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: 1734308
Sex: F
Age:
State:

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
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: pruritus all over her body; This is a spontaneous report from a contactable consumer (patient). A 54-year-old female patient received bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, Batch/Lot number: Unknown), dose 1 via an unspecified route of administration on 24Feb2021 as dose 1, single for covid-19 immunization. The patient's medical history and concomitant medications were not reported. On Mar2021, patient experienced pruritus all over her body. The clinical course was reported as follows: The patient received the first dose of the Pfizer Covid vaccine on 24Feb2021. On Mar2021, (reported as week ago) she started feeling pruritus all over her body. She did not care much about it since she did not have any rash but she cannot resist the urge to scratch herself. She has an appointment to get the second dose on 16Mar2021 and she asked if she should get to the appointment and get the vaccine. The outcome for pruritus all over her body was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734309
Sex: F
Age:
State: CA

Vax Date: 03/01/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: itchiness; This is a spontaneous report from a contactable consumer. A 16-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in Mar2021 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunisation. The patient's medical history and concomitant medications were not reported. On an unspecified date, the patient experienced itchiness after use of product. Patient's hands, feet and low back were itchy on and off for the first two days. Reporter was a little concerned, stating "I always associate itchiness with allergy and God forbid, anaphylaxis, but it seemed to all go well." The outcome of event was unknown. Reporter wanted to know if patient should be put on an antihistamine before getting her second vaccine in two weeks. No follow-up attempts are possible; Information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1734310
Sex: F
Age:
State: CA

Vax Date: 02/28/2021
Onset Date:
Rec V Date: 09/25/2021
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: little redness on her arm; This is a spontaneous report from a Regulatory Authority. from a contactable consumer (patient). A female patient of an unspecified age received bnt162b2 (BNT162B2, solution for injection, Lot number was not reported) dose 2 via an unspecified route of administration on 28Feb2021 as dose 2, single for COVID-19 immunisation. The patient medical history and concomitant medication was not reported. The patient previously took first dose bnt162b2 via an unspecified route of administration on 02Feb2021 for COVID-19 immunisation. On an unspecified date the patient experienced little redness on her arm. The outcome of the event was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1734311
Sex: F
Age:
State: WA

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 09/25/2021
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: Chills; joint aches; left arm pain; This is a spontaneous report from a contactable consumer (patient). A 46-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EN6208), via an unspecified route of administration, administered in Arm Left on 11Mar2021 15:15 (at the age of 46-years-old) as dose 2, single for COVID-19 immunisation. Medical history included high blood pressure. Concomitant medications included amlodipine and levothyroxine, both taken for an unspecified indication, start and stop dates were not reported. The patient previously received the first dose of BNT162B2 (Batch/Lot Number: EN6201), administered in Left arm on 19Feb2021 at 04:00 PM for COVID-19 immunisation. The patient experienced chills, joint aches and left arm pain on 12Mar2021 at 06:00. There was no treatment received for the events. The outcome of the events was recovering. No follow-up attempts are possible. No further information is expected.

Other Meds: AMLODIPINE; LEVOTHYROXINE

Current Illness:

ID: 1734312
Sex: F
Age:
State:

Vax Date: 03/03/2021
Onset Date: 03/09/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: body aches; slight cough; congestion; fever; slight headache; This is a spontaneous report from a non-contactable consumer received from a Pfizer. A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 03Mar2021 (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient's medical history and concomitant medications were not reported. It was reported that when the patient got vaccine on 03Mar2021, she didn't get any side effects until today 09Mar2021, she had body aches, slight cough, congestion, fever, and slight headache. The outcome of the events was unknown. No follow-up attempts are possible, information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1734313
Sex: U
Age:
State: AZ

Vax Date: 03/01/2021
Onset Date: 03/05/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: experiencing joint and muscle pain; experiencing joint and muscle pain; This is a spontaneous report from a contactable consumer (patient). A 76-year-old patient of an unspecified gender received BNT162B2 (Pfizer-BioNTech COVID-19 vaccine), via an unspecified route of administration, administered in the left arm on 01Mar2021 at 12:45 (lot number was not reported) as dose 1, single for COVID-19 immunization. Medical history included Guillain Barre and allergies to sulfa on unknown dates. The patient did not have COVID prior to vaccination. The patient was not tested for COVID post vaccination. The patient did not receive other vaccines in four weeks and other medication in two weeks. About four to five days after the vaccine, on 05Mar2021 (as reported), the patient started experiencing joint and muscle pain. These have not improved and have actually gotten worse. Pain killers do not help. The outcome of the events was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734314
Sex: F
Age:
State: IL

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
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: Extreme fatigue; Injection site soreness; Injection site itch; Minor headache; Exacerbated pain in arthritic SI joints; This is a spontaneous report from a contactable consumer (patient). A 50-year-old non-pregnant female patient received bnt162b2 (BNT162B2), via an unspecified route of administration, administered in Arm Right on 01Mar2021 14:00, at the age of 50-years-old, (Lot Number: 59267-1000-01) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included Depression, Anxiety, Asthma, SI joint arthritis, obesity, migraines, and environmental allergies. The patient did not have COVID-10 prior the vaccination. Concomitant medications included bupropion hydrochloride (WELLBUTRIN); sertraline hydrochloride (ZOLOFT); modafinil; folic acid; and ibuprofen, all were taken for unspecified indication, start and stop date were not reported. On 01Mar2021 20:30, the patient experienced extreme fatigue, injection site soreness, injection site itch, minor headache, and exacerbated pain in arthritic SI joints. The patient was not tested for COVID-19 post vaccination. The outcome of the events was not recovered. No treatment was received for the events. No follow up attempts are possible. No further information is expected.

