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: 1717938
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Shot was a little achy next day but he says more achy today; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Shot was a little achy next day but he says more achy today) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 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 PAIN (Shot was a little achy next day but he says more achy today). At the time of the report, PAIN (Shot was a little achy next day but he says more achy today) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication was not provided. Treatment information was not provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1717939
Sex: F
Age:
State: NJ

Vax Date: 09/08/2021
Onset Date:
Rec V Date: 09/21/2021
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: trouble sleeping; tiny fever/fever; joint pain; headache; This spontaneous case was reported by a consumer and describes the occurrence of INSOMNIA (trouble sleeping), PYREXIA (tiny fever/fever), ARTHRALGIA (joint pain) and HEADACHE (headache) 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 08-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced INSOMNIA (trouble sleeping), PYREXIA (tiny fever/fever), ARTHRALGIA (joint pain) and HEADACHE (headache). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] for Adverse event, at an unspecified dose and frequency. At the time of the report, INSOMNIA (trouble sleeping), PYREXIA (tiny fever/fever), ARTHRALGIA (joint pain) and HEADACHE (headache) outcome was unknown. Patient received third dose of COVID-19 vaccine Moderna on 08Sep2021. Patient experienced joint pain, a tiny fever, trouble sleeping and possibly headache. Patient stated it wasnot serious. Patient took aspirin and it was not clear if also took Excedrin to treat symptoms. No concomitant medications reported.

Other Meds:

Current Illness:

ID: 1717940
Sex: M
Age: 41
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: administered with expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine). At the time of the report, EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Crosslinked with MOD21-141427, MOD21-141586, MOD21-141640, MOD21-141641, MOD21-141642, MOD21-141643, MOD21-141644, MOD21-141645, MOD21-141646. There were 9 patients instead of 10 as initially reported. This case is for the 9th patient. Concomitant medications was not provided by the reporter Treatment information was not provided This case was linked to MOD-2021-314567, MOD-2021-314573, MOD-2021-314570, MOD-2021-314793 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Possible NNI.

Other Meds:

Current Illness:

ID: 1717941
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Got COVID after being vaccinated with the Moderna COVID19 vaccine; 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 COVID-19 (Got COVID after being vaccinated with the Moderna COVID19 vaccine ) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (Got COVID after being vaccinated with the Moderna COVID19 vaccine ). At the time of the report, COVID-19 (Got COVID after being vaccinated with the Moderna COVID19 vaccine ) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication use was reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1717942
Sex: U
Age:
State:

Vax Date: 04/01/2021
Onset Date:
Rec V Date: 09/21/2021
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: Got COVID after vaccination; shortness of breath; headaches; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Got COVID after vaccination), DYSPNOEA (shortness of breath) and HEADACHE (headaches) 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 01-Apr-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 COVID-19 (Got COVID after vaccination), DYSPNOEA (shortness of breath) and HEADACHE (headaches). At the time of the report, COVID-19 (Got COVID after vaccination), DYSPNOEA (shortness of breath) and HEADACHE (headaches) outcome was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1717943
Sex: M
Age:
State: IL

Vax Date: 01/20/2021
Onset Date: 02/18/2021
Rec V Date: 09/21/2021
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: Sick after second Shot; Chills after second Shot; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Sick after second Shot) and CHILLS (Chills after second Shot) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Feb-2021, the patient experienced ILLNESS (Sick after second Shot) and CHILLS (Chills after second Shot). On 19-Feb-2021, ILLNESS (Sick after second Shot) and CHILLS (Chills after second Shot) had resolved. No concomitant medication was provided. No treatment medication was provided. Patient was Out of it, after second Shot.

Other Meds:

Current Illness:

ID: 1717944
Sex: U
Age:
State: GA

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Had numbness and tingling in her face, neck and cheeks; Had numbness and tingling in her face, neck and cheeks; Had achiness for a couple of days; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (Had numbness and tingling in her face, neck and cheeks), PARAESTHESIA (Had numbness and tingling in her face, neck and cheeks) and PAIN (Had achiness for a couple of days) 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 HYPOAESTHESIA (Had numbness and tingling in her face, neck and cheeks), PARAESTHESIA (Had numbness and tingling in her face, neck and cheeks) and PAIN (Had achiness for a couple of days). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, HYPOAESTHESIA (Had numbness and tingling in her face, neck and cheeks) and PARAESTHESIA (Had numbness and tingling in her face, neck and cheeks) had resolved and PAIN (Had achiness for a couple of days) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were reported. This case was linked to MOD-2021-314631 (Patient Link).

Other Meds:

Current Illness:

ID: 1717945
Sex: F
Age: 38
State: GA

Vax Date: 07/31/2021
Onset Date: 08/01/2021
Rec V Date: 09/21/2021
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: Experienced hives in arms, hands and legs; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Experienced hives in arms, hands and legs) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032B21A) for COVID-19 vaccination. Concurrent medical conditions included Anxiety and ADHD. Concomitant products included LISDEXAMFETAMINE MESILATE (VYVANSE) for ADHD, DESVENLAFAXINE SUCCINATE MONOHYDRATE (PRISTIQ) for Anxiety, LORATADINE (CLARITIN [LORATADINE]) for an unknown indication. On 31-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Aug-2021, the patient experienced URTICARIA (Experienced hives in arms, hands and legs). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) on 01-Aug-2021 for Hives, at a dose of 1 dosage form. On 01-Aug-2021, URTICARIA (Experienced hives in arms, hands and legs) had resolved. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was withdrawn on an unknown date.

