioxide level got lower.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 021A21A) for COVID-19 vaccination. Concurrent medical conditions included Rheumatoid arthritis. Concomitant products included LITHIUM for an unknown indication. On 14-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced THERAPEUTIC RESPONSE UNEXPECTED (after I received both of my Moderna Covid-19 vaccines. My .Rheumatoid Arthritis got better. My lipid panels got better as well. I take Lithium and my Lithium level increased. My Chloride level got higher and my Carbon Dioxide level got lower.). At the time of the report, THERAPEUTIC RESPONSE UNEXPECTED (after I received both of my Moderna Covid-19 vaccines. My .Rheumatoid Arthritis got better. My lipid panels got better as well. I take Lithium and my Lithium level increased. My Chloride level got higher and my Carbon Dioxide level got lower.) had resolved. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood chloride: higher (High) Higher. On an unknown date, Carbon dioxide: lower (Low) Lower. On an unknown date, Lipids: got better Got Better. Lithium levels Increased. No treatment medications were provided. This case was linked to MOD-2021-211489 (Patient Link).

Other Meds: LITHIUM

Current Illness: Rheumatoid arthritis

ID: 1710896
Sex: U
Age:
State:

Vax Date: 07/20/2021
Onset Date:
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: Test Name: Covid; Test Result: Positive ; Result Unstructured Data: Positive

Allergies:

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

Symptoms: Positive for Covid; severe illness; This spontaneous case was reported by a consumer and describes the occurrence of SARS-COV-2 TEST POSITIVE (Positive for Covid) and ILLNESS (severe illness) 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 20-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 (Positive for Covid) and ILLNESS (severe illness). At the time of the report, SARS-COV-2 TEST POSITIVE (Positive for Covid) and ILLNESS (severe illness) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1710897
Sex: F
Age:
State:

Vax Date: 02/08/2021
Onset Date:
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:

Allergies:

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

Symptoms: shoulder warm; shoulder swollen; Extra dose administered; swollen lymph node under arm; Shoulder sore; This spontaneous case was reported by a consumer and describes the occurrence of SKIN WARM (shoulder warm), SWELLING (shoulder swollen), EXTRA DOSE ADMINISTERED (Extra dose administered), LYMPHADENOPATHY (swollen lymph node under arm) and ARTHRALGIA (Shoulder sore) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 08-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 third 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 SKIN WARM (shoulder warm), SWELLING (shoulder swollen), EXTRA DOSE ADMINISTERED (Extra dose administered), LYMPHADENOPATHY (swollen lymph node under arm) and ARTHRALGIA (Shoulder sore). At the time of the report, SKIN WARM (shoulder warm), SWELLING (shoulder swollen), LYMPHADENOPATHY (swollen lymph node under arm) and ARTHRALGIA (Shoulder sore) outcome was unknown and EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. Patient is taking steroids. No treatment medications were reported This case was linked to MOD-2021-294169 (Patient Link).

Other Meds:

Current Illness:

ID: 1710898
Sex: M
Age: 71
State: FL

Vax Date: 08/09/2021
Onset Date:
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: Pain in extremity

Symptoms: a little bit of a reaction; was kind of foggy headed/didn't see good for about a week or so/but nothing real bad; had pain in his arm for 2 days; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (a little bit of a reaction), FEELING ABNORMAL (was kind of foggy headed/didn't see good for about a week or so/but nothing real bad) and PAIN IN EXTREMITY (had pain in his arm for 2 days) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-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 VACCINATION COMPLICATION (a little bit of a reaction), FEELING ABNORMAL (was kind of foggy headed/didn't see good for about a week or so/but nothing real bad) and PAIN IN EXTREMITY (had pain in his arm for 2 days). At the time of the report, VACCINATION COMPLICATION (a little bit of a reaction) and FEELING ABNORMAL (was kind of foggy headed/didn't see good for about a week or so/but nothing real bad) outcome was unknown and PAIN IN EXTREMITY (had pain in his arm for 2 days) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 23-Aug-2021: Follow up contains updated Reporter details, patient initials, gender, dose details and events details like pain in extremity and feeling abnormal.

Other Meds:

Current Illness:

ID: 1710899
Sex: M
Age: 82
State: IL

Vax Date: 03/01/2021
Onset Date:
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:

Allergies:

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

Symptoms: Mild symptoms from first shot; This spontaneous case was reported by a physician and describes the occurrence of VACCINATION COMPLICATION (Mild symptoms from first shot) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included COVID-19 in January 2020. In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Mild symptoms from first shot). At the time of the report, VACCINATION COMPLICATION (Mild symptoms from first shot) 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. Concomitant medication not provided by reporter. Treatment information not provided by reporter. This case was linked to MOD-2021-294314 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 26-Aug-2021: Patient demographic details were added and route of administration of vaccine was added On 30-Aug-2021: Follow up received on 30- AUG-2021 contain non-significant information.

