VAERS 2021 Database www.vaers.hhs.gov

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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: 1721532
Sex: F
Age: 52
State: NY

Vax Date: 01/22/2021
Onset Date: 02/20/2021
Rec V Date: 09/22/2021
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: Mild flu like symptoms; Minor gastro symptoms; Flushing; Chills; Temperature of 99 degrees Fahrenheit; Tired; This spontaneous case was reported by a physician and describes the occurrence of INFLUENZA LIKE ILLNESS (Mild flu like symptoms), EPIGASTRIC DISCOMFORT (Minor gastro symptoms), FLUSHING (Flushing), CHILLS (Chills) and PYREXIA (Temperature of 99 degrees Fahrenheit) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013L20A and 032L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included MULTIVITAMINS [VITAMINS NOS] and CALCIUM for an unknown indication. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Feb-2021, the patient experienced INFLUENZA LIKE ILLNESS (Mild flu like symptoms), EPIGASTRIC DISCOMFORT (Minor gastro symptoms), FLUSHING (Flushing), CHILLS (Chills), PYREXIA (Temperature of 99 degrees Fahrenheit) and FATIGUE (Tired). On 23-Feb-2021, INFLUENZA LIKE ILLNESS (Mild flu like symptoms), EPIGASTRIC DISCOMFORT (Minor gastro symptoms), FLUSHING (Flushing), CHILLS (Chills), PYREXIA (Temperature of 99 degrees Fahrenheit) and FATIGUE (Tired) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment information included Acupuncture. This case was linked to MOD-2021-272312 (Patient Link).

Other Meds: MULTIVITAMINS [VITAMINS NOS]; CALCIUM

Current Illness:

ID: 1721533
Sex: F
Age: 53
State: FL

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Test Name: Pain Scale; Result Unstructured Data: 10/10

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: She was one week past the second dose due date; Electrical shocks on the right side of her face; Trigeminal neuralgia became bilateral; Trigeminal neuralgia flare up; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (She was one week past the second dose due date), ELECTRIC SHOCK SENSATION (Electrical shocks on the right side of her face), TRIGEMINAL NEURALGIA (Trigeminal neuralgia flare up) and TRIGEMINAL NEURALGIA (Trigeminal neuralgia became bilateral) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051C21A) for COVID-19 vaccination. The patient's past medical history included Lumbar strain, Neurostimulator implantation (For Lumbar issue) and Microvascular decompression (2 failed surgeries for Trigeminal neuralgia) from May 2019 to December 2020. Concurrent medical conditions included Trigeminal neuralgia (Left side) since 2019 and Chronic kidney disease (Stage 3b) since 2008. Concomitant products included CARBAMAZEPINE (TEGRETOL), TRAMADOL and CARBAMAZEPINE from 01-Sep-2019 to an unknown date for Trigeminal neuralgia. On 01-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Jul-2021, the patient experienced TRIGEMINAL NEURALGIA (Trigeminal neuralgia flare up). On 19-Jul-2021, the patient experienced ELECTRIC SHOCK SENSATION (Electrical shocks on the right side of her face) and TRIGEMINAL NEURALGIA (Trigeminal neuralgia became bilateral). On 05-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (She was one week past the second dose due date). On 08-Jul-2021, TRIGEMINAL NEURALGIA (Trigeminal neuralgia flare up) had resolved. At the time of the report, PRODUCT DOSE OMISSION ISSUE (She was one week past the second dose due date) had resolved, ELECTRIC SHOCK SENSATION (Electrical shocks on the right side of her face) outcome was unknown and TRIGEMINAL NEURALGIA (Trigeminal neuralgia became bilateral) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Pain assessment: 10/10 (High) 10/10. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication reported also include cold medicine occasionally for the trigeminal neuralgia. The patient consulted a new neurologist and was about to start new medications. This case was linked to MOD-2021-319322 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 13-Sep-2021: Patient details, Medical history, Lab data, Concomitant medication and Event updated

Other Meds: TEGRETOL; TRAMADOL; CARBAMAZEPINE

Current Illness: Chronic kidney disease (Stage 3b); Trigeminal neuralgia (Left side)

ID: 1721534
Sex: F
Age: 66
State: PA

Vax Date: 02/16/2021
Onset Date: 02/18/2021
Rec V Date: 09/22/2021
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: Left arm was just aching fierce/ badly aching left arm/sharp pain in various parts of arm; Swelling travelled down her arm and to her hand; She was so groggy, she just stayed in bed and tried to get comfortable; discomfort in arm; Side effect of vaccine; Heaviness in arm; wrist stiffness; swelling at back of my hand; began to loose strenth in my hands; Sharp stabbing pain in her wrist,; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Left arm was just aching fierce/ badly aching left arm/sharp pain in various parts of arm), PERIPHERAL SWELLING (Swelling travelled down her arm and to her hand), SOMNOLENCE (She was so groggy, she just stayed in bed and tried to get comfortable), DISCOMFORT (discomfort in arm) and VACCINATION COMPLICATION (Side effect of vaccine) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 028L20A and 010H21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Penicillin allergy, Sulfonamide allergy, Allergy to antibiotic (Chloromycetin) and Drug allergy (morphine). Concomitant products included ASCORBIC ACID, BETACAROTENE, CUPRIC OXIDE, TOCOPHERYL ACETATE, ZINC OXIDE (PRESERVISION) for Eye abnormality NOS, CALCIUM for an unknown indication. On 16-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 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 18-Feb-2021 at 3:30 AM, the patient experienced PAIN IN EXTREMITY (Left arm was just aching fierce/ badly aching left arm/sharp pain in various parts of arm), PERIPHERAL SWELLING (Swelling travelled down her arm and to her hand), SOMNOLENCE (She was so groggy, she just stayed in bed and tried to get comfortable), DISCOMFORT (discomfort in arm), VACCINATION COMPLICATION (Side effect of vaccine), LIMB DISCOMFORT (Heaviness in arm), MUSCULOSKELETAL STIFFNESS (wrist stiffness), PERIPHERAL SWELLING (swelling at back of my hand), ASTHENIA (began to loose strenth in my hands) and ARTHRALGIA (Sharp stabbing pain in her wrist,). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) ongoing since an unknown date at an unspecified dose and frequency; PREDNISONE (oral) from 01-Aug-2021 to 06-Aug-2021 for Adverse event, at a dose of UNK, bid and FUROSEMIDE (LASIX FAIBLE) (oral) from 06-Aug-2021 to 13-Aug-2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Left arm was just aching fierce/ badly aching left arm/sharp pain in various parts of arm), PERIPHERAL SWELLING (Swelling travelled down her arm and to her hand), SOMNOLENCE (She was so groggy, she just stayed in bed and tried to get comfortable), DISCOMFORT (discomfort in arm), VACCINATION COMPLICATION (Side effect of vaccine), LIMB DISCOMFORT (Heaviness in arm), MUSCULOSKELETAL STIFFNESS (wrist stiffness), PERIPHERAL SWELLING (swelling at back of my hand), ASTHENIA (began to loose strenth in my hands) and ARTHRALGIA (Sharp stabbing pain in her wrist,) had not resolved. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) dosing remained unchanged. Concomitant product includes oral women's multi vitamin 2 per day for general health and oral mega red 1 per day for eye health. Patient was a redhead. This case was linked to MOD-2021-278684 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 13-Sep-2021: followup includes concomitant medications and medical history