Other Meds: CLARITIN [LORATADINE]; PRISTIQ; VYVANSE

Current Illness: ADHD; Anxiety

ID: 1717946
Sex: F
Age: 77
State: UT

Vax Date: 01/22/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: Feeling low; Dizzy; Weak; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 642620A) for COVID-19 vaccination. No Medical History information was reported. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak). On 09-Sep-2021, FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak) had resolved. Concomitant medication details were not reported by the reporter. Treatment details was not reported by the reporter.

Other Meds:

Current Illness:

ID: 1717947
Sex: F
Age: 69
State: TX

Vax Date: 08/24/2021
Onset Date: 08/28/2021
Rec V Date: 09/21/2021
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: 4-5 days later, I noticed my motor skills are slow/getting up from bed is difficult; Walking difficulty; Leg discomfort; She is experiencing pain in her joints, knees, and elbows; This spontaneous case was reported by a consumer and describes the occurrence of MOBILITY DECREASED (4-5 days later, I noticed my motor skills are slow/getting up from bed is difficult), GAIT DISTURBANCE (Walking difficulty), LIMB DISCOMFORT (Leg discomfort) and ARTHRALGIA (She is experiencing pain in her joints, knees, and elbows) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) for COVID-19 vaccination. Concomitant products included HYDROCHLOROTHIAZIDE, OLMESARTAN MEDOXOMIL (OLMESARTAN HCTZ), LEVOTHYROXINE, MULTIVITAMIN [VITAMINS NOS], CYANOCOBALAMIN (VITAMIN B12 [CYANOCOBALAMIN]) and COLECALCIFEROL (VITAMIN D3) for an unknown indication. On 24-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Aug-2021, the patient experienced MOBILITY DECREASED (4-5 days later, I noticed my motor skills are slow/getting up from bed is difficult), GAIT DISTURBANCE (Walking difficulty), LIMB DISCOMFORT (Leg discomfort) and ARTHRALGIA (She is experiencing pain in her joints, knees, and elbows). At the time of the report, MOBILITY DECREASED (4-5 days later, I noticed my motor skills are slow/getting up from bed is difficult), GAIT DISTURBANCE (Walking difficulty), LIMB DISCOMFORT (Leg discomfort) and ARTHRALGIA (She is experiencing pain in her joints, knees, and elbows) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment was not specified. This case was linked to MOD-2021-275275 (Patient Link).

Other Meds: OLMESARTAN HCTZ; LEVOTHYROXINE; MULTIVITAMIN [VITAMINS NOS]; VITAMIN B12 [CYANOCOBALAMIN]; VITAMIN D3

Current Illness:

ID: 1717948
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: severe adverse reactions; 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 ADVERSE REACTION (severe adverse reactions) 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 ADVERSE REACTION (severe adverse reactions). At the time of the report, ADVERSE REACTION (severe adverse reactions) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were provided. No treatment information was reported.

Other Meds:

Current Illness:

ID: 1717949
Sex: M
Age: 57
State: GA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: 101,2 ?F

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Fever (102,1 ?F); Chills; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F71A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LISINOPRIL for Hypertension. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, the patient experienced PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue). At the time of the report, PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101.2 (High) 101,2 ?F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.

Other Meds: LISINOPRIL

Current Illness:

ID: 1717950
Sex: F
Age:
State: CA

Vax Date: 03/10/2021
Onset Date:
Rec V Date: 09/21/2021
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: patient received a vaccine that had Expiration date Mar 06, 2021; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062G20A) for COVID-19 vaccination. No Medical History information was reported. On 10-Mar-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 EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021). At the time of the report, EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) 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 medications were reported. No Treatment information was reported.

Other Meds:

Current Illness:

ID: 1717951
Sex: F
Age: 25
State: TX

Vax Date: 08/10/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Test Date: 20210909; Test Name: BLOOD PRESSURE; Result Unstructured Data: LOW; Test Date: 20210909; Test Name: HEART RATE; Result Unstructured Data: HIGH

Allergies:

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

Symptoms: My blood pressure was 101/52/ low blood pressure; CHEST PAIN; NAUSEA; CHILLS; MYALGIA; I received the dose at 4pm, I wasn't feeling well when I went to bed.; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (I received the dose at 4pm, I wasn't feeling well when I went to bed.), HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA) and CHILLS (CHILLS) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 020F21A and 939902) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Medical history was not provided by the reporter. Concomitant products included MOMETASONE FUROATE (FLONASE [MOMETASONE FUROATE]) and MULTIVITAMIN [VITAMINS NOS] for an unknown indication. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021 at 4:00 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced MALAISE (I received the dose at 4pm, I wasn't feeling well when I went to bed.). On 09-Sep-2021, the patient experienced HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA), CHILLS (CHILLS) and MYALGIA (MYALGIA). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at an unspecified dose and frequency. At the time of the report, MALAISE (I received the dose at 4pm, I wasn't feeling well when I went to bed.), HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA), CHILLS (CHILLS) and MYALGIA (MYALGIA) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 09-Sep-2021, Blood pressure measurement: 101/52 (Low) LOW. On 09-Sep-2021, Heart rate: 116 (High) HIGH.