Other Meds: WELLBUTRIN; ZOLOFT; MODAFINIL; FOLIC ACID; IBUPROFEN

Current Illness:

ID: 1734315
Sex: F
Age:
State: TN

Vax Date: 03/07/2021
Onset Date: 03/10/2021
Rec V Date: 09/25/2021
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: shortness of breath; This is a spontaneous report from a contactable health care professional (patient). A 64-year-old female patient received BNT162B2 (Pfizer-BioNTech COVID-19 vaccine), via an unspecified route of administration on 07Mar2021 at 15:00 (lot number was not reported) as dose number unknown, single for COVID-19 immunization. The patient's medical history was not reported. The patient did not have COVID prior to vaccination. The patient did not receive other vaccines in four weeks. The patient received other unspecified medications in two weeks. The patient has not been tested for COVID post vaccination. The patient previously received Benadryl and experienced allergies. The patient reported that since she had the shot, she has been having shortness of breath that started on 10Mar2021. The patient did not receive treatment for the event. The outcome of the event was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734316
Sex: F
Age:
State: CA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 09/25/2021
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: 20210314; Test Name: Fever; Result Unstructured Data: Test Result:99.6 Fahrenheit

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever (99.6F); Sore Arm; body aches; This is a spontaneous report from a contactable consumer (patient). A 49-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 13Mar2021 12:00 (Batch/Lot Number: EN6204) (at the age of 49 years) as dose 1, single for covid-19 immunisation. Medical history was none. There were no concomitant medications. There were no known allergies. There was no other vaccine in four weeks. The patient experienced fever (99.6f), sore arm, body aches, all on 14Mar2021 04:00 with outcome of not recovered. There was no treatment received for the events. Patient has no COVID prior vaccination and had not been tested for COVID post vaccination. The patient underwent lab tests and procedures which included body temperature: 99.6 Fahrenheit on 14Mar2021. No follow up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1734317
Sex: F
Age:
State: ID

Vax Date: 03/04/2021
Onset Date: 03/06/2021
Rec V Date: 09/25/2021
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: fatigue; chills; joint pain; low fever; nausea; loose stool; swollen lymph nodes; insomnia; head ache; scratchy throat; This is a spontaneous report from a contactable consumer (patient). A 67-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration administered in left arm on 04Mar2021 11:00 (Batch/Lot Number: EN6199) (at the age of 67-year-old) as DOSE 1, SINGLE for covid-19 immunisation. The patient was not pregnant at the time of vaccination. It was unknown if patient had covid prior vaccination. The patient has not been tested for covid post vaccination. Medical history included high blood pressure, hypothyroidism, gout, and known allergies to medications with bromine salts. There were no concomitant medications. On 06Mar2021 16:00, the patient experienced fatigue, chills, joint pain, low fever, nausea, loose stool, swollen lymph nodes, scratchy throat, insomnia, and head ache. No treatment was received for the events. The patient had not yet recovered from the events. No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1734318
Sex: M
Age:
State: IL

Vax Date: 03/09/2021
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
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: swelling underneath the armpit; This is a spontaneous report from a contactable consumer (patient). A 56-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in Deltoid Left on 09Mar2021 (Batch/Lot Number: EN6202) (at the age of 56 years) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. Medical history included sinus disorder from an unknown date and unknown if ongoing. Concomitant medication included cetirizine hydrochloride (ZYRTEC [CETIRIZINE HYDROCHLORIDE]) taken for sinus disorder, start and stop date were not reported. The patient was getting like a little side effect and experienced swelling underneath the armpit on an unspecified date in Mar2021 with outcome of unknown. Therapeutic measures were taken as a result of event (Ibuprofen). No follow-up attempts are possible, information about lot/batch number cannot be obtained. No further information is expected.

Other Meds: ZYRTEC [CETIRIZINE HYDROCHLORIDE]

Current Illness:

ID: 1734319
Sex: M
Age:
State: CA

Vax Date: 02/17/2021
Onset Date:
Rec V Date: 09/25/2021
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 in both shoulders and neck area; pain in both shoulders and neck area/ constantly sore in my neck; This is a spontaneous report from a contactable consumer (patient). A 53-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, administered in left arm on 17Feb2021 13:00 (Batch/Lot number was not reported) as dose 2, single for COVID-19 immunization. The patient's medical history was not reported; no known allergies. Concomitant medication included hydrochlorothiazide taken for an unspecified indication, start and stop date were not reported. Prior to vaccination, the patient did not have COVID and did not receive any other vaccine in four weeks. On an unspecified date, the patient was having pain in both shoulders and neck area for last two to three weeks. His shoulders ached down to the sockets and constantly sore in his neck. No treatment was received for the events. Post-vaccination, the patient has not been tested for COVID. Outcome of the events was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds: HYDROCHLOROTHIAZIDE

Current Illness:

ID: 1734320
Sex: M
Age:
State: MI

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 09/25/2021
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: 20210305; Test Name: Temperature; Result Unstructured Data: Test Result:100.9; Comments: 16:45

Allergies:

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

Symptoms: motion was more difficult; experiencing 100.9 Temperature; arm was sore; This is a spontaneous report from a contactable consumer (patient). A 60-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 at the age of 60-year-old, via an unspecified route of administration, administered in left arm on 04Mar2021 12:45 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunisation. Medical history included asthma. Concomitant medication included other medications (unspecified) in two weeks. No other vaccine in four weeks. The patient has known allergies to morphine. The patient was not diagnosed with COVID-19 prior to vaccination and was not tested for COVOD-19 post vaccination. The patient experienced arm was sore on 05Mar2021 14:00. The motion was more difficult and experiencing 100.9 temperature on 05Mar2021 16:45 (reported as after 28 hours). The patient did not received treatment for the events. The patient recovered from the events on an unspecified date. No follow-up attempts are possible. Information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734321
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
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 Name: fever; Result Unstructured Data: Test Result:low; Comments: low fever