Other Meds: PRESERVISION; CALCIUM

Current Illness: Allergy to antibiotic (Chloromycetin); Drug allergy (morphine); Penicillin allergy; Sulfonamide allergy

ID: 1721535
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: My husband got the vaccine and within 2 weeks he had lost 18 pounds, All of the weight was muscle and no fat.; His arms and legs lost almost all muscle tone; He was also completely exhausted; This spontaneous case was reported by a consumer and describes the occurrence of WEIGHT DECREASED (My husband got the vaccine and within 2 weeks he had lost 18 pounds, All of the weight was muscle and no fat.), HYPOTONIA (His arms and legs lost almost all muscle tone) and FATIGUE (He was also completely exhausted) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided. 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 WEIGHT DECREASED (My husband got the vaccine and within 2 weeks he had lost 18 pounds, All of the weight was muscle and no fat.), HYPOTONIA (His arms and legs lost almost all muscle tone) and FATIGUE (He was also completely exhausted). At the time of the report, WEIGHT DECREASED (My husband got the vaccine and within 2 weeks he had lost 18 pounds, All of the weight was muscle and no fat.) and HYPOTONIA (His arms and legs lost almost all muscle tone) outcome was unknown and FATIGUE (He was also completely exhausted) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided. No treatment medication was provided. Reporter said that her husband lost 18 pounds within 2 weeks of getting the vaccine. Reporter said that her husband was tested for every kind of cancer and disease and everything came back negative. Most recent FOLLOW-UP information incorporated above includes: On 27-Aug-2021: Non-Significant Follow-up On 14-Sep-2021: Follow-up received with NNI

Other Meds:

Current Illness:

ID: 1721536
Sex: M
Age:
State: MD

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Test Date: 2021; Test Name: Troponin; Result Unstructured Data: elevated

Allergies:

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

Symptoms: myocarditis; This literature-study case was reported in a literature article and describes the occurrence of MYOCARDITIS (myocarditis) in an adult male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In 2021, the patient experienced MYOCARDITIS (myocarditis) (seriousness criterion medically significant). At the time of the report, MYOCARDITIS (myocarditis) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Troponin: elevated (High) elevated. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered MYOCARDITIS (myocarditis) to be possibly related. No concomitant medication was reported. Patient received supportive care. Reportedly patient visited hospital for chest pain. Symptoms begun few days after receiving the product. Patient presented with acute onset of marked chest pain Infectious, ischemic, or autoimmune etiologies was not identified for myocarditis. Patient was physically fit by military standards and lacking any known history of cardiac disease, significant cardiac risk factors, or exposure to cardiotoxic agents. No structural abnormalities were noted on echocardiogram. Company Comment: This is a literature report of myocarditis in an adult male. Based on the current available information and temporal association between the use of the product, and the start date of the event, a causal relationship cannot be excluded. Further information has been requested to the author. Author conclusion: the clinical course suggests eosinophilic hypersensitivity myocarditis as described in the context of other drug-associated and vaccine-associated myocarditis. This case was linked to MOD-2021-284001, MOD-2021-284002, MOD-2021-284003, MOD-2021-284004, MOD-2021-284005, MOD-2021-284006, MOD-2021-284007, MOD-2021-284008, MOD-2021-284009, MOD-2021-284010, MOD-2021-284011, MOD-2021-284012, MOD-2021-245527, MOD-2021-284014, MOD-2021-284015, MOD-2021-284013, MOD-2021-284013 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 02-Jul-2021: Upon internal review on 08-Sep-2021 it was found that Incorrect reports were generated for a regulatory authority so Incorrect E2B Company Number was removed. Hence new reports generated with correct E2B Number. On 05-Jul-2021: Follow up received by safety 07-Jul-2021 included a report type updated to literature-study based on the initial additional document received. On 07-Jul-2021: Follow up received by safety 08-Jul-2021 included a full text article added with no new information.; Sender's Comments: This is a literature report of myocarditis in an adult male. Based on the current available information and temporal association between the use of the product, and the start date of the event, a causal relationship cannot be excluded. Further information has been requested to the author.

Other Meds:

Current Illness:

ID: 1721537
Sex: M
Age:
State: MD

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Test Date: 2021; Test Name: cardiac troponin levels; Result Unstructured Data: significantly elevated

Allergies:

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

Symptoms: myocarditis; This literature-study case was reported in a literature article and describes the occurrence of MYOCARDITIS (myocarditis) in an adult male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. LITERATURE REFERENCE: No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In 2021, the patient experienced MYOCARDITIS (myocarditis) (seriousness criterion medically significant). At the time of the report, MYOCARDITIS (myocarditis) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Troponin: high (High) significantly elevated. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered MYOCARDITIS (myocarditis) to be possibly related. No concomitant medication was reported. Patient received supportive care. Patient presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. Infectious, ischemic, or autoimmune etiologies was not identified for myocarditis. Patient was physically fit and lacking any known history of cardiac disease, significant cardiac risk factors, or exposure to cardiotoxic agents. No structural abnormalities were noted on echocardiograms. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. Company Comment: Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. Author conclusion: the clinical course suggests eosinophilic hypersensitivity myocarditis as described in the context of other drug-associated and vaccine-associated myocarditis. This case was linked to MOD-2021-284001, MOD-2021-284002, MOD-2021-284003, MOD-2021-284004, MOD-2021-284005, MOD-2021-284006, MOD-2021-284007, MOD-2021-284008, MOD-2021-284009, MOD-2021-284010, MOD-2021-284011, MOD-2021-284012, MOD-2021-284013, MOD-2021-284014, MOD-2021-245527 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 02-Jul-2021: Upon internal review on 08-Sep-2021 E2B Company Number was updated from US-MODERNATX, INC.-MOD-2021-245527 to US-MODERNATX, INC.- MOD-2021-284015 On 05-Jul-2021: Follow up received by safety 07-Jul-2021 included a report type updated to literature-study based on the initial additional document received. On 07-Jul-2021: Follow up received by safety 08-Jul-2021 included a full text article added with no new information.; Sender's Comments: Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1721538
Sex: M
Age: 38
State: DC

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/22/2021
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: Sick all weekend; Chills on the body; A little fever; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Sick all weekend), CHILLS (Chills on the body) and PYREXIA (A little fever) in a 38-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040C21A) 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) (unknown route) 1 dosage form. On 27-Aug-2021, the patient experienced ILLNESS (Sick all weekend), CHILLS (Chills on the body) and PYREXIA (A little fever). At the time of the report, ILLNESS (Sick all weekend), CHILLS (Chills on the body) and PYREXIA (A little fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided.