Other Meds: FLONASE [MOMETASONE FUROATE]; MULTIVITAMIN [VITAMINS NOS]

Current Illness:

ID: 1717952
Sex: U
Age:
State:

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: stomach is queasy; 100.4 fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) 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. On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) and CHILLS (chills). At the time of the report, ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) and CHILLS (chills) had not resolved. 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: 1717953
Sex: M
Age: 48
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Test Date: 202109; Test Name: Body temperature; Result Unstructured Data: 103 F

Allergies:

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

Symptoms: he is complaining of lots of muscle pain/the muscle ache is moderate/muscle ache is still ongoing; he had high fevers as well/his fever was 103F; This spontaneous case was reported by a nurse and describes the occurrence of MYALGIA (he is complaining of lots of muscle pain/the muscle ache is moderate/muscle ache is still ongoing) and PYREXIA (he had high fevers as well/his fever was 103F) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) for COVID-19 vaccination. The patient's past medical history included COVID-19 in 2020 and Mechanical ventilation in 2020. On 02-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Sep-2021, the patient experienced MYALGIA (he is complaining of lots of muscle pain/the muscle ache is moderate/muscle ache is still ongoing) and PYREXIA (he had high fevers as well/his fever was 103F). The patient was treated with IBUPROFEN (MOTRIN [IBUPROFEN]) for Fever, at an unspecified dose and frequency and METHOCARBAMOL (ROBAXIN) for Adverse event, at an unspecified dose and frequency. On 03-Sep-2021, PYREXIA (he had high fevers as well/his fever was 103F) had resolved. At the time of the report, MYALGIA (he is complaining of lots of muscle pain/the muscle ache is moderate/muscle ache is still ongoing) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In September 2021, Body temperature: 103 (High) 103 F. 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 provided by the reporter It was reported that the patient was a healthy person with no comorbidities and he exercise regularly He had infected with COVID 19 and nearly lost his life as he was on ventilator His wife reported that he had a natural immunity against the virus Most recent FOLLOW-UP information incorporated above includes: On 09-Sep-2021: Follow-up contains lot number updated.

Other Meds:

Current Illness:

ID: 1717954
Sex: U
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Lot of people got sick; Experienced anxiety before the vaccine which is panic related due to covid; Lot of people felt tired/Fatigued; 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 ILLNESS (Lot of people got sick), ANXIETY (Experienced anxiety before the vaccine which is panic related due to covid) and FATIGUE (Lot of people felt tired/Fatigued) 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 ILLNESS (Lot of people got sick), ANXIETY (Experienced anxiety before the vaccine which is panic related due to covid) and FATIGUE (Lot of people felt tired/Fatigued). At the time of the report, ILLNESS (Lot of people got sick), ANXIETY (Experienced anxiety before the vaccine which is panic related due to covid) and FATIGUE (Lot of people felt tired/Fatigued) outcome was unknown. 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: 1717955
Sex: F
Age:
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 09/21/2021
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: patient received a vaccine that had Expiration date Mar 06, 2021; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062G20A) for COVID-19 vaccination. No Medical History information was reported. On 10-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021). On 10-Mar-2021, EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment medications were provided. On 10 March 2021 the vaccine was moved from freezer to refrigerator. This case was linked to MOD-2021-307189 (Patient Link).

Other Meds:

Current Illness:

ID: 1717956
Sex: F
Age:
State: GA

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Felt sick; Bad rash; Injection site got swollen; Numbness in right side of face; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Felt sick), HYPOAESTHESIA (Numbness in right side of face), RASH (Bad rash) and VACCINATION SITE SWELLING (Injection site got swollen) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ILLNESS (Felt sick), HYPOAESTHESIA (Numbness in right side of face), RASH (Bad rash) and VACCINATION SITE SWELLING (Injection site got swollen). At the time of the report, ILLNESS (Felt sick), RASH (Bad rash) and VACCINATION SITE SWELLING (Injection site got swollen) outcome was unknown and HYPOAESTHESIA (Numbness in right side of face) had resolved. Concomitant medication details were not reported by the reporter. Treatment details included Benadryl after the first dose adverse event. This case was linked to MOD-2021-314623 (Patient Link).

Other Meds:

Current Illness:

ID: 1717957
Sex: U
Age:
State:

Vax Date:
Onset Date: 09/09/2021
Rec V Date: 09/21/2021
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: Im pale after receiving the vaccination; This spontaneous case was reported by a consumer and describes the occurrence of PALLOR (Im pale after receiving the 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 09-Sep-2021, the patient experienced PALLOR (Im pale after receiving the vaccination). At the time of the report, PALLOR (Im pale after receiving the vaccination) 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 provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1717958
Sex: F
Age: 36
State: TX

Vax Date: 12/29/2020
Onset Date: 12/01/2020
Rec V Date: 09/21/2021
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: Arm pain; injection site pain; Arthralgias; Headache; This spontaneous case was reported by a physician and describes the occurrence of PAIN IN EXTREMITY (Arm pain), VACCINATION SITE PAIN (injection site pain), ARTHRALGIA (Arthralgias) and HEADACHE (Headache) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025L20A) for COVID-19 vaccination. Concurrent medical conditions included Immunosuppression. On 29-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In December 2020, the patient experienced PAIN IN EXTREMITY (Arm pain), VACCINATION SITE PAIN (injection site pain), ARTHRALGIA (Arthralgias) and HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Arm pain), VACCINATION SITE PAIN (injection site pain), ARTHRALGIA (Arthralgias) and HEADACHE (Headache) 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 included immunosuppressant medication. This case was linked to MOD-2021-314740, MOD-2021-314741 (Patient Link).

