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: 1714664
Sex: F
Age: 58
State: TX

Vax Date: 02/07/2021
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Test Name: Ultrasound; Result Unstructured Data: No blood clots; Test Name: X-ray; Result Unstructured Data: No broken arms

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sore arm; This spontaneous case was reported by a patient and describes the occurrence of MYALGIA (Sore arm) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013M20A) for COVID-19 vaccination. No Medical History information was reported. On 07-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYALGIA (Sore arm). At the time of the report, MYALGIA (Sore arm) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Ultrasound scan: normal (normal) No blood clots. On an unknown date, X-ray: normal (normal) No broken arms. Concomitant medications were not provided by reporter. Treatment information was not provided by reporter. This case was linked to MOD-2021-286887 (Patient Link).

Other Meds:

Current Illness:

ID: 1714665
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: Adverse reaction; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Adverse reaction) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (Adverse reaction). At the time of the report, VACCINATION COMPLICATION (Adverse reaction) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1714666
Sex: F
Age: 70
State: FL

Vax Date: 02/10/2021
Onset Date:
Rec V Date: 09/20/2021
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: A bad welt on the arm; Rash all over the top of the arm; Extreme headaches both times; Temperature elevation; Could not eat; Was sleeping a lot; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (A bad welt on the arm), RASH (Rash all over the top of the arm), HEADACHE (Extreme headaches both times), BODY TEMPERATURE INCREASED (Temperature elevation) and EATING DISORDER (Could not eat) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 015M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Tachycardia. Concomitant products included ATENOLOL for Tachycardia. On 10-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced URTICARIA (A bad welt on the arm), RASH (Rash all over the top of the arm), HEADACHE (Extreme headaches both times), BODY TEMPERATURE INCREASED (Temperature elevation), EATING DISORDER (Could not eat) and SOMNOLENCE (Was sleeping a lot). At the time of the report, URTICARIA (A bad welt on the arm), RASH (Rash all over the top of the arm), HEADACHE (Extreme headaches both times), BODY TEMPERATURE INCREASED (Temperature elevation), EATING DISORDER (Could not eat) and SOMNOLENCE (Was sleeping a lot) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications include Atenolol for tachycardia. Treatment medications were not reported. This case was linked to MOD-2021-314916 (Patient Link).

Other Meds: ATENOLOL

Current Illness:

ID: 1714667
Sex: F
Age: 64
State: OH

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

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

Lab Data: Test Date: 20210904; Test Name: Blood pressure; Result Unstructured Data: Normal; Test Date: 20210904; Test Name: heart rate; Result Unstructured Data: highest was 110and the lowest was 100

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: slight pressure in left temple; some aches in the bones; light headedness for 2 days; brain fog; smelling a burnt smell/smelling burnt leaf smell; runny nose; fatigue for a couple of days; arm sore at left shoulder/left side muscle pain; axillary area sore for couple days; left lymph node sore for couple days; rapid heart rate/highest heart rate 110; half hour of chills; This spontaneous case was reported by a consumer and describes the occurrence of PALPITATIONS (rapid heart rate/highest heart rate 110), HEAD DISCOMFORT (slight pressure in left temple), BONE PAIN (some aches in the bones), DIZZINESS (light headedness for 2 days) and CONFUSIONAL STATE (brain fog) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Long QT and Allergy. Concomitant products included LEVOTHYROXINE and VITAMIN D3 for an unknown indication. On 04-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Sep-2021, the patient experienced PALPITATIONS (rapid heart rate/highest heart rate 110). On an unknown date, the patient experienced HEAD DISCOMFORT (slight pressure in left temple), BONE PAIN (some aches in the bones), DIZZINESS (light headedness for 2 days), CONFUSIONAL STATE (brain fog), PAROSMIA (smelling a burnt smell/smelling burnt leaf smell), RHINORRHOEA (runny nose), FATIGUE (fatigue for a couple of days), MYALGIA (arm sore at left shoulder/left side muscle pain), AXILLARY PAIN (axillary area sore for couple days), CHILLS (half hour of chills) and LYMPH NODE PAIN (left lymph node sore for couple days). At the time of the report, HEAD DISCOMFORT (slight pressure in left temple), BONE PAIN (some aches in the bones), DIZZINESS (light headedness for 2 days), CONFUSIONAL STATE (brain fog), PAROSMIA (smelling a burnt smell/smelling burnt leaf smell), RHINORRHOEA (runny nose), MYALGIA (arm sore at left shoulder/left side muscle pain), AXILLARY PAIN (axillary area sore for couple days), CHILLS (half hour of chills) and LYMPH NODE PAIN (left lymph node sore for couple days) had resolved and FATIGUE (fatigue for a couple of days) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 04-Sep-2021, Blood pressure measurement: normal (normal) Normal. On 04-Sep-2021, Heart rate: 110-100 (High) highest was 110and the lowest was 100. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment information was provided. ? Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Non-Significant follow-up contain no new information