Allergies:

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

Symptoms: Low fever; mild headache; fatigue; This is a spontaneous report from a non-contactable consumer (reported for herself). A 20-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection, lot number and expiry date not reported), via an unspecified route of administration, administered in right arm on an unspecified date as dose 1, single for covid-19 immunisation. The patient's medical history was not reported. The patient was not pregnant at the time of the report. The patient had no Covid prior vaccination. There were no concomitant medications. The patient no other vaccine in four weeks. The most recent vaccine was administered in a public health. On an unspecified date, the patient experienced low fever (body temperature), mild headache, and fatigue. No treatments received in response to the events reported. The patient was not tested for Covid post vaccination. The outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734322
Sex: F
Age:
State: NJ

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 09/25/2021
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: low grade fever; Felt aches the next day after shot 2 low grade fever; This spontaneous report from a contactable consumer (patient). A 55-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 11Mar2021 (Batch/Lot Number: En6206) (at the age of 55 years) as dose 2, single for covid-19 immunisation. Medical history included rheumatoid arthritis and known allergies: Sulfa from an unknown date and unknown if ongoing. The patient's concomitant medications were not reported. Historical vaccine included bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 administered in Arm Left on 18Feb2021 08:00 AM (Batch/Lot Number: El9266) (at the age of 55 years) for covid-19 immunisation. There was no other vaccine in four weeks. The patient felt aches the next day after shot 2, and low grade fever, both on 12Mar2021 06:45 with outcome of recovered. There was no treatment received for the events. Patient has no COVID prior vaccination and had not been tested for COVID post vaccination. No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1734323
Sex: F
Age:
State: TX

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 09/25/2021
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: fatigue; low grade fever; chills; This is a spontaneous report from a non-contactable consumer (patient herself). A 50-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in left arm on 06Mar2021 (Batch/Lot Number: EN6205) at the age of 50 years as dose 1, single for COVID-19 immunisation. Medical history included COVID-19 prior to vaccination. The patient had no known allergies. There were no concomitant medications, no other vaccine in four weeks, and no other medications in two weeks. On 07Mar2021 06:00, the patient experienced fatigue, low grade fever, and chills. No treatment was required for the events. Outcome of the events was recovered on an unspecified date. The patient was not tested for COVID post vaccination. No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1734324
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: it caused an allergic reactions; This is a spontaneous report from a non-contactable consumer (patient reported for herself) from the Pfizer. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection, lot number and expiry date were not reported) via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient's medical history and concomitant medications were not reported. The patient previously took palbociclib in tablets and experienced allergic reactions (capsule did not cause reactions). On an unspecified date, the patient stated that it caused allergic reactions. Patient was inquiring why it causes different reactions. The outcome of the event was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734325
Sex: F
Age:
State: FL

Vax Date: 03/03/2021
Onset Date:
Rec V Date: 09/25/2021
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: chills; fever; headache; she became nauseous; This is a spontaneous report from a contactable consumer (patient) received from a regulatory authority. A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on 03Mar2021 (Batch/Lot number was not reported) as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history was not reported. The patient's concomitant medications were not reported. The patient received the first dose of BNT162B2 on 02Feb2021 for Covid-19 immunisation. The patient experienced chills, fever, headache and she became nauseous on an unspecified date. The outcome of the events was unknown. No follow-up attempts are possible; Information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1734326
Sex: F
Age:
State: FL

Vax Date: 03/11/2021
Onset Date: 03/13/2021
Rec V Date: 09/25/2021
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: swollen lower lip; This is a spontaneous report from a contactable consumer (patient). A 67-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was not reported), via an unspecified route of administration, administered in arm left on 11Mar2021 at 09:00 (at the age of 67-years-old) as dose 2, single for COVID-19 immunisation. Medical history included fillers in lips about 6 months ago. There were no concomitant medications. The patient previously received the first dose of BNT162B2 administered in arm left on 15Feb2021 at 09:00 AM (at the age of 67-years-old) for COVID-19 immunisation. The patient experienced swollen lower lip on 13Mar2021 at 05:00. There was no treatment received for the event. The outcome of the event was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734327
Sex: F
Age:
State: CA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 09/25/2021
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: slight nausea; Fever; arm soreness; This is a spontaneous report from a non-contactable consumer (patient). A 36-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in Arm Left on 13Mar2021 13:15 (lot number and expiry date: unknown) at the age of 36-years-old, as dose 1, single for Covid-19 immunisation. Medical history included known allergies to sulfa. Concomitant medications included ganoderma lucidum (REISHI MUSHROOM); astragalus mongholicus (ASTRAGALUS); sambucus nigra fruit (ELDERBERRY [SAMBUCUS NIGRA FRUIT]); and clarithromycin (CLARITIN) all taken for unspecified indications, start and stop dates were not reported. The vaccine was administered in a pharmacy or drug store. The patient did not receive other vaccines in four weeks. The patient was not diagnosed with Covid-19 before vaccination. On 13Mar2021, at 22:00, the patient experienced fever, arm soreness, and slight nausea. The patient did not receive treatment for the events. Outcome of the events was recovering. The patient has not been tested for Covid-19 after vaccination. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information expected.