Other Meds:

Current Illness: Immunosuppression

ID: 1717959
Sex: U
Age:
State: SD

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: two children less than 18 years old received the vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (two children less than 18 years old received the vaccine) 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 PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (two children less than 18 years old received the vaccine). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (two children less than 18 years old received the vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were provided. Clinical Pharmacist (caller) states he is not sure howold the children are, but they are just under the age of 18, he thinks they are 16 and 17 years of age were administered the moderna covid-19 vaccine instead of the Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1717960
Sex: M
Age: 36
State: CA

Vax Date: 03/19/2021
Onset Date: 04/22/2021
Rec V Date: 09/21/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Date: 2021; Test Name: C-reactive protein; Result Unstructured Data: C-reactive protein high; Test Date: 2021; Test Name: EKG; Result Unstructured Data: normal; Test Date: 2021; Test Name: EKG; Result Unstructured Data: irregular; Test Date: 2021; Test Name: MRI; Result Unstructured Data: Hospitalization for Atrial fibrillation

Allergies:

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

Symptoms: Atrial fibrillation; severe chills; severe fatigue; Severe shortness of breath; Panic attack/thought it was a heart attack; Was unable to drive for a while; tachycardia or fast heartbeat; Occasional PACs-premature atrial contraction; Mild Myocarditis when I was in ER; This spontaneous case was reported by a pharmacist and describes the occurrence of ATRIAL FIBRILLATION (Atrial fibrillation), CHILLS (severe chills), FATIGUE (severe fatigue), DYSPNOEA (Severe shortness of breath), PANIC ATTACK (Panic attack/thought it was a heart attack), IMPAIRED DRIVING ABILITY (Was unable to drive for a while), TACHYCARDIA (tachycardia or fast heartbeat), SUPRAVENTRICULAR EXTRASYSTOLES (Occasional PACs-premature atrial contraction) and MYOCARDITIS (Mild Myocarditis when I was in ER) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 042B21A and 036A21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 22-Apr-2021, the patient experienced ATRIAL FIBRILLATION (Atrial fibrillation) (seriousness criteria hospitalization, disability, medically significant and life threatening), CHILLS (severe chills) (seriousness criteria hospitalization, disability and life threatening), FATIGUE (severe fatigue) (seriousness criteria hospitalization, disability and life threatening), DYSPNOEA (Severe shortness of breath) (seriousness criteria hospitalization, disability and life threatening), PANIC ATTACK (Panic attack/thought it was a heart attack) (seriousness criteria hospitalization, disability and life threatening), IMPAIRED DRIVING ABILITY (Was unable to drive for a while) (seriousness criteria hospitalization, disability and life threatening), TACHYCARDIA (tachycardia or fast heartbeat) (seriousness criteria hospitalization, disability and life threatening), SUPRAVENTRICULAR EXTRASYSTOLES (Occasional PACs-premature atrial contraction) (seriousness criteria hospitalization, disability and life threatening) and MYOCARDITIS (Mild Myocarditis when I was in ER) (seriousness criteria hospitalization, disability, medically significant and life threatening). The patient was treated with ALPRAZOLAM (XANAX) ongoing since an unknown date for Adverse event, at an unspecified dose and frequency and DABIGATRAN ETEXILATE MESILATE (PRADAXA) ongoing since an unknown date for Adverse event, at an unspecified dose and frequency. At the time of the report, ATRIAL FIBRILLATION (Atrial fibrillation), CHILLS (severe chills), FATIGUE (severe fatigue), DYSPNOEA (Severe shortness of breath), PANIC ATTACK (Panic attack/thought it was a heart attack), IMPAIRED DRIVING ABILITY (Was unable to drive for a while), TACHYCARDIA (tachycardia or fast heartbeat), SUPRAVENTRICULAR EXTRASYSTOLES (Occasional PACs-premature atrial contraction) and MYOCARDITIS (Mild Myocarditis when I was in ER) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, C-reactive protein: high (High) C-reactive protein high. In 2021, Electrocardiogram: normal (normal) normal and irregular (abnormal) irregular. In 2021, Magnetic resonance imaging: abnormal (abnormal) Hospitalization for Atrial fibrillation. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant Medications were provided by the reporter Additional treatment medications included was Cardiac ablation in near future for Atrial fibrillation. Additional lab data included were ECG, Cardiac test, Cardiac enzymes and Troponin level - Within normal limits. 3 days after the second shot, patient had severe shortness of breath, thought it was a heart attack. Followed up with numerous doctors. It was recurring issue. Panic attack was diagnosed at first. Patient had to take 1 month off from work. It was confirmed Atrial fibrillation by cardiologist and electrophysiologist. And hence cardiac ablation is recommended in near future. Company comment: This case concerns a 36 year-old, male patient with no relevant medical history, who experienced the unexpected events of Atrial fibrillation, chills, fatigue, dyspnoea, panic attack, impaired driving ability, tachycardia, supraventricular extrasystoles and the expected event of myocarditis requiring hospitalization. The events occurred approximately 3 days after the second dose of Spikevax. The rechallenge was not applicable, as the event was reported exclusively after the second dose. The event of myocarditis is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of Spikevax is not affected by this report.; Sender's Comments: This case concerns a 36 year-old, male patient with no relevant medical history, who experienced the unexpected events of Atrial fibrillation, chills, fatigue, dyspnoea, panic attack, impaired driving ability, tachycardia, supraventricular extrasystoles and the expected event of myocarditis requiring hospitalization. The events occurred approximately 3 days after the second dose of Spikevax. The rechallenge was not applicable, as the event was reported exclusively after the second dose. The event of myocarditis is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of Spikevax is not affected by this report.