Other Meds:

Current Illness:

ID: 1721539
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (diarrhea) 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 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 DIARRHOEA (diarrhea). At the time of the report, DIARRHOEA (diarrhea) outcome was unknown. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1721540
Sex: M
Age: 81
State: MA

Vax Date: 02/07/2021
Onset Date: 03/01/2021
Rec V Date: 09/22/2021
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: He could not sleep/Keeps me awake at night; sweating; very tiny bumps that are almost invisible are just as itchy; very tiny bumps that are almost invisible are just as itchy / but itchiness is still there/ little freckle just as itchy; ER doctor said I had chicken pox/ It is on to my abdomen, arms, legs and feet.; horrendous rash/very tiny bumps that are almost invisible/raised all over his abdomen and legs; welts; Rash Bleeding; rash itched constantly/ just as itchy; This spontaneous case was reported by a consumer and describes the occurrence of RASH PAPULAR (horrendous rash/very tiny bumps that are almost invisible/raised all over his abdomen and legs), URTICARIA (welts), PURPURA (Rash Bleeding), RASH PRURITIC (rash itched constantly/ just as itchy) and INSOMNIA (He could not sleep/Keeps me awake at night) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036A21A and 030M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Heart block sinoatrial. On 07-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In March 2021, the patient experienced RASH PAPULAR (horrendous rash/very tiny bumps that are almost invisible/raised all over his abdomen and legs), URTICARIA (welts), PURPURA (Rash Bleeding) and RASH PRURITIC (rash itched constantly/ just as itchy). On an unknown date, the patient experienced INSOMNIA (He could not sleep/Keeps me awake at night), HYPERHIDROSIS (sweating), SKIN MASS (very tiny bumps that are almost invisible are just as itchy), PRURITUS (very tiny bumps that are almost invisible are just as itchy / but itchiness is still there/ little freckle just as itchy) and VARICELLA (ER doctor said I had chicken pox/ It is on to my abdomen, arms, legs and feet.). At the time of the report, RASH PAPULAR (horrendous rash/very tiny bumps that are almost invisible/raised all over his abdomen and legs), URTICARIA (welts), PURPURA (Rash Bleeding), RASH PRURITIC (rash itched constantly/ just as itchy), INSOMNIA (He could not sleep/Keeps me awake at night), HYPERHIDROSIS (sweating), SKIN MASS (very tiny bumps that are almost invisible are just as itchy) and VARICELLA (ER doctor said I had chicken pox/ It is on to my abdomen, arms, legs and feet.) outcome was unknown and PRURITUS (very tiny bumps that are almost invisible are just as itchy / but itchiness is still there/ little freckle just as itchy) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not reported It was stated that the patient took many medications related to his replaced aortic heart valve. Patient occasionally had elevated heart rate due to his heart condition. Dermatologist confirmed it was not chicken pox and was given a prescription cream. Patient had been to the hospital clinic 7 times for the rash. Patient was told to use off the shelf moisturizer and take cool showers. Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Follow up received information included Updated events.

Other Meds:

Current Illness:

ID: 1721541
Sex: U
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: Got Pfizer and Moderna; 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 INTERCHANGE OF VACCINE PRODUCTS (Got Pfizer and Moderna) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form and first dose of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On an unknown date, received second dose of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Got Pfizer and Moderna). At the time of the report, INTERCHANGE OF VACCINE PRODUCTS (Got Pfizer and Moderna) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant drugs were reported. No Treatment information were reported.

Other Meds:

Current Illness:

ID: 1721542
Sex: M
Age: 53
State: WA

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 09/22/2021
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: patient experienced a severe headache at 11:30 that was over 10 times hundred in pain level (patient mentioned 20 out of 10)/pulsating headache on the left side of cranium, about 2 inches of the left eye, with 0.5 out of 10 pain level.; This is not normal; Severe headache; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (This is not normal), HEADACHE (Severe headache) and HEADACHE (patient experienced a severe headache at 11:30 that was over 10 times hundred in pain level (patient mentioned 20 out of 10)/pulsating headache on the left side of cranium, about 2 inches of the left eye, with 0.5 out of 10 pain level.) in a 54-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 041B21A and 044A21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Mar-2021, the patient experienced FEELING ABNORMAL (This is not normal) and HEADACHE (Severe headache). On 04-Sep-2021, the patient experienced HEADACHE (patient experienced a severe headache at 11:30 that was over 10 times hundred in pain level (patient mentioned 20 out of 10)/pulsating headache on the left side of cranium, about 2 inches of the left eye, with 0.5 out of 10 pain level.). At the time of the report, FEELING ABNORMAL (This is not normal) outcome was unknown, HEADACHE (Severe headache) had resolved and HEADACHE (patient experienced a severe headache at 11:30 that was over 10 times hundred in pain level (patient mentioned 20 out of 10)/pulsating headache on the left side of cranium, about 2 inches of the left eye, with 0.5 out of 10 pain level.) had not resolved. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Patient experienced severe headache started on the second vaccination, and lasted for more than 5 weeks. Severe headaches from 1 in the morning to 6 in the morning, everyday. Patient said that it was not normal. On 04 Sep 2021, patient experienced a severe headache at 11:30 that was over 10 times hundred in pain level (patient mentioned 20 out of 10). Patient had to put pressure with his hand on the left side the cranium. Patient said that he went through hell and back on Saturday. His girlfriend was ready to call the paramedics, that was how bad it was. Patient said that he never had this in his life. As of now, patient had pulsating headache on the left side of my cranium, about 2 inches of the left eye, with 0.5 / 10 pain level. This case was linked to MOD-2021-310582 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Follow up contains no new information.

Other Meds:

Current Illness:

ID: 1721543
Sex: M
Age: 67
State: ND

Vax Date: 04/08/2021
Onset Date:
Rec V Date: 09/22/2021
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: pain; lmited strength in right arm; right arm injection site pain which has continued to point of sore arm/right arm pain of injection site began immediately and is still ongoing.; sore arm limited strength in right arm,; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (pain), ASTHENIA (lmited strength in right arm), VACCINATION SITE PAIN (right arm injection site pain which has continued to point of sore arm/right arm pain of injection site began immediately and is still ongoing.) and MYALGIA (sore arm limited strength in right arm,) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026B21A and 012A21A) for COVID-19 vaccination. Concomitant products included METFORMIN, SIMVASTATIN and GLIPIZIDE for an unknown indication. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-May-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 PAIN (pain), ASTHENIA (lmited strength in right arm), VACCINATION SITE PAIN (right arm injection site pain which has continued to point of sore arm/right arm pain of injection site began immediately and is still ongoing.) and MYALGIA (sore arm limited strength in right arm,). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at an unspecified dose and frequency and NAPROXEN SODIUM (ALEVE) for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN (pain), ASTHENIA (lmited strength in right arm) and MYALGIA (sore arm limited strength in right arm,) outcome was unknown and VACCINATION SITE PAIN (right arm injection site pain which has continued to point of sore arm/right arm pain of injection site began immediately and is still ongoing.) had not resolved. Treatment medication included oils for injection site. It was reported that patient is very active and still working. This case was linked to MOD-2021-311219 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 14-Sep-2021: Significant FU received on 14-SEP-2021,contain Reporter Address,Patient Height,Weight,Race and AE Outcome. On 14-Sep-2021: Contains NNI