Other Meds: REISHI MUSHROOM; ASTRAGALUS; ELDERBERRY [SAMBUCUS NIGRA FRUIT]; CLARITIN [CLARITHROMYCIN]

Current Illness:

ID: 1734328
Sex: F
Age:
State: TX

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 09/25/2021
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: Chills; fever; headache; This is a spontaneous report from a contactable other healthcare professional (patient). A 48-years-old non-pregnant female patient received bnt162b2 (BNT162B2, Lot number was not reported), dose 2 via an unspecified route of administration, administered in right arm on 12Mar2021 17:30 (at the age of 48-year-old) as dose 2, single for COVID-19 immunization in the Hospital. Medical history included hypothyroidism and allergy to shrimp. Concomitant medications included fexofenadine hydrochloride (ALLEGRA) and levothyroxine sodium (SYNTHROID). The patient previously took naproxen and experienced allergies. The patient previously received the first dose of bnt162b2 administered in left arm on 20Feb2021 18:00 (at the age of 48-year-old) as single dose for COVID-19 immunization. No other vaccine in four weeks. No Covid prior vaccination nor tested with Covid post vaccination. On 13Mar2021 17:00, the patient experienced chills, fever and headache. The patient received no treatment for the events. The outcome of the events recovered on unspecified date in 2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds: ALLEGRA; SYNTHROID

Current Illness:

ID: 1734329
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
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: Tiredness; Muscle pain/muscles are so sore from her neck to her feet; Joint pain; Feeling unwell/not feeling well; doesn't have any energy; she has been down; This is a spontaneous report from a contactable consumer (patient). A female patient of an unspecified age received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration on an unspecified date (Lot number was not reported) as dose 1, single for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. On an unspecified date, the patient experienced tiredness, muscle pain, joint pain, feeling unwell, doesn't have any energy and she has been down. Course of events: The patient had the first dose of the Pfizer Covid 19 vaccine. The patient was feeling tired and has gone downhill, she usually walks and goes to the gym and then she started not feeling well, she just doesn't have any energy. The caller has been going downhill a little bit each day, her muscles are so sore from her neck to her feet. The patient has been unable to do anything, it has been brewing since she had the shot. When the caller woke up this morning every muscle in her body is killing her. The patient wanted to know how does she get some kind of relief? The patient was looking at the side effects of the vaccine and checked off tiredness, muscle pain, joint pain, feeling unwell. Feeling unwell and tiredness started first, the caller can't go to the gym and it's not like her to say she can't do something. She knows that why she has been down is because of the shot because it is all new. The outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot been obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734330
Sex: F
Age:
State: NH

Vax Date: 03/12/2021
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: she developed rashes all over the face and neck; This is a spontaneous report from a Regulatory Authority. From a contactable consumer (patient). A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 12Mar2021 (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient reported that after a few hours when she left the facility (after 1st shot), she developed rashes all over the face and neck on an unspecified date in Mar2021 with outcome of unknown. No follow-up attempts are possible, information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734331
Sex: M
Age:
State: SD

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Test Date: 20210314; Test Name: temp; Result Unstructured Data: Test Result:high

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: upset stomach; vomiting; diarrhea; high temp; This is a spontaneous report from a Pfizer . A contactable consumer reported that a 19-year-old male patient (reporter's son) received BNT162B2 (Pfizer-BioNTech COVID-19 vaccine), via an unspecified route of administration on 13Mar2021 (lot number was not reported) as dose 1, single for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient started experiencing upset stomach, vomiting, has diarrhea and a high temp on 14Mar2021, 24 hours from receiving the first dose of the vaccine. The patient took Tylenol for event high temp. The outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734332
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
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: Callers dad had a fever; This is a spontaneous report from a Pfizer-sponsored program. A contactable consumer reported that a male patient of an unspecified age received bnt162b2 (BNT162B2), via an unspecified route of administration on an unspecified date (Lot number was not reported) as dose number unknown, single for Covid-19 immunization. The patient's medical history and concomitant medications were not reported. The caller's dad had a fever for the past day and a half after getting vaccine on an unspecified date. The outcome of the event was unknown. No follow-up attempts are possible; information about lot/batch number cannot been obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734333
Sex: F
Age:
State: TX

Vax Date: 03/12/2021
Onset Date:
Rec V Date: 09/25/2021
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: arthritis; This is a spontaneous report from a contactable consumer (patient) via Regulatory Authority.. A female patient of an unspecified age received bnt162b2, via an unspecified route of administration on 12Mar2021 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunisation. The patient's medical history was not reported. There were no concomitant medications. The patient previously took acetaminophen (TYLENOL) for arthritis. The patient experienced arthritis on an unspecified date with outcome of unknown. The clinical course was reported as follows: Patient got the first dose of the vaccine today (12Mar2021). She said she has arthritis and wants to know if she can resume taking Tylenol for her arthritis. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.

Other Meds:

Current Illness:

ID: 1734334
Sex: M
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
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: chills; body aches; nausea; Vomiting; coughing; This is a Spontaneous report from a contactable Pharmacist. A contactable Pharmacist reported on behalf of her husband that: A male patient of an unspecified age received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: ER8737), via an unspecified route of administration on 06Apr2021 as dose 2, single. The patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: EN6204), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced chills, body aches, nausea, vomiting, coughing on an unspecified date. caller asked if this was normal. Pharmacist (patient wife) also stated her husband experienced fever and then clarified to state he did not had a fever. She stated that was the patient's 2nd dose of the Pfizer Vaccine and the 1st dose was fine and this 2nd dose was horrible. The outcome of events was unknown. No Follow-up attempts are needed. No further information is expected.