Other Meds:

Current Illness:

ID: 1717961
Sex: U
Age:
State:

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/21/2021
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: expired 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 EXPIRED PRODUCT ADMINISTERED (expired dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 04721A) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired dose). At the time of the report, EXPIRED PRODUCT ADMINISTERED (expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported No treatment Drug was reported

Other Meds:

Current Illness:

ID: 1717962
Sex: F
Age: 64
State: IA

Vax Date: 02/16/2021
Onset Date:
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was administered a dose of the Moderna COVID from a pre drawn syringe stored at room temperature for 23 hours; ts that the third dose was given from a pre drawn syringe which had been stored at room temperature for longer than; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT STORAGE ERROR (Patient was administered a dose of the Moderna COVID from a pre drawn syringe stored at room temperature for 23 hours) and EXPIRED PRODUCT ADMINISTERED (ts that the third dose was given from a pre drawn syringe which had been stored at room temperature for longer than) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 019B21A and 023M20A) for COVID-19 vaccination. No Medical History information was reported. On 16-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Mar-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 an unknown date, the patient experienced PRODUCT STORAGE ERROR (Patient was administered a dose of the Moderna COVID from a pre drawn syringe stored at room temperature for 23 hours) and EXPIRED PRODUCT ADMINISTERED (ts that the third dose was given from a pre drawn syringe which had been stored at room temperature for longer than). At the time of the report, PRODUCT STORAGE ERROR (Patient was administered a dose of the Moderna COVID from a pre drawn syringe stored at room temperature for 23 hours) and EXPIRED PRODUCT ADMINISTERED (ts that the third dose was given from a pre drawn syringe which had been stored at room temperature for longer than) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications includes Acuvar Readihaler, Vitamin D, Multivitamin Treatment medications was not provided.

Other Meds:

Current Illness:

ID: 1717963
Sex: F
Age:
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 09/21/2021
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: patient received a vaccine that had Expiration date Mar 06, 2021; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062G20A) for COVID-19 vaccination. No Medical History information was reported. On 10-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 10-Mar-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021). On 10-Mar-2021, EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant drug was not reported. Treatment medication was not reported.

Other Meds:

Current Illness:

ID: 1717964
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: given doses after 30 days/doses that were stored longer than 30 days were administered to 30-40 indivuduals; 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 EXPIRED PRODUCT ADMINISTERED (given doses after 30 days/doses that were stored longer than 30 days were administered to 30-40 indivuduals) 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) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced EXPIRED PRODUCT ADMINISTERED (given doses after 30 days/doses that were stored longer than 30 days were administered to 30-40 indivuduals). At the time of the report, EXPIRED PRODUCT ADMINISTERED (given doses after 30 days/doses that were stored longer than 30 days were administered to 30-40 indivuduals) 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. Moderna vaccines were stored under improper storage conditions due to loss of power for more than 30 days and were administered to 30-40 individuals and none of the vail had temperature excursion and all the doses administered were 1st, 2nd and 3rd doses and were administered through intramuscular. No concomitant medications were provided by the reporter. No treatment medications were provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Follow-up received contains significant information updated list of patients who took expired vaccine and all details were provided.

Other Meds:

Current Illness:

ID: 1717965
Sex: M
Age:
State: CA

Vax Date: 03/10/2021
Onset Date:
Rec V Date: 09/21/2021
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: patient received a vaccine that had Expiration date Mar 06, 2021; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) in an 84-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062G20A) for COVID-19 vaccination. No Medical History information was reported. On 10-Mar-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 EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021). At the time of the report, EXPIRED PRODUCT ADMINISTERED (patient received a vaccine that had Expiration date Mar 06, 2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1717966
Sex: F
Age: 35
State: TX

Vax Date: 01/28/2020
Onset Date:
Rec V Date: 09/21/2021
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: Arm pain; Injection site pain; Arthralgias; Headache; All of that plus fever; This spontaneous case was reported by a physician and describes the occurrence of PAIN IN EXTREMITY (Arm pain), INJECTION SITE PAIN (Injection site pain), ARTHRALGIA (Arthralgias), HEADACHE (Headache) and PYREXIA (All of that plus fever) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 043L20A and 025L20A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jan-2020, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Dec-2020, 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 PAIN IN EXTREMITY (Arm pain), INJECTION SITE PAIN (Injection site pain), ARTHRALGIA (Arthralgias), HEADACHE (Headache) and PYREXIA (All of that plus fever). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Arm pain), INJECTION SITE PAIN (Injection site pain), ARTHRALGIA (Arthralgias), HEADACHE (Headache) and PYREXIA (All of that plus fever) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medication was reported. This case was linked to MOD-2021-314678, MOD-2021-314741 (Patient Link).

Other Meds:

Current Illness:

ID: 1717967
Sex: U
Age:
State: NY

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/21/2021
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: Administered a 1 mL dose instead of 0.5 mL; 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 ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL) 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 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 ml. On 09-Sep-2021, the patient experienced ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL). On 09-Sep-2021, ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was provided by the reporter.