Other Meds: LEVOTHYROXINE; VITAMIN D3

Current Illness: Allergy; Long QT

ID: 1714668
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: positive

Allergies:

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

Symptoms: I tested positive for COVID-19 after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (I tested positive for COVID-19 after vaccination) 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 COVID-19 (I tested positive for COVID-19 after vaccination). At the time of the report, COVID-19 (I tested positive for COVID-19 after vaccination) 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. Concomitant medications were not provided Treatment medications were not provided

Other Meds:

Current Illness:

ID: 1714669
Sex: M
Age:
State:

Vax Date: 03/01/2021
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: side effects were minor; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (side effects were minor) in an elderly male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Asthma. On 01-Mar-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 an unknown date, the patient experienced VACCINATION COMPLICATION (side effects were minor). At the time of the report, VACCINATION COMPLICATION (side effects were minor) outcome was unknown. The patient stated we were in our eighties. The problems we have were prior to the first shot. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Reporter did not allow further contact

Other Meds:

Current Illness: Asthma

ID: 1714670
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (COVID-19) 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 COVID-19 (COVID-19). At the time of the report, COVID-19 (COVID-19) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided No treatment received by the patient

Other Meds:

Current Illness:

ID: 1714671
Sex: U
Age:
State: TX

Vax Date: 06/11/2021
Onset Date:
Rec V Date: 09/20/2021
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: Administered past the 30 day refrigeration time; Temperature changes (in F): 41-42; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered past the 30 day refrigeration time) and PRODUCT STORAGE ERROR (Temperature changes (in F): 41-42) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 008C21A and 047B21A) 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) (Intramuscular) 1 dosage form. On 09-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered past the 30 day refrigeration time) and PRODUCT STORAGE ERROR (Temperature changes (in F): 41-42). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Administered past the 30 day refrigeration time) and PRODUCT STORAGE ERROR (Temperature changes (in F): 41-42) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1714672
Sex: U
Age:
State: TX

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/20/2021
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: administered past the 30 day refrigeration time; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT STORAGE ERROR (administered past the 30 day refrigeration time) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (administered past the 30 day refrigeration time). On 27-Aug-2021, PRODUCT STORAGE ERROR (administered past the 30 day refrigeration time) 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 treatment was provided. No treatment medication was provided.

Other Meds:

Current Illness:

ID: 1714673
Sex: F
Age: 55
State: OR

Vax Date: 03/25/2021
Onset Date: 03/29/2021
Rec V Date: 09/20/2021
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: Swollen left arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (Swollen left arm) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016B21A) for COVID-19 vaccination. Concurrent medical conditions included Fibromyalgia. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Mar-2021, the patient experienced VACCINATION SITE SWELLING (Swollen left arm). At the time of the report, VACCINATION SITE SWELLING (Swollen left arm) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. No concomitant medications information was reported. No treatment medications were provided. This case was linked to MOD-2021-315465 (Patient Link).