Other Meds: METFORMIN; SIMVASTATIN; GLIPIZIDE

Current Illness:

ID: 1721544
Sex: F
Age:
State: VA

Vax Date: 02/13/2021
Onset Date: 09/03/2021
Rec V Date: 09/22/2021
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: Second dose after more than 35 days; same rash came back; Slept all day; Lethargic; This spontaneous case was reported by a consumer and describes the occurrence of receiving second dose after more than 35 days, Slept all day, Lethargic, and RASH in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052E21A and 011M20A) for COVID-19 vaccination. No Medical History information was reported. On 13-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Sep-2021, the patient experienced SOMNOLENCE and Lethargic. On 04-Sep-2021, the patient experienced RASH. On an unknown date, the patient experienced receiving second dose after more than 35 days. On 03-Sep-2021, SOMNOLENCE and Lethargic had resolved. At the time of the report, second dose after more than 35 days and RASH had resolved. Patient stated that she also felt wiped out. No Concomitant and Treatment medication were reported. This case was linked to MOD-2021-310797 (Patient Link).

Other Meds:

Current Illness:

ID: 1721545
Sex: M
Age: 67
State: OR

Vax Date: 02/02/2021
Onset Date: 09/01/2021
Rec V Date: 09/22/2021
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: 20210903; Test Name: Heart Rate; Result Unstructured Data: 135 beats per minute.

Allergies:

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

Symptoms: did not feel well; This spontaneous case was reported by a consumer and describes the occurrence of did not feel well in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 029A21A, 010M20A and 0062G21A) for COVID-19 vaccination. No medical history information was provided. Concomitant products included ADENOSINE, METOPROLOL and ELIQUIS for an unknown indication. On 02-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Sep-2021, the patient experienced did not feel well. At the time of the report, did not feel well outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Sep-2021, Heart rate: 135 beats per minute (High). Treatment information was not provided. This case was linked to MOD-2021-311007, MOD-2021-311047 (Patient Link). Most recent FOLLOW-UP information incorporated above includes On 13-Sep-2021 Significant Follow up, Concomitants were added.

Other Meds: ADENOSINE; METOPROLOL; ELIQUIS

Current Illness:

ID: 1721546
Sex: M
Age: 49
State: NV

Vax Date: 04/29/2021
Onset Date:
Rec V Date: 09/22/2021
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: Beyond 35 days for 2nd dose; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Beyond 35 days for 2nd dose) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 043B21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Apr-2021, the patient 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 received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Beyond 35 days for 2nd dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Beyond 35 days for 2nd dose) had resolved. It was also reported that the patient has taken the second dose and had no issues Concomitant medication information was not provided. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 13-Sep-2021: Follow up received contained: Updated second dose; No AE experienced - Confirmation;

Other Meds:

Current Illness:

ID: 1721547
Sex: U
Age:
State:

Vax Date: 04/26/2021
Onset Date: 04/30/2021
Rec V Date: 09/22/2021
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: Chronic head pain/ my head had been hurting since April 30th; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (Chronic head pain/ my head had been hurting since April 30th) 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 26-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 30-Apr-2021, the patient experienced HEADACHE (Chronic head pain/ my head had been hurting since April 30th). At the time of the report, HEADACHE (Chronic head pain/ my head had been hurting since April 30th) outcome was unknown. No Concomitant medication information was reported. No treatment medications were provided. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1721548
Sex: F
Age:
State:

Vax Date:
Onset Date: 09/07/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Test Date: 20210904; Test Name: SARS-CoV-2 test; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210907; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive

Allergies:

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

Symptoms: Tested positive for COVID; Cough; Nasal congestion; Loss of taste; Loss of smell; Chills; Muscle ache; Headache; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Tested positive for COVID), COUGH (Cough), NASAL CONGESTION (Nasal congestion), AGEUSIA (Loss of taste) and ANOSMIA (Loss of smell) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Sep-2021, the patient experienced COVID-19 (Tested positive for COVID), COUGH (Cough), NASAL CONGESTION (Nasal congestion), AGEUSIA (Loss of taste), ANOSMIA (Loss of smell), CHILLS (Chills), MYALGIA (Muscle ache) and HEADACHE (Headache). The patient was treated with IBUPROFEN ongoing from 07-Sep-2021 for SARS-CoV-2 infection, at an unspecified dose and frequency. At the time of the report, COVID-19 (Tested positive for COVID), COUGH (Cough), NASAL CONGESTION (Nasal congestion), ANOSMIA (Loss of smell), CHILLS (Chills) and HEADACHE (Headache) had not resolved and AGEUSIA (Loss of taste) and MYALGIA (Muscle ache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 04-Sep-2021, SARS-CoV-2 test: negative (Negative) Negative. On 07-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications reported Treatment medications for SARS-CoV-2 infection included:Musinex All in One Cold/Flu-20 ML: Mornings from 08-SEP-2021 to till date. Musinex Nightshift Cold/Flu-20 ML: Evenings from 08-SEP-2021 to till date. Goodie Powder from 07-SEP-2021 to till date. Nose spray 2 times a day from 08-SEP-2021 to till date Most recent FOLLOW-UP information incorporated above includes: On 12-Sep-2021: Follow up received and it contains no new information On 12-Sep-2021: Follow up received: Patient initials, gender, age, events event outcome and treatment medications added.

Other Meds:

Current Illness:

ID: 1721549
Sex: U
Age:
State:

Vax Date: 07/28/2021
Onset Date:
Rec V Date: 09/22/2021
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: if i had my 1st dose on 7/28/21 can I still get my second dose within the next few days; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (if i had my 1st dose on 7/28/21 can I still get my second dose within the next few 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 28-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (if i had my 1st dose on 7/28/21 can I still get my second dose within the next few days). At the time of the report, PRODUCT DOSE OMISSION ISSUE (if i had my 1st dose on 7/28/21 can I still get my second dose within the next few days) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant drugs were reported. No Treatment information were reported.