Other Meds:

Current Illness:

ID: 1734335
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
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: I start having a dry cough which is until now I still suffering; I start having running nose; I just like I feel like I have covid on my situation right now; drug ineffective; This is a spontaneous report from a contactable consumer(patient).A 62-years-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration, administered in Arm Left on 26Mar2021 (Lot Number: EP6955) as dose 2, single and first dose via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) (at the age 62-years-old) as dose 1, single for COVID-19 immunization. Medical history included hypertension and blood cholesterol. Concomitant medications included telmisartan (TELMISARTAN) 40 mg, once a day taken for hypertension and atorvastatin (LIPITOR [ATORVASTATIN]) 40 mg, once a day taken for blood cholesterol. Patient does not have any lab tests. On 27Mar2021, the patient experienced Runny nose and on 28Mar2021, the patient had dry cough. In Mar2021, the patient had suspected Covid-19. It was reported that 2nd vaccine patient received last 26Mar2021 and 2nd day after vaccination, the Saturday 27Mar2021 she started having running nose and then the 2nd day Sunday the 28Mar2021 she started having a dry cough which was until now and she was still suffering as It's been like a week (one week after her vaccine) and she still has it. The patient wanted to know if she was going to be okay. Nothing was going to happen to her, that's what she was concerned. She just wanted to know if she was going to be okay. The first day she tried the because she thought it was an allergy so the first day she tried to take the allergy medicine but it doesn't work and even the 2nd day she tried to do it, it doesn't work so she just like she feel like had Covid on her situation right now but the vaccine she may have, it may be the side effect at last it was already a week, almost a week. Tomorrow was going to be a week that she had this or experiencing this. That's why she was concerned. Therapeutic medication taken as a result of event runny nose and cough included Allertec 10 mg. The outcome for event suspected Covid-19 was unknown and patient had not yet recovered from other events No follow-up attempts are possible. No further information is expected.

Other Meds: TELMISARTAN; LIPITOR [ATORVASTATIN]

Current Illness:

ID: 1734336
Sex: M
Age:
State: OH

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 09/25/2021
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: Diarrhea came two days after for four days.; Sore arm.; Head felt numb-ish; tingly on right side and sore shoulder/arm; tingly on right side and sore shoulder/arm; small bumps on head and headache/Bumps moving and forming in different areas side of vaccine; headache; Then, five days or later large bumps formed on head. Top of head, then moved to right side of head, lymph nodes and right side of neck swelling; Then, five days or later large bumps formed on head. Top of head, then moved to right side of head, lymph nodes and right side of neck swelling; Then, five days or later large bumps formed on head. Top of head, then moved to right side of head, lymph nodes and right side of neck swelling; Face swelling; Throat swelling; This is a spontaneous report from a contactable consumer (patient). A 46-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: ER8734), via an unspecified route of administration, administered in Arm Right on 10Apr2021 14:00 (at the age of 46-year-old) as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications. Patient did not have any known allergies. Patient did not receive any other vaccine in four weeks and did not receive any other medications in two weeks. Patient did not have covid prior vaccination and covid was not tested post vaccination. Patient reported that Diarrhea came two days after (on 12Apr2021) for four days. Sore arm, Head felt numb-ish, tingly on right side and sore shoulder/arm. Then, small bumps on head and headache. Then, five days or later large bumps formed on head, top of head, then moved to right side of head, lymph nodes and right side of neck swelling. Very severe headache 7 days later. Emergency call was made to doctor and doctor was visited. Bumps moving and forming in different areas side of vaccine. Also experienced face swelling, throat swelling all on right side. Adverse events started on 10Apr2021 18:00. Adverse events resulted in doctor or other healthcare professional office/clinic visit. Patient received treatment as Benadryl, Tylenol and Advil so far. The outcome of diarrhea was recovered on 16Ap2021 and for all other events was not recovered. No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1734337
Sex: F
Age:
State: TN

Vax Date: 01/26/2021
Onset Date: 02/09/2021
Rec V Date: 09/25/2021
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: my right shoulder was sore; fatigued; random pains; For three days the bottom of my left foot was moderately painful; This is spontaneous report from a contactable other HCP. This 40-year-old female non-pregnant other HCP reported for herself she received bnt162b2 (BNT162B2) formulation: Solution for injection, dose 2 (Lot Number: EL3302 expiry date was unknown) via an unspecified route of administered in arm left on 26Jan2021 as a single dose for covid-19 immunisation. Medical history included sjogren's syndrome, raynaud's phenomenon, epilepsy from an unknown date and unknown if ongoing. Concomitant medication(s) included lamotrigine taken for an unspecified indication, start and stop date were not reported. Historical vaccine dose 1 product=COVID 19, pfizer/biontech, (lot number=EL 1284 expiry date was unknown) via Intramuscular route of administration at left arm on 05Jan2021 05:45 PM. The patient did not receive any other vaccine within four weeks prior to the COVID vaccine. The patient had lamotrigine medications in two weeks. Prior to the vaccination the patient was not diagnosed with COVID-19. Since the vaccination the patient had not been tested for COVID-19. Patient had Known allergies with salicylates. She had sjogrens syndrome and over the course of 14 days post 2nd vaccination she developed random pains. For three days the bottom of her left foot was moderately painful; for 3 days her right shoulder was sore even though it was the opposite arm of the vaccination site. She was also very fatigued for 12-24 hours after each dose. Outcome of the events was recovered on an unspecified date. No follow-up attempts are possible. No further information is expected.

Other Meds: LAMOTRIGINE

Current Illness:

ID: 1734339
Sex: F
Age:
State: CA

Vax Date: 01/05/2021
Onset Date: 01/01/2021
Rec V Date: 09/25/2021
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: Pain at injection for 4 days; Numbness/tingling at injection for 3 hours; Numbness/tingling at injection for 3 hours; Flushing for 4 days; This is a spontaneous report from a contactable consumer (patient). A 30-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection and lot number: EJ1685) via an unspecified route of administration in left arm on 05Jan2021 10:35 (at the age of 30 years). as dose 1, single dose for COVID -19 immunization (Hospital, Workplace clinic). The patient medical history and concomitant medications were none. Vaccine Administered at Military Facility was no. The patient did not have a history of any previous allergies to specific products or any conditions indicative of an allergy. Patient was not taking any medication prior to the event being reported. The patient did not receive any recent vaccines for other conditions prior to the event being reported. The patient did not receive any recent vaccines for SARS-CoV2 other than Pfizer-Biontech COVID-19 vaccine prior to the event being reported. The patient did not receive any other vaccines around the time of Pfizer biotech COVID -19 vaccine vaccination. In Jan2021 the patient experienced pain at injection for 4 days, flushing 4 days. Numbness/ tingling at injection for 3 hours. It was reported that there was no multiorgan involvement, respiratory, difficulty breathing, sensation of throat closure, sneezing, rhinorrhea, cardiovascular, measured hypotension, shock, tachycardia, capillary refill time>3sec, reduced central pulse volume, decreased level of consciousness, loss of consciousness, dermatological/mucosal, generalised urticaria, generalised erythema, angioedema, generalized pruritus with skin rash, generalized pruritus without skin rash, generalised prickle sensation, localised injection site urticaria, red and itchy eyes, gastrointestinal, diarrhea, abdominal pain, nausea, vomiting, any other sign/symptoms. Patient did not receive any new medication or treatment or procedure for the events. AE does not require a visit to Emergency room or physician room. The patient was bot admitted to hospital. The patient did not provide the information regarding the reported adverse events with the use of the product. The outcome of the events was unknown. No follow-up attempts are possible. No further information was provided.

Other Meds:

Current Illness:

ID: 1734340
Sex: F
Age:
State: NY

Vax Date: 06/29/2021
Onset Date: 07/01/2021
Rec V Date: 09/25/2021
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: Rash all over my stomach and groin plus diarrhea; Rash all over my stomach and groin plus diarrhea; This is a spontaneous report from a contactable consumer or other non hcp. A 39-year-old non-pregnant female patient received bnt162b2 (BNT162B2, Solution for injection), dose 1 via an unspecified route of administration, administered in Arm Right on 29Jun2021 17:45 (Vaccination at the age of 39 years) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included covid-19 (covid prior vaccination: Yes) from an unknown date and Known allergies: No. No other vaccine in four weeks. Had covid prior vaccination and covid not tested post vaccination. The patient experienced rash all over my stomach and groin plus diarrhea on 01Jul2021 10:00. Outcome of the events was unknown. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1734341
Sex: M
Age:
State: ID

Vax Date: 06/15/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:160/110; Test Name: blood drawn; Result Unstructured Data: Test Result:low in vitamin B; Test Name: stress test; Result Unstructured Data: Test Result:perfect

Allergies:

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

Symptoms: blood pressure going through roof and back down; feeling of everything inside me is crawling.; body aches; severe left hip pain; mood swings or ongoing irritability; mood swings or ongoing irritability; speech has been kind of jumbled, hard time saying what he is thinking.; depression; This is a spontaneous report from a contactable consumer or other non hcp. A 55-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection), dose 2 via an unspecified route of administration, administered in Arm Left on 15Jun2021 15:30 (Batch/Lot Number: EW0168) as dose 2, single (age at vaccination 55-year-old) for covid-19 immunisation. Medical history included allergic to tetanus and bee stings from an unknown date and unknown if ongoing and Back in December 2020 when he felt covid coming, it had felt like it almost cut him in half and his whole left side felt weird and hurt. The patient's concomitant medications were not reported. The patient previously took tetanus anti toxin and experienced allergic to tetanus. Historical vaccine information included bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection) on 30Mar2021 (age at vaccination 55-year-old), lot number: ER8727 for covid-19 immunisation and experienced headache, bnt162b2 for covid-19 immunisation and experienced eyes had flash burn, eyes were matted shut, unusual cramping above ankles, jittery. The patient experienced feeling of everything inside me is crawling, body aches, severe left hip pain, mood swings or ongoing irritability, speech has been kind of jumbled, hard time saying what he is thinking, depression, blood pressure going through roof and back down (medically significant) on an unspecified date. It was reported that He received his second dose, and he was still having side effects. Reports he hasn't heard of anything like this for this long. Outcome: Still ongoing, today is an odd day where he does not feel any of it today and as of yesterday, they were all still there. Sometimes one day a week he will feel really good, and it may be longer than a week, but at times he has one day he has felt really good and then next day he is back down again. Since he got the second shot there are other side effects that have come up. Since his second dose he has had severe left hip pain, mood swings or ongoing irritability, speech has been kind of jumbled, hard time saying what he is thinking. His work wants to fire him because they are saying that people cannot talk to him because he jumps down people's throats when he talks to them. He has had some depression and he told his doctor about it and his doctor was reluctant to do anything. His doctor had him suggestions on doing small changes since his blood pressure was going through the roof and back down, it was up to 160/110 and he was put on medication. He was put on dlmesartan for his blood pressure. He was put on a high dose for a couple of days and then he was told to take it whenever his blood pressure is high. He has to take his blood pressure now to monitor it. Outcome of side effects after second dose: Ongoing, persisting almost daily. Reports that right after both shots reported side effects were mild for a few days and then a week later was when they really hit. He had his blood drawn and was sent for stress test and everything came back perfect. He was told that heh was just low in vitamin B. The patient underwent lab tests and procedures which included blood pressure measurement: 160/110, blood test: low in vitamin b, cardiac stress test: perfect on an unknown date. The outcome for all event were unknown. Follow-up attempts are completed. No further information is expected.