Other Meds:

Current Illness: Fibromyalgia

ID: 1714674
Sex: M
Age: 52
State: NY

Vax Date: 08/04/2021
Onset Date: 09/08/2021
Rec V Date: 09/20/2021
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: Next day, he felt awful; dizziness; anxiousness; fatigue; hot red spot the size of a silver dollar; arm was swollen and large/Next day, his arm felt the same; hot red spot the size of a silver dollar; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness), SKIN WARM (hot red spot the size of a silver dollar) and PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same) in a 52-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 005C21A and 006C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 04-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced SKIN WARM (hot red spot the size of a silver dollar), PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same) and ERYTHEMA (hot red spot the size of a silver dollar). On 09-Sep-2021, the patient experienced FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness) and FATIGUE (fatigue). At the time of the report, FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness), SKIN WARM (hot red spot the size of a silver dollar), PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same), ERYTHEMA (hot red spot the size of a silver dollar) and FATIGUE (fatigue) was resolving. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1714675
Sex: F
Age: 25
State:

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
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: Difficult to breathing; Chills; Headache; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache). At the time of the report, DYSPNOEA (Difficult to breathing), CHILLS (Chills) and HEADACHE (Headache) outcome was unknown. No concomitant medication reported. No treatment information was provided

Other Meds:

Current Illness:

ID: 1714676
Sex: M
Age: 97
State: NY

Vax Date: 08/11/2021
Onset Date: 09/08/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: High

Allergies:

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

Symptoms: 101.6 degrees fever; Post vaccine fatigue; product storage error; product administration error; Expired dose administered to patient/Expired vaccine dose; This spontaneous case was reported by a nurse and describes the occurrence of PYREXIA (101.6 degrees fever), FATIGUE (Post vaccine fatigue), EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose), PRODUCT STORAGE ERROR (product storage error) and PRODUCT ADMINISTRATION ERROR (product administration error) in a 98-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002S21A) 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) (Intramuscular) .5 milliliter. On 08-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to .5 milliliter. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose) and PRODUCT ADMINISTRATION ERROR (product administration error). On an unknown date, the patient experienced PYREXIA (101.6 degrees fever), FATIGUE (Post vaccine fatigue) and PRODUCT STORAGE ERROR (product storage error). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency and IBUPROFEN at an unspecified dose and frequency. On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose) and PRODUCT ADMINISTRATION ERROR (product administration error) had resolved. At the time of the report, PYREXIA (101.6 degrees fever) and FATIGUE (Post vaccine fatigue) outcome was unknown and PRODUCT STORAGE ERROR (product storage error) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101.6 (High) High. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. The reporter states that the patient received expired vaccine. vial that was opened on 01 September 2021 from the refrigerator was used that put back in refrigerator and took back out of refrigerator on 08 Sep 2021 and reporter states patient had an immune response due to fever 101.6 degrees fever and post vaccine fatigue

Other Meds:

Current Illness:

ID: 1714677
Sex: F
Age:
State: SC

Vax Date: 08/11/2021
Onset Date: 08/01/2021
Rec V Date: 09/20/2021
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: Little itching on the injection arm; Little swelling on the injection arm; This spontaneous case was reported by a patient and describes the occurrence of VACCINATION SITE SWELLING (Little swelling on the injection arm) and VACCINATION SITE PRURITUS (Little itching on the injection arm) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048B21A) 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) (Intramuscular) 1 dosage form. In August 2021, the patient experienced VACCINATION SITE SWELLING (Little swelling on the injection arm) and VACCINATION SITE PRURITUS (Little itching on the injection arm). At the time of the report, VACCINATION SITE SWELLING (Little swelling on the injection arm) and VACCINATION SITE PRURITUS (Little itching on the injection arm) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. No concomitant medications were reported. Treatment information was not provided. This case was linked to MOD-2021-315671 (Patient Link).

Other Meds:

Current Illness:

ID: 1714678
Sex: F
Age: 42
State: TX

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/20/2021
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: losing my hair a lot/ hair is falling out/ huge bald spot; body aches; tired; sore arm; tracers in my eyes/see water squigglies in the air; This spontaneous case was reported by a consumer and describes the occurrence of VITREOUS FLOATERS (tracers in my eyes/see water squigglies in the air), ALOPECIA (losing my hair a lot/ hair is falling out/ huge bald spot), MYALGIA (sore arm), MYALGIA (body aches) and FATIGUE (tired) in a 42-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Aug-2021, the patient experienced VITREOUS FLOATERS (tracers in my eyes/see water squigglies in the air) and MYALGIA (sore arm). On 19-Aug-2021, the patient experienced MYALGIA (body aches) and FATIGUE (tired). On an unknown date, the patient experienced ALOPECIA (losing my hair a lot/ hair is falling out/ huge bald spot). At the time of the report, VITREOUS FLOATERS (tracers in my eyes/see water squigglies in the air), ALOPECIA (losing my hair a lot/ hair is falling out/ huge bald spot), MYALGIA (sore arm), MYALGIA (body aches) and FATIGUE (tired) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1714679
Sex: F
Age:
State: SC

Vax Date: 09/08/2021
Onset Date:
Rec V Date: 09/20/2021
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: Itching on the injection arm but it is more than first dose; Swelling on the injection arm but it is more than with the first dose; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itching on the injection arm but it is more than first dose) and VACCINATION SITE SWELLING (Swelling on the injection arm but it is more than with the first dose) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014C21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE PRURITUS (Itching on the injection arm but it is more than first dose) and VACCINATION SITE SWELLING (Swelling on the injection arm but it is more than with the first dose). At the time of the report, VACCINATION SITE PRURITUS (Itching on the injection arm but it is more than first dose) and VACCINATION SITE SWELLING (Swelling on the injection arm but it is more than with the first dose) had not resolved. No Concomitant medication details were provided. No Treatment medication details were provided. This case was linked to MOD-2021-315645 (Patient Link).

Other Meds:

Current Illness:

ID: 1714680
Sex: F
Age: 58
State: CA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/20/2021
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: Itchiness; Big red well; Swelling; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012E21A) for COVID-19 vaccination. Concurrent medical conditions included Sulfonamide allergy and Drug allergy. Concomitant products included MULTIVITAMINS [VITAMINS NOS] and LISINOPRIL for an unknown indication. On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Sep-2021, the patient experienced VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling). The patient was treated with PARACETAMOL (TYLENOL) for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling) 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.

Other Meds: MULTIVITAMINS [VITAMINS NOS]; LISINOPRIL

Current Illness: Drug allergy; Sulfonamide allergy

ID: 1714681
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: high

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Incidence of fever they day after/have a fever of 100.4; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Incidence of fever they day after/have a fever of 100.4) 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 PYREXIA (Incidence of fever they day after/have a fever of 100.4). At the time of the report, PYREXIA (Incidence of fever they day after/have a fever of 100.4) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100.4 (High) high. 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

Other Meds:

Current Illness:

ID: 1714682
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: Is diarrhea a side effect?; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Is diarrhea 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 DIARRHOEA (Is diarrhea a side effect?). At the time of the report, DIARRHOEA (Is diarrhea a side effect?) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were not reported. No treatment medications were not provided.

Other Meds:

Current Illness:

ID: 1714683
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Test Date: 2021; Test Name: COVID-19; Test Result: Negative ; Result Unstructured Data: Negative

Allergies:

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

Symptoms: Itchy; Redness; Sore arm; Headache; Shingles between his ear and temple, down to the back of his neck; This spontaneous case was reported by a consumer and describes the occurrence of HERPES ZOSTER (Shingles between his ear and temple, down to the back of his neck), PRURITUS (Itchy), ERYTHEMA (Redness), PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included PREDNISONE for an unknown indication. 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) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced HERPES ZOSTER (Shingles between his ear and temple, down to the back of his neck), PRURITUS (Itchy), ERYTHEMA (Redness), PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache). At the time of the report, HERPES ZOSTER (Shingles between his ear and temple, down to the back of his neck) had resolved and PRURITUS (Itchy), ERYTHEMA (Redness), PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, COVID-19: negative (Negative) Negative. No treatment information was provided Prior to the vaccine around last holiday season, patient has been getting lots of headache and blurred vision. Several tests were done and doctors then found out that he had a condition that could cause blindness if not treated. That is why he was prescribed with Prednisone. This case was linked to MOD-2021-318230 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 12-Sep-2021: Follow-up information received on 12-SEP-2021 and contains non-significant information

Other Meds: PREDNISONE

Current Illness:

ID: 1714684
Sex: F
Age: 45
State: HI

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
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: Redness at injection site; Pain at injection site; This spontaneous case was reported by a consumer and describes the occurrence of INJECTION SITE ERYTHEMA (Redness at injection site) and INJECTION SITE PAIN (Pain at injection site) in a 45-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040C21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Sep-2021, the patient experienced INJECTION SITE ERYTHEMA (Redness at injection site) and INJECTION SITE PAIN (Pain at injection site). At the time of the report, INJECTION SITE ERYTHEMA (Redness at injection site) and INJECTION SITE PAIN (Pain at injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant product reported by reporter. No treatment medication reported by reporter.

Other Meds:

Current Illness:

ID: 1714685
Sex: U
Age:
State: TX

Vax Date: 09/06/2021
Onset Date: 09/06/2021
Rec V Date: 09/20/2021
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: administered past the 30 day refrigeration time; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered past the 30 day refrigeration time) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form(s). On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered past the 30 day refrigeration time). At the time of the report, EXPIRED PRODUCT ADMINISTERED (administered past the 30 day refrigeration time) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication reported No treatment information provided by the reporter

Other Meds:

Current Illness:

ID: 1714686
Sex: F
Age: 57
State: TX

Vax Date: 01/11/2021
Onset Date: 09/09/2021
Rec V Date: 09/20/2021
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: Big knot at injection site; Weakness; Shooting pain inside her head; Chills; Nausea; Extra dose administered; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MASS (Big knot at injection site), ASTHENIA (Weakness), OFF LABEL USE (Extra dose administered), HEADACHE (Shooting pain inside her head) and CHILLS (Chills) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 062E21A and 015M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced OFF LABEL USE (Extra dose administered). On 10-Sep-2021, the patient experienced VACCINATION SITE MASS (Big knot at injection site), ASTHENIA (Weakness), HEADACHE (Shooting pain inside her head), CHILLS (Chills) and NAUSEA (Nausea). On 09-Sep-2021, OFF LABEL USE (Extra dose administered) outcome was unknown. On 11-Sep-2021, HEADACHE (Shooting pain inside her head), CHILLS (Chills) and NAUSEA (Nausea) had resolved. At the time of the report, VACCINATION SITE MASS (Big knot at injection site) and ASTHENIA (Weakness) had not resolved. No concomitant medication reported. No treatment medication reported.

Other Meds:

Current Illness:

ID: 1714687
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

ID: 1714688
Sex: M
Age:
State: TX

Vax Date: 08/18/2021
Onset Date:
Rec V Date: 09/20/2021
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: the blood pressure goes high and low al day long; the pulse and the blood presure goes high and low all day along; some fatigue; This spontaneous case was reported by a consumer and describes the occurrence of BLOOD PRESSURE FLUCTUATION (the blood pressure goes high and low al day long), HEART RATE IRREGULAR (the pulse and the blood presure goes high and low all day along) and FATIGUE (some fatigue) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. Concurrent medical conditions included Heart disease, unspecified. On 18-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 BLOOD PRESSURE FLUCTUATION (the blood pressure goes high and low al day long), HEART RATE IRREGULAR (the pulse and the blood presure goes high and low all day along) and FATIGUE (some fatigue). At the time of the report, BLOOD PRESSURE FLUCTUATION (the blood pressure goes high and low al day long), HEART RATE IRREGULAR (the pulse and the blood presure goes high and low all day along) and FATIGUE (some fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment information was reported. Patient reported- No pain no discomfort no breathing issues.

Other Meds:

Current Illness: Heart disease, unspecified

ID: 1714689
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: Cough; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (Cough) 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 COUGH (Cough). At the time of the report, COUGH (Cough) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient had been exposed to the virus. No Concomitant medications were reported. No Treatment information was reported.. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1714690
Sex: M
Age:
State: VA

Vax Date: 09/05/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
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: First dose on 5 Aug 2021, second dose on 10 Sept 2021; This spontaneous case was reported by a consumer and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First dose on 5 Aug 2021, second dose on 10 Sept 2021) 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 Chemotherapy (Every two weeks) since an unknown date. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 10-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First dose on 5 Aug 2021, second dose on 10 Sept 2021). On 10-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First dose on 5 Aug 2021, second dose on 10 Sept 2021) had resolved. No Concomitant medication was reported. No treatment medications were reported. This case was linked to MOD-2021-318336 (Patient Link).