Other Meds:

Current Illness:

ID: 1710900
Sex: M
Age: 58
State: FL

Vax Date: 03/27/2021
Onset Date: 04/25/2021
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:

Allergies:

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

Symptoms: pain on his arm; lost range of motion in his left shoulder; fever; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (pain on his arm), JOINT RANGE OF MOTION DECREASED (lost range of motion in his left shoulder) and PYREXIA (fever) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 016321a and 020b21a) for COVID-19 vaccination. No Medical History information was reported. On 27-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Apr-2021, the patient experienced PYREXIA (fever). In May 2021, the patient experienced PAIN IN EXTREMITY (pain on his arm) and JOINT RANGE OF MOTION DECREASED (lost range of motion in his left shoulder). On 26-Apr-2021, PYREXIA (fever) had resolved. At the time of the report, PAIN IN EXTREMITY (pain on his arm) and JOINT RANGE OF MOTION DECREASED (lost range of motion in his left shoulder) had not resolved. No concomitant medication reported. No treatment medication reported.

Other Meds:

Current Illness:

ID: 1710901
Sex: M
Age: 68
State: NJ

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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:

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

Symptoms: Swelling extended down the wrist; Tired; Little bit of headache; Red; Paretic; Itchy; Induration/not painful but there was induration; Arm was swollen at injection site; Arm was sore/arm was sore, similar as previous vaccination; This spontaneous case was reported by an other health care professional and describes the occurrence of PAIN IN EXTREMITY (Arm was sore/arm was sore, similar as previous vaccination), ERYTHEMA (Red), PARESIS (Paretic), PRURITUS (Itchy) and INDURATION (Induration/not painful but there was induration) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Immunosuppression (Immune suppressive disease). Concomitant products included ESOMEPRAZOLE SODIUM (NEXIUM [ESOMEPRAZOLE SODIUM]) and ACETYLSALICYLIC ACID (BABY ASPIRIN) for an unknown indication. On 16-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced PAIN IN EXTREMITY (Arm was sore/arm was sore, similar as previous vaccination). On 18-Aug-2021, the patient experienced ERYTHEMA (Red), PARESIS (Paretic), PRURITUS (Itchy), INDURATION (Induration/not painful but there was induration), VACCINATION SITE SWELLING (Arm was swollen at injection site), FATIGUE (Tired) and HEADACHE (Little bit of headache). On 20-Aug-2021, the patient experienced JOINT SWELLING (Swelling extended down the wrist). The patient was treated with HYDROCORTISONE (topical) at a dose of 1.5 %. On 18-Aug-2021, FATIGUE (Tired) and HEADACHE (Little bit of headache) had resolved. At the time of the report, PAIN IN EXTREMITY (Arm was sore/arm was sore, similar as previous vaccination), ERYTHEMA (Red), PARESIS (Paretic), PRURITUS (Itchy) and INDURATION (Induration/not painful but there was induration) outcome was unknown and VACCINATION SITE SWELLING (Arm was swollen at injection site) and JOINT SWELLING (Swelling extended down the wrist) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment information also included: Anti histamines This case was linked to MOD-2021-294494 (Patient Link).

Other Meds: NEXIUM [ESOMEPRAZOLE SODIUM]; BABY ASPIRIN

Current Illness: Immunosuppression (Immune suppressive disease)

ID: 1710902
Sex: M
Age: 83
State: CA

Vax Date: 01/09/2021
Onset Date: 01/09/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: Sore injection site arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (Sore injection site arm) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027L20A) for COVID-19 vaccination. No Medical History information was reported. On 09-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Jan-2021, the patient experienced VACCINATION SITE PAIN (Sore injection site arm). At the time of the report, VACCINATION SITE PAIN (Sore injection site arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant drugs were reported. No Treatment information were reported. This case was linked to MOD-2021-294383, MOD-2021-294508 (Patient Link).