Other Meds:

Current Illness:

ID: 1721550
Sex: M
Age: 70
State: OH

Vax Date: 01/07/2021
Onset Date: 02/15/2021
Rec V Date: 09/22/2021
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: Numbness in both feet, bilateral paresthesia in feet; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (Numbness in both feet, bilateral paresthesia in feet) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013M2A and 039K20-2A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension, Hypercholesterolemia, GERD, BPH and Erectile dysfunction. Concomitant products included TAMSULOSIN HYDROCHLORIDE (TAMSULOSIN [TAMSULOSIN HYDROCHLORIDE]) for BPH, TADALAFIL for Erectile dysfunction, OMEPRAZOLE for GERD, BISOPROLOL FUMARATE, HYDROCHLOROTHIAZIDE (BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE) for Hypertension, FLUTICASONE PROPIONATE for Sinus congestion, ATORVASTATIN and COLECALCIFEROL (VITAMIN D3) for an unknown indication. On 07-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Feb-2021, the patient experienced HYPOAESTHESIA (Numbness in both feet, bilateral paresthesia in feet). At the time of the report, HYPOAESTHESIA (Numbness in both feet, bilateral paresthesia in feet) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. After the first vaccine in January, then five weeks later, the patient had numbness in both feet. Patient had underwent several lab tests- X-rays, bloodwork and all sorts of test run and still was not able to explain why the both feet were numb. The both feet were numb and he had an electromyograph done, very symetric, the numbness developed after the second vaccine, this was a fast gradual onset. No treatment information was provided. Medical history also include unspecified prostate. Lab test done: EMG- June 14 2021 Heavy Metal Scan- May 19,2021 HGB A1C- May 19,2021 Immunofixation Screen- May 19 2021 Vitamin B12- April 2021 TSH BLD- April 15 2021 T4 Free/ Free Thyrox- April 15 2021 T# BLD- April 2021 XR Sacrum/Coccyx 3V AP/LAT- April 15 2021 XR Lumbar General 3V AP/LAT/L5-S1- April 15 2021 Most recent FOLLOW-UP information incorporated above includes: On 14-Sep-2021: Patient details, Medical history, Concomitant medication, Event start date and Outcome updated.

Other Meds: TAMSULOSIN [TAMSULOSIN HYDROCHLORIDE]; BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE; ATORVASTATIN; OMEPRAZOLE; VITAMIN D3; FLUTICASONE PROPIONATE; TADALAFIL

Current Illness: BPH; Erectile dysfunction; GERD; Hypercholesterolemia; Hypertension

ID: 1721551
Sex: F
Age: 76
State: MO

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 09/22/2021
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: Changed my whole attitude, making me mean; Sore left arm at injection site; This spontaneous case was reported by a consumer and describes the occurrence of MOOD ALTERED (Changed my whole attitude, making me mean) and MYALGIA (Sore left arm at injection site) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011A21A) for COVID-19 vaccination. The patient's past medical history included Shingles. Concurrent medical conditions included Sleeplessness (inability to sleep on her left side because of dizziness after shingles diagnosis) and Osteopenia. Concomitant products included APOAEQUORIN (PREVAGEN [APOAEQUORIN]) and CHONDROITIN SULFATE, GLUCOSAMINE HYDROCHLORIDE (OSTEO BI-FLEX [CHONDROITIN SULFATE;GLUCOSAMINE HYDROCHLORIDE]) for an unknown indication. On 28-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Feb-2021, the patient experienced MYALGIA (Sore left arm at injection site). On an unknown date, the patient experienced MOOD ALTERED (Changed my whole attitude, making me mean). At the time of the report, MOOD ALTERED (Changed my whole attitude, making me mean) and MYALGIA (Sore left arm at injection site) 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. Treatment information was not provided. This case was linked to MOD-2021-312939. Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: Follow up received on 08-sep-2021. includes new event as vaccine series ulter whole attitude, Patient age, Medical history.

Other Meds: PREVAGEN [APOAEQUORIN]; OSTEO BI-FLEX [CHONDROITIN SULFATE;GLUCOSAMINE HYDROCHLORIDE]

Current Illness: Osteopenia; Sleeplessness (inability to sleep on her left side because of dizziness after shingles diagnosis)

ID: 1721552
Sex: M
Age:
State:

Vax Date: 09/07/2021
Onset Date:
Rec V Date: 09/22/2021
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: Painful arm; Headache/head feels like it's about to explode; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Painful arm) and HEADACHE (Headache/head feels like it's about to explode) 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 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (Painful arm) and HEADACHE (Headache/head feels like it's about to explode). At the time of the report, PAIN IN EXTREMITY (Painful arm) and HEADACHE (Headache/head feels like it's about to explode) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications reported. No treatment information was reported by reporter. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1721553
Sex: F
Age:
State:

Vax Date: 08/05/2021
Onset Date: 09/04/2021
Rec V Date: 09/22/2021
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: feeling miserable; aches; nausea; dizziness; chills; fever; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (feeling miserable), MYALGIA (aches), NAUSEA (nausea), DIZZINESS (dizziness) and CHILLS (chills) in an 87-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017E21A and 939893) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 05-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-Sep-2021, the patient experienced CHILLS (chills) and PYREXIA (fever). On an unknown date, the patient experienced FEELING ABNORMAL (feeling miserable), MYALGIA (aches), NAUSEA (nausea) and DIZZINESS (dizziness). At the time of the report, FEELING ABNORMAL (feeling miserable), MYALGIA (aches), NAUSEA (nausea), DIZZINESS (dizziness), CHILLS (chills) and PYREXIA (fever) outcome was unknown. Not Provided No concomitant medications was reported. No treatment information was provided. This case was linked to MOD-2021-313344 (Patient Link).

Other Meds:

Current Illness:

ID: 1721554
Sex: F
Age: 73
State: IL

Vax Date: 03/02/2021
Onset Date:
Rec V Date: 09/22/2021
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: Test Name: body temperature; Result Unstructured Data: low grade fever.

Allergies:

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

Symptoms: injection site had turned red with the other 2 doses.; low grade fever after second dose; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE ERYTHEMA and PYREXIA in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031LZ0A) for COVID-19 vaccination. Concurrent medical conditions included Cancer (She's in reminiscent for 10 years for a cancer.). Concomitant products included TIMOLOL for Glaucoma, ATORVASTATIN, ZOLPIDEM, and LATANOPROST for an unknown indication. On 02-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 VACCINATION SITE ERYTHEMA and PYREXIA. At the time of the report, VACCINATION SITE ERYTHEMA outcome was unknown and PYREXIA had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: low grade fever (High). The concomitant drug Denlafaxine is used as substitute drug. Treatment information was not provided. This case was linked to MOD-2021-313629, MOD-2021-313718, MOD-2021-312651 (Patient Link).

Other Meds: ATORVASTATIN; ZOLPIDEM; TIMOLOL; LATANOPROST

Current Illness:

ID: 1721555
Sex: M
Age: 58
State: NJ

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 09/22/2021
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: soreness in left arm; tiredness, fatigue; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (soreness in left arm) and FATIGUE (tiredness, fatigue) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047A21A) for COVID-19 vaccination. No Medical History was reported. Concomitant products included METOPROLOL for Blood pressure high, ROSUVASTATIN for Cholesterol, METFORMIN for Diabetes, LISINOPRIL and ACETYLSALICYLIC ACID (ASPIRIN LOW) for an unknown indication. On 22-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Mar-2021, the patient experienced VACCINATION SITE PAIN (soreness in left arm) and FATIGUE (tiredness, fatigue). The patient was treated with IBUPROFEN for Adverse event, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE PAIN (soreness in left arm) and FATIGUE (tiredness, fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication included Low Dose Aspirin This case was linked to MOD-2021-313941 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up received and contains NNI

Other Meds: METOPROLOL; LISINOPRIL; ROSUVASTATIN; METFORMIN; ASPIRIN LOW

Current Illness:

ID: 1721556
Sex: F
Age:
State:

Vax Date: 09/03/2021
Onset Date: 09/06/2021
Rec V Date: 09/22/2021
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: pain in lower right quadrant of the abdomen/Pain persist and comes and goes / sever and last for long period of time/pain scale she ranks it an 7 and sometimes 8 out of 10; This spontaneous case was reported by a physician and describes the occurrence of ABDOMINAL PAIN LOWER (pain in lower right quadrant of the abdomen/Pain persist and comes and goes / sever and last for long period of time/pain scale she ranks it an 7 and sometimes 8 out of 10) in a 20-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 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced ABDOMINAL PAIN LOWER (pain in lower right quadrant of the abdomen/Pain persist and comes and goes / sever and last for long period of time/pain scale she ranks it an 7 and sometimes 8 out of 10). At the time of the report, ABDOMINAL PAIN LOWER (pain in lower right quadrant of the abdomen/Pain persist and comes and goes / sever and last for long period of time/pain scale she ranks it an 7 and sometimes 8 out of 10) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. lab data included Appendicitis and tested for pregnancy, other gynecological conditions and UTI with unknown results. No concomitant medications reported. No treatment reported

Other Meds:

Current Illness:

ID: 1721557
Sex: U
Age:
State: NJ

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/22/2021
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: administered expired doses; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered expired doses) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032M20A) for COVID-19 vaccination. No Medical History information was reported. On 07-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered expired doses). On 07-Sep-2021, EXPIRED PRODUCT ADMINISTERED (administered expired doses) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not provided by reporter. Treatment information was not provided by reporter. This case was linked to MOD-2021-314573, MOD-2021-314570. Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Start date of drug, event and batch number were updated. On 15-Sep-2021: Possible NNI.

Other Meds:

Current Illness:

ID: 1721558
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: Small muscle twitching; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE TWITCHING (Small muscle twitching) 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 MUSCLE TWITCHING (Small muscle twitching). At the time of the report, MUSCLE TWITCHING (Small muscle twitching) 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 reported.

Other Meds:

Current Illness:

ID: 1721559
Sex: F
Age: 70
State: MT

Vax Date: 02/19/2021
Onset Date:
Rec V Date: 09/22/2021
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: arm hurts, first time hurts more; felt poor, not good; weak; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (arm hurts, first time hurts more), FEELING ABNORMAL (felt poor, not good) and ASTHENIA (weak) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031M20A) for COVID-19 vaccination. No Medical History information was reported. On 19-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 PAIN IN EXTREMITY (arm hurts, first time hurts more), FEELING ABNORMAL (felt poor, not good) and ASTHENIA (weak). At the time of the report, PAIN IN EXTREMITY (arm hurts, first time hurts more), FEELING ABNORMAL (felt poor, not good) and ASTHENIA (weak) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication was not reported. Treatment information was not reported. This case was linked to MOD-2021-314593 (Patient Link).

Other Meds:

Current Illness:

ID: 1721560
Sex: F
Age: 53
State: LA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/22/2021
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: flu-like symptoms; was hurting; she had a fever of 101F; she had nausea; throwing up; This spontaneous case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (flu-like symptoms), PAIN (was hurting), PYREXIA (she had a fever of 101F), NAUSEA (she had nausea) and VOMITING (throwing up) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Aug-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu-like symptoms), PAIN (was hurting), PYREXIA (she had a fever of 101F), NAUSEA (she had nausea) and VOMITING (throwing up). At the time of the report, INFLUENZA LIKE ILLNESS (flu-like symptoms), PAIN (was hurting), PYREXIA (she had a fever of 101F), NAUSEA (she had nausea) and VOMITING (throwing up) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient reported that she is on many concomitant medications but does not remember any names. No treatment medications were reported. This case was linked to MOD-2021-314587 (Patient Link).

Other Meds:

Current Illness:

ID: 1721561
Sex: M
Age: 55
State: AZ

Vax Date: 05/01/2021
Onset Date:
Rec V Date: 09/22/2021
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: Joint pain intensified, after 2nd dose; It intensifies after 2 dose; pain all day long. still hurts; got 2nd dose 40 days later; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (Joint pain intensified, after 2nd dose), CONDITION AGGRAVATED (It intensifies after 2 dose), PAIN (pain all day long. still hurts) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (got 2nd dose 40 days later) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided by the reporter. In May 2021, the patient 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 received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ARTHRALGIA (Joint pain intensified, after 2nd dose), CONDITION AGGRAVATED (It intensifies after 2 dose), PAIN (pain all day long. still hurts) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (got 2nd dose 40 days later). The patient was treated with IBUPROFEN for Adverse event, at an unspecified dose and frequency; NAPROXEN for Adverse event, at an unspecified dose and frequency and MARIJUANA for Adverse event, at an unspecified dose and frequency. At the time of the report, ARTHRALGIA (Joint pain intensified, after 2nd dose), CONDITION AGGRAVATED (It intensifies after 2 dose) and PAIN (pain all day long. still hurts) outcome was unknown and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (got 2nd dose 40 days later) had resolved. Concomitant medication included asthma inhaler (as needed). This case was linked to MOD-2021-229286 (Patient Link).

Other Meds:

Current Illness:

ID: 1721562
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: side effec; 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 effec) 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 VACCINATION COMPLICATION (side effec). At the time of the report, VACCINATION COMPLICATION (side effec) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.

Other Meds:

Current Illness:

ID: 1721563
Sex: F
Age: 50
State: FL

Vax Date: 05/06/2021
Onset Date:
Rec V Date: 09/22/2021
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: thought I was going to die; breathing hasn't subsided; chest pain; everything was coming up, could not hold nothing, nothing stays in my body; left arm redness/red circle was worse than after 2nd dose; left arm had swelling/arm got big and swollen; a lot of pain in left arm; baseball-size bump or ball under left arm, against breast; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (thought I was going to die), RESPIRATORY RATE INCREASED (breathing hasn't subsided), CHEST PAIN (chest pain), VOMITING (everything was coming up, could not hold nothing, nothing stays in my body) and VACCINATION SITE ERYTHEMA (left arm redness/red circle was worse than after 2nd dose) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 06-May-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced FEELING ABNORMAL (thought I was going to die), RESPIRATORY RATE INCREASED (breathing hasn't subsided), CHEST PAIN (chest pain), VOMITING (everything was coming up, could not hold nothing, nothing stays in my body), VACCINATION SITE ERYTHEMA (left arm redness/red circle was worse than after 2nd dose), VACCINATION SITE SWELLING (left arm had swelling/arm got big and swollen), VACCINATION SITE PAIN (a lot of pain in left arm) and LYMPHADENOPATHY (baseball-size bump or ball under left arm, against breast). At the time of the report, FEELING ABNORMAL (thought I was going to die), RESPIRATORY RATE INCREASED (breathing hasn't subsided), CHEST PAIN (chest pain), VOMITING (everything was coming up, could not hold nothing, nothing stays in my body), VACCINATION SITE ERYTHEMA (left arm redness/red circle was worse than after 2nd dose), VACCINATION SITE SWELLING (left arm had swelling/arm got big and swollen), VACCINATION SITE PAIN (a lot of pain in left arm) and LYMPHADENOPATHY (baseball-size bump or ball under left arm, against breast) outcome was unknown. .Concomitant product usage include steroids. Treatment medications was not reported. This case was linked to MOD-2021-314562, MOD-2021-314597 (Patient Link).