Other Meds:

Current Illness: Chemotherapy (Every two weeks.)

ID: 1714691
Sex: U
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: fibromyalgia; joint pain; 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 FIBROMYALGIA (fibromyalgia) and ARTHRALGIA (joint pain) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced FIBROMYALGIA (fibromyalgia) and ARTHRALGIA (joint pain). At the time of the report, FIBROMYALGIA (fibromyalgia) and ARTHRALGIA (joint pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1714692
Sex: F
Age:
State: PA

Vax Date:
Onset Date:
Rec V Date: 09/20/2021
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: Pregnant patient received fluzone, no AE; Initial information received on 09-Sep-2021 regarding an unsolicited valid non-serious case from an other health professional and physician. This case involves pregnant female patient (unknown age) who was exposed to INFLUENZA VACCINE TRIVALENT (FLUZONE). Data regarding this pregnancy were received prospectively, i.e. before pregnancy outcome was known. The reported event occurred at unknown gestation period (exposure during pregnancy). The date of last menstrual period was reported as 08-May-2021. The estimated delivery due date was 17-Feb-2022. The information on patient's previous pregnancy was unknown. It was unknown if the patient had any medical history, concomitant disease or risk factor. It was unknown if the patient received concomitant medication. The patient's past medical treatment(s), vaccination(s), and family history were not provided. On an unknown date, the patient received a dose of suspect FLUZONE (one dosage form, lot 477325SA and expiration date: 30-Jun-2022) via intramuscular route in an unknown administration site for prophylactic vaccination. It was a case of vaccine exposure during pregnancy (same day latency). It was unknown if the patient experienced any additional symptoms/events. It was unknown if there were laboratory data/results available. It was not reported if the patient received a corrective treatment. At time of reporting, no adverse event was reported and the outcome was unknown for the reported event. Additionally, at time of reporting, the outcome of the pregnancy was unknown.

Other Meds:

Current Illness:

ID: 1714693
Sex: F
Age: 28
State: PA

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: N/A

Allergies: Peanuts, Treenuts, Soy

Symptom List: Nausea

Symptoms: I felt fine throughout the day? just a little arm soreness until about 9pm, I felt extremely tired. I went to bed and woke up at 11:53pm with excruciating right arm / Axilla pain . Then the chills set in, I woke up at 5AM with profuse sweating., neck and back stiffness. That morning I noticed my axilla is largely swollen and very sore to touch. Today, continued axilla swelling and very sore arm.

Other Meds: N/A

Current Illness: N/ A

ID: 1714694
Sex: F
Age: 36
State: NJ

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain

Symptoms: 1 week after the shot, symptoms are worse with the pain in left arm & neck & back. Also have pain behind my left knee. Still experiencing radiating pain from the area where the shot was received. Been using heat/ice/tylonel.

Other Meds: Vitaful, probiotics, Restasis, Zyrtec

Current Illness: Preeclampsia due to pregnancy. Had baby.

ID: 1714695
Sex: F
Age: 63
State: NY

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Swollen Neck, ever since then my neck will still get swollen but then goes down.

Other Meds: Metformin HCL, Escitalopram Oxalate, Simvastatin, CQ10, D3, C vitamins

Current Illness: None

ID: 1714696
Sex: F
Age: 40
State: OR

Vax Date: 07/07/2021
Onset Date: 07/16/2021
Rec V Date: 09/20/2021
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: None.

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

Symptoms: Menstrual cycle changes: increased pain and duration of cramps, heavier flow, increased emotional/cognitive stress. I received the vaccine in July and my periods in July, August, and September have all been more difficult than before the vaccine.

Other Meds: Vitamins B, C & D; Magnesium.

Current Illness: None.

ID: 1714697
Sex: F
Age: 25
State: NY

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: OBGYN put in all lab tests that could impact period/hormones and nothing unusual was found.