Other Meds:

Current Illness:

ID: 1710903
Sex: M
Age: 29
State: WI

Vax Date: 08/20/2021
Onset Date: 08/20/2021
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: vaccine administered and temperature exposure > 24 hours; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (vaccine administered and temperature exposure > 24 hours) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Aug-2021 at 8:19 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Aug-2021 at 8:19 AM, the patient experienced EXPIRED PRODUCT ADMINISTERED (vaccine administered and temperature exposure > 24 hours). On 20-Aug-2021 at 8:19 AM, EXPIRED PRODUCT ADMINISTERED (vaccine administered and temperature exposure > 24 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered EXPIRED PRODUCT ADMINISTERED (vaccine administered and temperature exposure > 24 hours) to be possibly related. It was reported that the vial was punctured on 11-Aug-2021 and kept in fridge for 9 days. The expired vaccine was administered to five patients. Concomitant drug was not reported. Treatment medication was not reported. Most recent FOLLOW-UP information incorporated above includes: On 04-Sep-2021: Follow-up information contains additional reporter, patient initials, dose details, event details and Race.

Other Meds:

Current Illness:

ID: 1710904
Sex: U
Age:
State: NY

Vax Date:
Onset Date:
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Most people get anxious; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of ANXIETY (Most people get anxious) 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 ANXIETY (Most people get anxious). At the time of the report, ANXIETY (Most people get anxious) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1710905
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
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: 1 punctured vial exposed to refrigerator temperature range (2-8 C) for "48 hours"; Expired vaccine administered to patient; 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 EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to patient) and PRODUCT STORAGE ERROR (1 punctured vial exposed to refrigerator temperature range (2-8 C) for "48 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. In 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In 2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to patient). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (1 punctured vial exposed to refrigerator temperature range (2-8 C) for "48 hours"). In 2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to patient) had resolved. At the time of the report, PRODUCT STORAGE ERROR (1 punctured vial exposed to refrigerator temperature range (2-8 C) for "48 hours") had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication information was reported. No treatment medications were provided.

Other Meds:

Current Illness:

ID: 1710906
Sex: F
Age: 88
State: FL

Vax Date: 03/23/2021
Onset Date: 08/01/2021
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 Name: Covid- 19; Test Result: Negative ; Result Unstructured Data: Negative

Allergies:

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

Symptoms: Extra dose administered; wasn't feeling good; it was really awful/felt so terrible all over/Her head was fuzzy.; couldn't function/still felt that she could hardly get around; having ill; they said this is probably a reaction to the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (wasn't feeling good), FEELING ABNORMAL (it was really awful/felt so terrible all over/Her head was fuzzy.), IMPAIRED WORK ABILITY (couldn't function/still felt that she could hardly get around), ILLNESS (having ill) and VACCINATION COMPLICATION (they said this is probably a reaction to the vaccine) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052E21A, 046B21A and 006BZ1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cancer (She received cancer treatment prior to vaccination.). Concomitant products included PANCREATIN (CREON) for an unknown indication. On 23-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In August 2021, the patient experienced MALAISE (wasn't feeling good), FEELING ABNORMAL (it was really awful/felt so terrible all over/Her head was fuzzy.), IMPAIRED WORK ABILITY (couldn't function/still felt that she could hardly get around), ILLNESS (having ill) and VACCINATION COMPLICATION (they said this is probably a reaction to the vaccine). On 23-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXTRA DOSE ADMINISTERED (Extra dose administered). On 23-Aug-2021, EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. At the time of the report, MALAISE (wasn't feeling good), FEELING ABNORMAL (it was really awful/felt so terrible all over/Her head was fuzzy.), IMPAIRED WORK ABILITY (couldn't function/still felt that she could hardly get around), ILLNESS (having ill) and VACCINATION COMPLICATION (they said this is probably a reaction to the vaccine) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. Patients reported that no treatment medications were received.

Other Meds: CREON

Current Illness: Cancer (She received cancer treatment prior to vaccination.)

ID: 1710907
Sex: M
Age:
State: FL

Vax Date: 08/24/2021
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: Test Name: Body temperature; Result Unstructured Data: woke up with a temperature of 99.5

Allergies:

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

Symptoms: Woke up with a temperature of 99.5; Has a little soreness where the injection was; Feels a little rundown; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Woke up with a temperature of 99.5), VACCINATION SITE PAIN (Has a little soreness where the injection was) and FATIGUE (Feels a little rundown) 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 24-Aug-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. In August 2021, the patient experienced VACCINATION SITE PAIN (Has a little soreness where the injection was) and FATIGUE (Feels a little rundown). On 24-Aug-2021, the patient experienced PYREXIA (Woke up with a temperature of 99.5). At the time of the report, PYREXIA (Woke up with a temperature of 99.5), VACCINATION SITE PAIN (Has a little soreness where the injection was) and FATIGUE (Feels a little rundown) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 99.5 (High) woke up with a temperature of 99.5. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am