Other Meds:

Current Illness:

ID: 1734342
Sex: M
Age: 49
State: PA

Vax Date: 02/25/2021
Onset Date: 03/25/2021
Rec V Date: 09/25/2021
Hospital: Y

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

Lab Data: Test Name: cholesterol; Result Unstructured Data: More than doubled in a month. Cholesterol was shot up over 250 from under 100; Test Name: cholesterol; Result Unstructured Data: After vaccination,Cholesterol was under 100 had no symptoms of shortness of breath.; Test Date: 20210311; Test Name: cholesterol; Result Unstructured Data: good blood work related to cholesterol.; Test Name: Cardiac catheterization; Result Unstructured Data: my "widowmaker" was 100% blocked; Test Name: Ejection fraction; Result Unstructured Data: 20-25%; Test Date: 20210311; Test Name: A1C; Result Unstructured Data: 6.8

Allergies:

Symptom List: Tremor

Symptoms: heart attack, thrombosis, chest discomfort, hyperhidrosis, dyspnoea, hypoaesthesia; chest started to tighten; Chest pain; Tiredness; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (heart attack, thrombosis, chest discomfort, hyperhidrosis, dyspnoea, hypoaesthesia) and CHEST DISCOMFORT (chest started to tighten) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002B21A and 023M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Weight loss (Lost 40 Ibs due to Ozempic and Invokana medications). Concurrent medical conditions included Type 2 diabetes mellitus (controlled with other medicines; A1c was 6.8 on 11-Mar-2021) since 05-Dec-2003. Concomitant products included ATORVASTATIN from 24-Mar-2019 to an unknown date for Cholesterol, METFORMIN from 24-May-2003 to an unknown date, CANAGLIFLOZIN (INVOKANA [CANAGLIFLOZIN]) from 24-Mar-2019 to 23-Apr-2021 and SEMAGLUTIDE (OZEMPIC) from 24-Mar-2019 to an unknown date for Diabetes. On 25-Feb-2021 at 8:45 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Mar-2021 at 8:45 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 25-Mar-2021, the patient experienced CHEST PAIN (Chest pain) and FATIGUE (Tiredness). On 23-Apr-2021, the patient experienced CHEST DISCOMFORT (chest started to tighten) (seriousness criterion hospitalization). On 23-Apr-2021 at 11:15 AM, the patient experienced MYOCARDIAL INFARCTION (heart attack, thrombosis, chest discomfort, hyperhidrosis, dyspnoea, hypoaesthesia) (seriousness criteria hospitalization and medically significant). The patient was hospitalized from 23-Apr-2021 to 25-Apr-2021 due to CHEST DISCOMFORT and MYOCARDIAL INFARCTION. On 25-Mar-2021, CHEST PAIN (Chest pain) had resolved. On 26-Mar-2021, FATIGUE (Tiredness) had resolved. At the time of the report, MYOCARDIAL INFARCTION (heart attack, thrombosis, chest discomfort, hyperhidrosis, dyspnoea, hypoaesthesia) had not resolved and CHEST DISCOMFORT (chest started to tighten) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Mar-2021, Blood cholesterol: below 100 (normal) good blood work related to cholesterol.. On 11-Mar-2021, Glycosylated haemoglobin: 6.8 (abnormal) 6.8. On an unknown date, Blood cholesterol: 250 (abnormal) More than doubled in a month. Cholesterol was shot up over 250 from under 100 and under 100 (abnormal) After vaccination,Cholesterol was under 100 had no symptoms of shortness of breath.. On an unknown date, Catheterisation cardiac: abnormal (abnormal) my "widowmaker" was 100% blocked. On an unknown date, Ejection fraction: 20-25% (abnormal) 20-25%. Patient had good blood work related to cholesterol on 11-Mar-2021, however it was more than doubled in a month following administration of suspect drug. Patient was taking 40mg of Atorvastatin, previously was taking 40mg of pravastatin with some results but my endocrinologist wanted patient to go even lower so he prescribed 40mg Atorvastatin which I take once per day and have been for over 2 years. Patient was concomitantly taking medications for type 2 diabetes. Patient had treated with blood thinners for the rest of my life. On 25-MAR-2021 approximately 7 hours after in the evening patient had experienced some chest pain that lasted maybe 1 hour, could still breathe as normal and had took the next day off from work due to tiredness. Patient was released from the hospital 72 hours later and had required a life vest for release. Patient was sent to cardiac rehab for 6 weeks and was off the life vest due ejection fraction returning to normal levels. Patients widow maker was 100% blocked and would placed a stent as per the cardiologist. Company comment: This case concerns 49-year-old male patient with a history of Type 2 diabetes mellitus, who experienced the unexpected event of Myocardial Infarction. The event occurred approximately one month after the second dose of mRNA-1273. The rechallenge was not applicable as the events happened after the second dose. The medical history of Type 2 diabetes mellitus and patient?s age remain a confounder. The benefit-risk relationship of Spikevax is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Added patient demographic details, start date of diabetes, medical history, lab data, concomitant medications, vaccine information, facility information ,added events, outcome of events- Heart attack, heart attack with 100% blockage updated from unknown to not recovered and Clot event from recovering to not recovered/resolved, added start date and stop date of hospitalization and updated narrative.; Sender's Comments: This case concerns 49-year-old male patient with a history of Type 2 diabetes mellitus, who experienced the unexpected event of Myocardial Infarction. The event occurred approximately one month after the second dose of mRNA-1273. The rechallenge was not applicable as the events happened after the second dose. The medical history of Type 2 diabetes mellitus and patient?s age remain a confounder. The benefit-risk relationship of Spikevax is not affected by this report.