Other Meds:

Current Illness:

ID: 1717968
Sex: M
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: A 15 and ? year old received the vaccine; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 09-Sep-2021 and was forwarded to Moderna on 09-Sep-2021. This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 15 and ? year old received the vaccine) in a 15-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 ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 15 and ? year old received the vaccine). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 15 and ? year old received the vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1717969
Sex: F
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: 50 cent sized red raised skin; rash; fever; chills; lethargic; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 09-Sep-2021 and was forwarded to Moderna on 09-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of RASH ERYTHEMATOUS (50 cent sized red raised skin), RASH (rash), PYREXIA (fever), CHILLS (chills) and LETHARGY (lethargic) in a 58-year-old female 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced RASH ERYTHEMATOUS (50 cent sized red raised skin), RASH (rash), PYREXIA (fever), CHILLS (chills) and LETHARGY (lethargic). At the time of the report, RASH ERYTHEMATOUS (50 cent sized red raised skin), RASH (rash), PYREXIA (fever), CHILLS (chills) and LETHARGY (lethargic) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medication was reported No treatment drug was reported

Other Meds:

Current Illness:

ID: 1717970
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Test Name: Body temperature; Result Unstructured Data: 103.3?F; Test Name: Body temperature; Result Unstructured Data: 102.3?F.

Allergies:

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

Symptoms: This spontaneous case reported by a consumer, describes the occurrence of pyrexia (temp currently 103.3?F/102.3?F) in a male patient, of an unknown age, who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. No medical history reported. On an unknown date, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On an unknown date, patient experienced pyrexia (temp currently 103.3?F/102.3?F). At the time of the report, pyrexia (temp currently 103.3?F/102.3?F): not resolved. Diagnostic results: On an unknown date, body temperature: 103.3?F (high) 103.3 and 102.3?F (high). The action taken with mRNA-1273 (Moderna COVID-19 vaccine): unknown. Concomitant production use and treatment information not reported.

Other Meds:

Current Illness:

ID: 1717971
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: My spouse received the Pfizer vaccine on the first dose and the second Moderna is there any reason for concern?; This spontaneous case was reported by a consumer and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (My spouse received the Pfizer vaccine on the first dose and the second Moderna is there any reason for concern?) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. Previously administered products included for an unreported indication: PFIZER BIONTECH COVID-19 VACCINE. 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 INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (My spouse received the Pfizer vaccine on the first dose and the second Moderna is there any reason for concern?). At the time of the report, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (My spouse received the Pfizer vaccine on the first dose and the second Moderna is there any reason for concern?) had resolved. No concomitant medications were reported. No treatment medications were reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1717972
Sex: M
Age: 34
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: administered with expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) in a 35-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine). At the time of the report, EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not provided. This case was linked to MOD-2021-314567, MOD-2021-314570, MOD-2021-314573, MOD-2021-314793, MOD-2021-314545, MOD-2021-314555, MOD-2021-314805, MOD-2021-314810, MOD-2021-314805 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up information included no new information

Other Meds:

Current Illness:

ID: 1717973
Sex: M
Age: 62
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: Administered with expired vaccine; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine). On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was provided by the reporter. This case was linked to MOD-2021-314570, MOD-2021-314573, MOD-2021-314805, MOD-2021-314545, MOD-2021-314555, MOD-2021-314567, MOD-2021-314810, MOD-2021-314810 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up information included no new information

Other Meds:

Current Illness:

ID: 1717974
Sex: U
Age:
State:

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

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

Lab Data: Test Date: 202109; Test Name: Body temperature; Result Unstructured Data: Fever of 101.5 degrees F

Allergies:

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

Symptoms: Feels like he got dragged; Vomiting; Fever of 101.5 degrees F; Aches; Chills; This spontaneous case was reported by a consumer and describes the occurrence of GAIT DISTURBANCE (Feels like he got dragged), VOMITING (Vomiting), PYREXIA (Fever of 101.5 degrees F), PAIN (Aches) 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. On 08-Sep-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 GAIT DISTURBANCE (Feels like he got dragged), VOMITING (Vomiting), PYREXIA (Fever of 101.5 degrees F), PAIN (Aches) and CHILLS (Chills). At the time of the report, GAIT DISTURBANCE (Feels like he got dragged), VOMITING (Vomiting), PYREXIA (Fever of 101.5 degrees F), PAIN (Aches) and CHILLS (Chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In September 2021, Body temperature: 101.5 (High) Fever of 101.5 degrees F. No concomitant medications were mentioned. No treatment details were reported.

Other Meds:

Current Illness:

ID: 1717975
Sex: M
Age: 84
State: UT

Vax Date: 02/08/2021
Onset Date: 03/08/2021
Rec V Date: 09/21/2021
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: Caller reported his own AE; Soreness in his arm; Blood in his urine; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Caller reported his own AE), PAIN IN EXTREMITY (Soreness in his arm) and BLOOD URINE PRESENT (Blood in his urine) in an 84-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 007N20A and 012A21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Mar-2021, the patient experienced PAIN IN EXTREMITY (Soreness in his arm) and BLOOD URINE PRESENT (Blood in his urine). On an unknown date, the patient experienced VACCINATION COMPLICATION (Caller reported his own AE). At the time of the report, VACCINATION COMPLICATION (Caller reported his own AE), PAIN IN EXTREMITY (Soreness in his arm) and BLOOD URINE PRESENT (Blood in his urine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medication were reported. No treatment medication were reported. Most recent FOLLOW-UP information incorporated above includes: On 09-Sep-2021: Follow up contain significant information: Events - Blood in urine a nd soreness in arm were added. Dose 2 details added. Dose 1 details updated.