Other Meds:

Current Illness:

ID: 1721564
Sex: U
Age:
State: KS

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: expired vaccine that was punctured past 12 hours; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired vaccine that was punctured past 12 hours) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047B21A) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired vaccine that was punctured past 12 hours). At the time of the report, EXPIRED PRODUCT ADMINISTERED (expired vaccine that was punctured past 12 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment information were reported by the reporter

Other Meds:

Current Illness:

ID: 1721565
Sex: F
Age:
State:

Vax Date: 09/08/2021
Onset Date:
Rec V Date: 09/22/2021
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: feeling tired and lazy; Headache; aches all over; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (feeling tired and lazy), HEADACHE (Headache) and MYALGIA (aches all over) in an adult female patient 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced FATIGUE (feeling tired and lazy), HEADACHE (Headache) and MYALGIA (aches all over). At the time of the report, FATIGUE (feeling tired and lazy), HEADACHE (Headache) and MYALGIA (aches all over) 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. It was reported that the patient is in her 60's age.

Other Meds:

Current Illness:

ID: 1721566
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: Given the vaccination at a conroe location yesterday morning and i it started to build in size on my arm last night today it feels; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (Given the vaccination at a conroe location yesterday morning and i it started to build in size on my arm last night today it feels) 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 SITE SWELLING (Given the vaccination at a conroe location yesterday morning and i it started to build in size on my arm last night today it feels). At the time of the report, VACCINATION SITE SWELLING (Given the vaccination at a conroe location yesterday morning and i it started to build in size on my arm last night today it feels) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medication was reported. No treatment medications were reported

Other Meds:

Current Illness:

ID: 1721567
Sex: F
Age:
State: CA

Vax Date: 02/11/2021
Onset Date: 01/08/2021
Rec V Date: 09/22/2021
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: her pain became worse/more PHN pain/middle of my back to the area under my left breast/increased pain; her post-herpetic neuralgia pain became worse; This spontaneous case was reported by a consumer and describes the occurrence of POST HERPETIC NEURALGIA (her post-herpetic neuralgia pain became worse) and PAIN (her pain became worse/more PHN pain/middle of my back to the area under my left breast/increased pain) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012M20A and 025A21A) for COVID-19 vaccination. No specified medical history has been reported. Concurrent medical conditions included Osteoarthritis since 01-Jan-1986, Post herpetic neuralgia (increased pain) since 14-Apr-2017 and Food allergy (Avocado, banana, pineapple). Concomitant products included AMLODIPINE BESILATE (AMLODIL [AMLODIPINE BESILATE]) for Blood pressure, METOPROLOL SUCCINATE (TOPROL XL) for Blood pressure high, APIXABAN (ELIQUIS) from 02-Jan-2019 to an unknown date for Heartbeats skipped. On 11-Feb-2021 at 11:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Mar-2021 at 10:00 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 08-Jan-2021, the patient experienced POST HERPETIC NEURALGIA (her post-herpetic neuralgia pain became worse). On an unknown date, the patient experienced PAIN (her pain became worse/more PHN pain/middle of my back to the area under my left breast/increased pain). At the time of the report, POST HERPETIC NEURALGIA (her post-herpetic neuralgia pain became worse) and PAIN (her pain became worse/more PHN pain/middle of my back to the area under my left breast/increased pain) had not 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. Patient had experienced significantly more post-herpetic neuralgia pain, which was radiating from middle of the back to the area under left breast. Treatment medication was not provided. AREDs2 was used two per day Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up received contains additional Significant Follow up reporter details updated, patient detail updated,medical history updated,product detail updated,concomitant coded

Other Meds: ELIQUIS; AMLODIL [AMLODIPINE BESILATE]; TOPROL XL

Current Illness: Food allergy (Avocado, banana, pineapple); Osteoarthritis; Post herpetic neuralgia (increased pain)

ID: 1721568
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: Spinal Migraine; Leg weakness; 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 MIGRAINE (Spinal Migraine) and MUSCULAR WEAKNESS (Leg weakness) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MIGRAINE (Spinal Migraine) and MUSCULAR WEAKNESS (Leg weakness). At the time of the report, MIGRAINE (Spinal Migraine) and MUSCULAR WEAKNESS (Leg weakness) outcome was unknown. No concomitant medication reported. No treatment medication reported.

Other Meds:

Current Illness:

ID: 1721569
Sex: F
Age: 70
State: FL

Vax Date: 02/10/2021
Onset Date:
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: Temperature elevated

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: A bad welt on the arm; Could not eat; Was sleeping a lot; Rash all over the top of the arm; Extreme headaches; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (A bad welt on the arm), EATING DISORDER (Could not eat), SOMNOLENCE (Was sleeping a lot), RASH (Rash all over the top of the arm) and HEADACHE (Extreme headaches) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 044A21A and 015M20A) for COVID-19 vaccination. Concurrent medical conditions 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 10-Mar-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 URTICARIA (A bad welt on the arm), EATING DISORDER (Could not eat), SOMNOLENCE (Was sleeping a lot), RASH (Rash all over the top of the arm) and HEADACHE (Extreme headaches). At the time of the report, URTICARIA (A bad welt on the arm), EATING DISORDER (Could not eat), SOMNOLENCE (Was sleeping a lot), RASH (Rash all over the top of the arm) and HEADACHE (Extreme headaches) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: (High) Temperature elevated. Treatment details was not reported by the reporter. This case was linked to MOD-2021-314914 (Patient Link).

Other Meds: ATENOLOL

Current Illness: Tachycardia

ID: 1721570
Sex: F
Age:
State: NY

Vax Date: 01/13/2021
Onset Date: 02/10/2021
Rec V Date: 09/22/2021
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: Limited tiredness; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Limited tiredness) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013M20A and 012L20A) for COVID-19 vaccination. No Medical History information was reported. On 13-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 10-Feb-2021, the patient experienced FATIGUE (Limited tiredness). On 11-Feb-2021, FATIGUE (Limited tiredness) had resolved. No relevant concomitant medications were reported. No treatment information was provided This case was linked to MOD-2021-314586, MOD-2021-314933. Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Non-Significant follow up received. Added patient pregnancy status

Other Meds:

Current Illness:

ID: 1721571
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/22/2021
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: Test Name: Body temperature; Result Unstructured Data: fever of 104

Allergies:

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

Symptoms: fever of 104; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (fever of 104) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PYREXIA (fever of 104). At the time of the report, PYREXIA (fever of 104) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 104 (abnormal) fever of 104. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication provided. No treatment medication provided.