Other Meds: ATORVASTATIN; METFORMIN; INVOKANA [CANAGLIFLOZIN]; OZEMPIC

Current Illness: Type 2 diabetes mellitus (controlled with other medicines; A1c was 6.8 on 11-Mar-2021)

ID: 1734344
Sex: M
Age: 70
State: OH

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/25/2021
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: patient received DAPTACEL instead of ADACEL/no adverse event; DAPTACEL was given to 70 years elderly male patient/no adverse event; Initial information was received on 16-Sep-2021 regarding an unsolicited valid non-serious case from other health professional and physician via call center via Medical Information (Reference number- 00773106). This case is linked to case 2021SA309592(CLUSTER). This case involves a 70 years old male patient who received DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE [DAPTACEL] instead of DIPHTHERIA-2/TETANUS/5 AC PERTUSSIS VACCINE [ADACEL] (wrong product administered and product administered to patient of inappropriate age). The patient's medical history, past medical treatment, vaccination, concomitant medication and family history were not provided. On 10-Aug-2021, the patient received a 0.5 ml dose of suspect DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE (lot number: C5687AA and expiry date: 09-DEC-2021) via an intramuscular route in the deltoid nos for prophylactic vaccination. It was of actual medication error due to wrong vaccine administered and inappropriate age at vaccine administration (latency: same day) At the time of reporting, no adverse event reported. It was reported "caller asks if the patient's should be injected with Adacel now, or if the Daptacel was sufficient." This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1734345
Sex: F
Age: 59
State: OK

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/25/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: administered expired vaccine with no reported adverse event; Initial information received on 16-Sep-2021 regarding an unsolicited valid non-serious case received from an other health professional via Media Information (under the reference 00773128). This case involved a 59 years old female patient who had administered expired dose of INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT] (expired product administered). The patient's past medical history, medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. The patient had no concomitant vaccine. On 16-SEP-2021, the patient received a dose of suspect INFLUENZA QUADRIVAL A-B VACCINE (0.5ml, total, lot UJ477AB and expiration date: 30-Jun-2021) via intramuscular route in the right deltoid for prophylactic vaccination. It was an actual medication error due to expired vaccine used (same day latency). It was reported, "they administered expired FLUZONE QUADRIVALENT to a patient; asks if they need to revaccinate following administration of expired product". At time of reporting, the outcome was unknown for the reported event. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in the Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1734346
Sex: F
Age:
State: CO

Vax Date:
Onset Date:
Rec V Date: 09/25/2021
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: multiple excurion occured during shiping time with no adverse event; Initial information received on 16-Sep-2021 regarding an unsolicited valid non-serious case received from a other health care profession and non-healthcare professional via Medical Information under reference - 00773210. This case involves a unknown age of 13 female patient's were vaccinated INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE [FLUZONE HIGH-DOSE QUADRIVALENT] which went on multiple temperature excursions (product storage error). The patient's medical history, medical treatment(s), vaccination(s) and family history were not provided. No concomitant therapy was given. On an unknown date, the patient's received a 0.7 mL (total) dose of INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE (lot - UJ716AB and expiry date 30-06-2022) via an unknown route at an unknown administration site for prophylactic vaccination. It was reported "The caller stated that she was contacted by a Sanofi Rep who advised her that her recent shipment of FLUZONE HIGH DOSE QUADRIVALENT was not viable. The caller stated that she has already contacted Sanofi regarding a product replacement, as directed by her Sanofi Rep. The caller stated that the product was shipped on 02 SEP 2021 and received on 07 SEP 2021. The caller stated that 13 patients have received the vaccine since delivery. At this time, the caller is requesting medical information for the proper care for the 13 patients who received the vaccine. Note from Agent; At the time of the call back the clinic did not have the information for the patients that received the vaccines." It was a case of a actual medication error due to incorrect product storage. At the time of reporting, no adverse event reported. Outcome of event was unknown. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in the Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1734347
Sex: M
Age: 12
State: OH

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: nurse was supposed to vaccinate 3 patients with Adacel, however vaccinated them with Daptacel instead in error with no reported adverse event; Vaccine was given to the wrong patient with no adverse event; nitial information received on 16-Sep-2021 regarding an unsolicited valid non-serious case from a consumer/non health care professional and physician via Media Information (under reference 00773251). This case is linked to cluster cases 2021SA309592 and 2021SA310131. This case involves a 12 years old male patient who received DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE [DAPTACEL] instead of DIPHTHERIA, TETANUS AND ACELLULAR PERTUSSIS VACCINE [ADACEL] (wrong product administered and product administered to patient of inappropriate age). The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included HPV VACCINE VLP RL1 4V (YEAST) (GARDASIL) and MENINGOCOCCAL VACCINE A/C/Y/W CONJ (DIP TOX) (MENACTRA) [lot number and expiration date were not reported] via unknown route in an unknown administration site for prophylactic vaccination. On 17-Aug-2021, the patient received a 0.5 mL dose of suspect DAPTACEL (TOTAL, lot C5687AA and expiration date: 09-Dec-2021) via intramuscular route in the deltoid for prophylactic vaccination. It was an actual medication error due to wrong vaccine administered and inappropriate age at vaccine administration (same day latency). It was reported "Director of Quality stated DAPTACEL ( 253 - DAPTACEL) was given to the wrong patient population and wanted recommendations. Caller stated ADACEL was supposed to be administered. Director of Quality states that a nurse was supposed to vaccinate 3 patients with Adacel, however vaccinated them with Daptacel instead in error. The caller asks if the patient's should be injected with Adacel now, or if the Daptacel was sufficient. The caller states that this occurred because the Daptacel and Adacel sound the same." At time of reporting, no adverse event reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds: GARDASIL; MENACTRA

Current Illness:

ID: 1734357
Sex: M
Age: 38
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734358
Sex: M
Age: 65
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734359
Sex: M
Age: 58
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734360
Sex: M
Age: 58
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734361
Sex: M
Age: 74
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734362
Sex: M
Age: 34
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734363
Sex: M
Age: 85
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734364
Sex: F
Age: 76
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734365
Sex: M
Age: 60
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734366
Sex: F
Age: 71
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734367
Sex: M
Age: 62
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1734368
Sex: F
Age: 32
State:

Vax Date: 09/23/2021
Onset Date:
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am