Other Meds:

Current Illness:

ID: 1717976
Sex: F
Age: 67
State: CA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 09/21/2021
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: Arm hurt a little; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Arm hurt a little) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 042L20A) for COVID-19 vaccination. Concurrent medical conditions included Lupus erythematosus and Immunocompromised. Concomitant products included HYDROXYCHLOROQUINE, METHOTREXATE, FOLIC ACID, OMEPRAZOLE, CALCIUM FOLINATE (LEUCOVORIN CALCIUM), DICYCLOVERINE, VITAMIN C [ASCORBIC ACID] and VITAMIN D [VITAMIN D NOS] for an unknown indication. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Jan-2021, the patient experienced PAIN IN EXTREMITY (Arm hurt a little). At the time of the report, PAIN IN EXTREMITY (Arm hurt a little) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. No Concomitant medications were reported. No Treatment medications were reported. This case was linked to MOD-2021-314861, MOD-2021-314862 (Patient Link).

Other Meds: HYDROXYCHLOROQUINE; METHOTREXATE; FOLIC ACID; OMEPRAZOLE; LEUCOVORIN CALCIUM; DICYCLOVERINE; VITAMIN C [ASCORBIC ACID]; VITAMIN D [VITAMIN D NOS]

Current Illness: Immunocompromised; Lupus erythematosus

ID: 1717977
Sex: F
Age: 67
State: CA

Vax Date: 01/29/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Arm is hot four fingers bellow the injection site.; Red is like four fingers bellow the injection site; Felt beaten up; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A, 042L20A and 01A21A) for COVID-19 vaccination. Concurrent medical conditions included Lupus-like syndrome and Immunocompromised. Concomitant products included HYDROXYCHLOROQUINE, METHOTREXATE, FOLIC ACID, OMEPRAZOLE, CALCIUM FOLINATE (LEUCOVORIN CALCIUM), DICYCLOVERINE, Vitamin C and Vitamin D for an unknown indication. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up). At the time of the report, VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up) outcome was unknown. No treatment medication reported. This case was linked to MOD-2021-314861 (Patient Link).

Other Meds: HYDROXYCHLOROQUINE; METHOTREXATE; FOLIC ACID; OMEPRAZOLE; LEUCOVORIN CALCIUM; DICYCLOVERINE; Vitamin C; Vitamin D

Current Illness: Immunocompromised; Lupus-like syndrome

ID: 1717978
Sex: F
Age: 93
State:

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 09/21/2021
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: hives; itching; rashes; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (hives), PRURITUS (itching) and RASH (rashes) in a 93-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, the patient experienced URTICARIA (hives), PRURITUS (itching) and RASH (rashes). At the time of the report, URTICARIA (hives), PRURITUS (itching) and RASH (rashes) had not resolved. 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: 1717979
Sex: M
Age: 36
State: LA

Vax Date: 07/25/2021
Onset Date: 08/24/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Test Date: 20210824; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: POSITIVE

Allergies:

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

Symptoms: >35 days since first dose - has not received second dose at this time; Tested positive for COVID after first dose; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (>35 days since first dose - has not received second dose at this time) and COVID-19 (Tested positive for COVID after first dose) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 059E21A) for COVID-19 vaccination. No Medical History information was reported. On 25-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Aug-2021, the patient experienced COVID-19 (Tested positive for COVID after first dose). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (>35 days since first dose - has not received second dose at this time). At the time of the report, PRODUCT DOSE OMISSION ISSUE (>35 days since first dose - has not received second dose at this time) had resolved and COVID-19 (Tested positive for COVID after first dose) 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. Patient was advised not to take second dose on scheduled time due to COVID positive Concomitant medications were not provided. Treatment information was not provided

Other Meds:

Current Illness:

ID: 1717980
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: Adverse reaction from the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Adverse reaction from the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Lymphedema (Lymphedema arm). 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 from the vaccine). At the time of the report, VACCINATION COMPLICATION (Adverse reaction from the vaccine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. No treatment medications were provided. The patient had lymphedema arm and wants to take booster dose. The patient had to take the booster dose in the hip just like the flu shot. Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Follow up received included no new information.

Other Meds:

Current Illness: Lymphedema (Lymphedema arm)

ID: 1717981
Sex: F
Age: 56
State: KY

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 09/21/2021
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: rash on her abdomen and chest that went away after 24hours; This spontaneous case was reported by a consumer and describes the occurrence of RASH (rash on her abdomen and chest that went away after 24hours) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013M20A and 008A21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Feb-2021, the patient experienced RASH (rash on her abdomen and chest that went away after 24hours). On 07-Feb-2021, RASH (rash on her abdomen and chest that went away after 24hours) had resolved. No treatment informations were reported

Other Meds:

Current Illness:

ID: 1717982
Sex: M
Age: 56
State: AL

Vax Date: 08/04/2021
Onset Date:
Rec V Date: 09/21/2021
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: right thigh muscle and bicep/ tighten up; right arm and leg are cramping/diagnosed with muscle spasms; sore/ eerie-feeling; low grade temperature/running a temp; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE TIGHTNESS (right thigh muscle and bicep/ tighten up), MUSCLE SPASMS (right arm and leg are cramping/diagnosed with muscle spasms), PAIN (sore/ eerie-feeling) and PYREXIA (low grade temperature/running a temp) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 034C21A) for COVID-19 vaccination. 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) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced MUSCLE TIGHTNESS (right thigh muscle and bicep/ tighten up), MUSCLE SPASMS (right arm and leg are cramping/diagnosed with muscle spasms), PAIN (sore/ eerie-feeling) and PYREXIA (low grade temperature/running a temp). At the time of the report, MUSCLE TIGHTNESS (right thigh muscle and bicep/ tighten up), MUSCLE SPASMS (right arm and leg are cramping/diagnosed with muscle spasms), PAIN (sore/ eerie-feeling) and PYREXIA (low grade temperature/running a temp) outcome was unknown. Concomitant medications were not provided. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1717983
Sex: M
Age: 33
State: FL