Allergies: None

Symptom List: Tremor

Symptoms: I no longer have my period.

Other Meds: None

Current Illness: None

ID: 1714698
Sex: F
Age: 63
State: MO

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Teeth-chattering chills (around 30 minutes duration), fever, nausea and vomiting, tired, bruising, swelling and redness at the injection site. The bruising, redness and swelling is still present today (9-20).

Other Meds: Collagen with C, L-Lysine 500 mg, B-12 500mg, Calcium Magnesium and Zinc, and One-A-Day Women?s Vitamins.

Current Illness: None

ID: 1714699
Sex: M
Age: 24
State: MO

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714700
Sex: F
Age: 26
State: TX

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1714701
Sex: F
Age: 45
State: MO

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1714702
Sex: F
Age: 77
State: MA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early-

Other Meds:

Current Illness:

ID: 1714703
Sex: F
Age: 26
State: DC

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: Systemic: eyesight was going out. blurred vision-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Systemic: Visual Changes/Disturbances-Severe, Additional Details: after receive shot pt started to have blurred vision, tingling sweating, back pain. the vision wasnt coming back so we called the ambulance. she started to feel better. they check her vitals, everything fine. maybe having a panic attack

Other Meds:

Current Illness:

ID: 1714704
Sex: F
Age: 45
State: NJ

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: Site: Pain at Injection Site-Mild

Other Meds:

Current Illness:

ID: 1714705
Sex: F
Age: 55
State: CA

Vax Date: 08/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: After 72 hours, terrible Migraine and cluster headaches started 24 hours a day non- stop since 2nd vaccine. With Dizziness, nausea & pain in stomach, left upper chest pains off & on, and high blood pressure(never had before)

Other Meds:

Current Illness: No

ID: 1714706
Sex: F
Age: 48
State: MN

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Patient had a "cool" sensation in her throat-Severe, Systemic: Vomiting-Severe, Additional Details: Patient felt as if she may vomit. She did not vomit while in the store. I called paramedics after Benadryl was given. I have not had any other contact with the patient or the paramedics since the incident.

Other Meds:

Current Illness:

ID: 1714708
Sex: F
Age: 33
State: IL

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1714709
Sex: M
Age: 55
State: CA

Vax Date: 08/22/2021
Onset Date: 08/22/2021
Rec V Date: 09/20/2021
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: Systemic: stiffness in the arm-Mild, Additional Details: pt, he claims after getting the vaccine his arm is a little stiff. No other adverse reaction seen but pt experienced stiffness in the arm

Other Meds:

Current Illness:

ID: 1714710
Sex: F
Age: 66
State: MA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
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: Site: Swelling at Injection Site-Medium, Additional Details: PT RECEIVED 3RD COVID-19 MODERNA VACCINE.CALLED PHARMACY THE NEXT DAY THAT HER ARM WAS SWOLLEN AFTER SHE WENT TO VISIT HER PROVIDER.

Other Meds:

Current Illness:

ID: 1714711
Sex: F
Age: 44
State: FL

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

Other Meds:

Current Illness:

ID: 1714712
Sex: F
Age: 42
State: NV

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
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: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Additional Details: Patient immediately after receiving of vaccine experienced bleeding; a cotton ball was applied, and patient's arm was cleansed with alcohol swaps. Bleeding stopped, patient stated they felt okay after a 15 minute monitoring period, and went home after. 09/19/2021 called and reported bruising and that the arm felt hot to the touch. Patient was recommended to contact a health care provider to be checked out with symptoms, and that we would be checking back to monitor how patient was doing.

Other Meds:

Current Illness:

ID: 1714713
Sex: F
Age: 58
State: CA

Vax Date: 09/18/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Will be calling my doctor when he opens office today

Allergies: No

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

Symptoms: Woke up with discomfort of the left side collar bone . Ran my hand across it to find a painful lump

Other Meds: Syntroid, norvasc, candlesartan, lexapro, plaqunial, vitamin d and benlysta IV form

Current Illness: Systemic lupus sojromes syndrome hashimotos , high blood pressure

ID: 1714714
Sex: F
Age: 26
State: FL

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am