Other Meds:

Current Illness:

ID: 1721572
Sex: F
Age:
State: FL

Vax Date: 08/27/2021
Onset Date: 09/09/2021
Rec V Date: 09/22/2021
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: Not feeling good; Headache; Fever; Tested positive for COVID 19; This spontaneous case was reported by a consumer and describes the occurrence of SARS-COV-2 TEST POSITIVE (Tested positive for COVID 19), MALAISE (Not feeling good), HEADACHE (Headache) and PYREXIA (Fever) in a 20-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) 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 09-Sep-2021, the patient experienced SARS-COV-2 TEST POSITIVE (Tested positive for COVID 19). On an unknown date, the patient experienced MALAISE (Not feeling good), HEADACHE (Headache) and PYREXIA (Fever). At the time of the report, SARS-COV-2 TEST POSITIVE (Tested positive for COVID 19), MALAISE (Not feeling good), HEADACHE (Headache) and PYREXIA (Fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication was reported. No treatment medication was reported. Reporter did not allow further contact

Other Meds:

Current Illness:

ID: 1721573
Sex: M
Age: 54
State: TN

Vax Date: 09/07/2021
Onset Date: 09/01/2021
Rec V Date: 09/22/2021
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: 20210908; Test Name: Body temperature; Result Unstructured Data: 101.8

Allergies:

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

Symptoms: Felt really bad; had fever/Running a fever; Kinda tired; Headache; Chilling (chills); knees hurt (when he does not have knee pain normall); felt sick to stomach and still does; Congestion in throat; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL DISCOMFORT (felt sick to stomach and still does), THROAT TIGHTNESS (Congestion in throat), FEELING ABNORMAL (Felt really bad), ARTHRALGIA (knees hurt (when he does not have knee pain normall)) and PYREXIA (had fever/Running a fever) in a 54-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 07-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Sep-2021, the patient experienced FATIGUE (Kinda tired). On 08-Sep-2021, the patient experienced FEELING ABNORMAL (Felt really bad) and PYREXIA (had fever/Running a fever). In September 2021, the patient experienced ABDOMINAL DISCOMFORT (felt sick to stomach and still does), THROAT TIGHTNESS (Congestion in throat), ARTHRALGIA (knees hurt (when he does not have knee pain normall)), HEADACHE (Headache) and CHILLS (Chilling (chills)). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at a dose of 1 dosage form. At the time of the report, ABDOMINAL DISCOMFORT (felt sick to stomach and still does) had not resolved and THROAT TIGHTNESS (Congestion in throat), FEELING ABNORMAL (Felt really bad), ARTHRALGIA (knees hurt (when he does not have knee pain normall)), PYREXIA (had fever/Running a fever), FATIGUE (Kinda tired), HEADACHE (Headache) and CHILLS (Chilling (chills)) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Sep-2021, Body temperature: 101.8 (High) 101.8. 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 relevant concomitant medications were reported.

Other Meds:

Current Illness:

ID: 1721574
Sex: M
Age: 42
State: KY

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: Approximately 30 minutes after receiving the vaccine the following occurred: I began sweating profusely and coughing. I began coughing so hard, I could not catch my breath between coughs. I began feeling dizzy and light headed. This lasted for approximately 1 hour.

Other Meds: none

Current Illness: none

ID: 1721575
Sex: F
Age: 30
State: WA

Vax Date: 09/09/2021
Onset Date: 09/11/2021
Rec V Date: 09/22/2021
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: Codeine Morphine

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

Symptoms: I am on nexplanon and haven?t had a period in nearly 6 years, replaced 2x now. I maybe have light spotting if anything. Not even a full 48 hours after my vaccine I wake up to the heaviest most painful period of my life, with the hugest clots I have ever seen. Concerned me quite a bit, but heard from other that they had similar experiences after the first shot. When the period ended up lasting 9 days, ended today, that?s when I knew there was an issue. Prior to nexplanon, my periods would average 3-4 days and super light flow. I have never had an issue with heavy bleeding, cramping and clots. And before im told it?s because I haven?t had an actual period in so long, NO! I know my body and that WAS NOT normal! Not to mention, reading about and being told by numerous other females that experienced this EXACT symptom after their first vaccine, that tells me it is related! This needs to be listed as a potential side effect for females or something needs to be changed in this vaccine. That reaction CANNOT be normal, nor healthy.

Other Meds: Adderall XR 30mg once daily Nexplanon

Current Illness: N/a

ID: 1721576
Sex: M
Age: 36
State: CA

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Ecg - afib

Allergies:

Symptom List: Vomiting

Symptoms: Woke up the next morning with abnormal heart beat, pain in chest. Did an ecg using my apple watch and it said Afib. Went to er and doctor did ecg and confirmed Afib. Reset on its own 2 hours later while in the waiting room.

Other Meds: None

Current Illness: None

ID: 1721577
Sex: F
Age: 41
State:

Vax Date: 06/14/2021
Onset Date: 08/01/2021
Rec V Date: 09/22/2021
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: pollen Betula and Artemisia

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: had no allergy, which is very strong in August to pollen Artemisia.

Other Meds:

Current Illness:

ID: 1721578
Sex: F
Age: 59
State: PA

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/22/2021
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: Seasonal allergies. Food and other allergies unkown.

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

Symptoms: 9/4/21 Injection site painful all throughout arm. Had stomach pain, Nerve pain in some fingers. Left side pain and very Tired. 9/5/21 Woke up with severe muscular pain in my left shoulder going up the left side of my neck. This continued for 2 days and developed into a stiff neck on 9/7/21. The neck stiffness continued for over a week. 9/14/21 I experienced nerve pain in a tooth in my upper left jaw. 9/20/21 My upper lip broke out in a fever blister.

Other Meds: Melatonin, 5HTP for sleep the night after vaccination. Multivitamins

Current Illness: None

ID: 1721579
Sex: U
Age:
State:

Vax Date: 09/01/2021
Onset Date: 09/09/2021
Rec V Date: 09/22/2021
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: Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen; Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen; This spontaneous case was reported by a consumer and describes the occurrence of INJECTION SITE ERYTHEMA (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen) and INJECTION SITE SWELLING (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen) 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 01-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced INJECTION SITE ERYTHEMA (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen) and INJECTION SITE SWELLING (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen). At the time of the report, INJECTION SITE ERYTHEMA (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen) and INJECTION SITE SWELLING (Received my first dose on September 1. Now on September 9, the arm with the injection site is red and swollen) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were reported. No Treatment information was reported.

Other Meds:

Current Illness:

ID: 1721580
Sex: M
Age: 16
State:

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Patient was underage for vaccine requirements. No adverse reaction occurred. Patient was seen by a medical provider the day of and the following day. No adverse outcome noted.

Other Meds:

Current Illness: N/A

ID: 1721581
Sex: F
Age: 36
State: AK

Vax Date: 09/10/2021
Onset Date: 09/20/2021
Rec V Date: 09/22/2021
Hospital:

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

Lab Data: Na

Allergies: Sulfa bextra cipro Codiene carafate

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

Symptoms: Headaches started a little over one week post second shot. Not relieved with ibuprofen, Tylenol or water. Increased skin sensitivity again with intense itching at times causing open sores on face.

Other Meds: Birth control

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am