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/21/2021
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: Not feeling well; Arm was sore ,body aches; Temperature; Sweats; Body was burning hot; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats), BURNING SENSATION (Body was burning hot) and MALAISE (Not feeling well) in a 33-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 009C21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Sep-2021, the patient experienced MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats) and BURNING SENSATION (Body was burning hot). On an unknown date, the patient experienced MALAISE (Not feeling well). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency and DEXTROMETHORPHAN HYDROBROMIDE, GUAIFENESIN, PARACETAMOL, PSEUDOEPHEDRINE HYDROCHLORIDE (DAYQUIL) for Adverse event, at an unspecified dose and frequency. At the time of the report, MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats), BURNING SENSATION (Body was burning hot) and MALAISE (Not feeling well) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Temporal temperature on right aide was 102.2 and on left side was 102.3. No concomitant medications were reported.

Other Meds:

Current Illness:

ID: 1717984
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/21/2021
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: about 2 weeks ago started to have facial swelling where filler was/but only on one side; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING FACE (about 2 weeks ago started to have facial swelling where filler was/but only on one side) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included Dermal filler injection (Patient had fillers placed in cheeks about two week ago) in 2021. 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 SWELLING FACE (about 2 weeks ago started to have facial swelling where filler was/but only on one side). At the time of the report, SWELLING FACE (about 2 weeks ago started to have facial swelling where filler was/but only on one side) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported Treatment included steroids Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1717985
Sex: F
Age:
State: NY

Vax Date: 02/08/2021
Onset Date:
Rec V Date: 09/21/2021
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: Before getting the third dose, they had some blood tests done and they showed low electrolytes.; Severe pain; Had red patch 4-6 inches long underneath injection site; Had a red swelling on the injection site; Lymph nodes were red under the shot; Fatigue; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 09-Sep-2021 and was forwarded to Moderna on 09-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of ELECTROLYTE IMBALANCE (Before getting the third dose, they had some blood tests done and they showed low electrolytes.), PAIN (Severe pain), RASH (Had red patch 4-6 inches long underneath injection site), INJECTION SITE SWELLING (Had a red swelling on the injection site) and INJECTION SITE LYMPHADENOPATHY (Lymph nodes were red under the shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012M20A, 013A21A and 022C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 08-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ELECTROLYTE IMBALANCE (Before getting the third dose, they had some blood tests done and they showed low electrolytes.), PAIN (Severe pain), RASH (Had red patch 4-6 inches long underneath injection site), INJECTION SITE SWELLING (Had a red swelling on the injection site), INJECTION SITE LYMPHADENOPATHY (Lymph nodes were red under the shot) and FATIGUE (Fatigue). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at a dose of 2 dosage form every six hours. At the time of the report, ELECTROLYTE IMBALANCE (Before getting the third dose, they had some blood tests done and they showed low electrolytes.), PAIN (Severe pain), RASH (Had red patch 4-6 inches long underneath injection site), INJECTION SITE SWELLING (Had a red swelling on the injection site), INJECTION SITE LYMPHADENOPATHY (Lymph nodes were red under the shot) and FATIGUE (Fatigue) outcome was unknown. No concomitant medication was reported. No treatment medication was reported. This case was linked to MOD-2021-314896 (Patient Link).

Other Meds:

Current Illness:

ID: 1717986
Sex: M
Age:
State: FL

Vax Date:
Onset Date: 02/01/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I had a sore arm at the injection site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (I had a sore arm at the injection site) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. Concurrent medical conditions included Food allergy (Allergy to shrimp.). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Feb-2021, the patient experienced VACCINATION SITE PAIN (I had a sore arm at the injection site). At the time of the report, VACCINATION SITE PAIN (I had a sore arm at the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications reported. No treatment medications reported. This case was linked to MOD-2021-314936 (Patient Link).

Other Meds:

Current Illness:

ID: 1717987
Sex: M
Age: 62
State: NY

Vax Date: 06/28/2021
Onset Date:
Rec V Date: 09/21/2021
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: second dose "put him down"; really sick for 2 days; couldn't get out of bed; chills; body aches; This spontaneous case was reported by a consumer and describes the occurrence of DEPRESSED MOOD (second dose "put him down"), ILLNESS (really sick for 2 days), BEDRIDDEN (couldn't get out of bed), CHILLS (chills) and MYALGIA (body aches) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027C21A and 845812A) for COVID-19 vaccination. No Medical History information was reported. 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 an unknown date, the patient experienced DEPRESSED MOOD (second dose "put him down"), ILLNESS (really sick for 2 days), BEDRIDDEN (couldn't get out of bed), CHILLS (chills) and MYALGIA (body aches). At the time of the report, DEPRESSED MOOD (second dose "put him down"), ILLNESS (really sick for 2 days), BEDRIDDEN (couldn't get out of bed), CHILLS (chills) and MYALGIA (body aches) outcome was unknown. Concomitant medications were not provided. Treatment information was not provided.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am