VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1740580
Sex: F
Age: 30
State: AZ

Vax Date: 08/21/2021
Onset Date: 09/18/2021
Rec V Date: 09/28/2021
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: I was experiencing pretty bad diarrhea/it has been consistent since saturday/I've had it for 2 days straight; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (I was experiencing pretty bad diarrhea/it has been consistent since saturday/I've had it for 2 days straight) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A and 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Sep-2021, the patient experienced DIARRHOEA (I was experiencing pretty bad diarrhea/it has been consistent since saturday/I've had it for 2 days straight). At the time of the report, DIARRHOEA (I was experiencing pretty bad diarrhea/it has been consistent since saturday/I've had it for 2 days straight) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The concomitant medication reported as OTC allergy pill. The treatment included was Drinking more water, limiting diet.

Other Meds:

Current Illness:

ID: 1740581
Sex: F
Age: 45
State: SC

Vax Date: 04/24/2021
Onset Date:
Rec V Date: 09/28/2021
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: pike on ear infections; dizziness; always spinning; affected equilibrium; This spontaneous case was reported by a consumer and describes the occurrence of EAR INFECTION (pike on ear infections), DIZZINESS (dizziness), VERTIGO (always spinning) and BALANCE DISORDER (affected equilibrium) in a 45-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 018b21a and 037c21a) for COVID-19 vaccination. No Medical History information was reported. On 24-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-May-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 EAR INFECTION (pike on ear infections), DIZZINESS (dizziness), VERTIGO (always spinning) and BALANCE DISORDER (affected equilibrium). The patient was treated with OFLOXACIN at an unspecified dose and frequency and MECLIZINE [MECLOZINE] for Dizziness, at an unspecified dose and frequency. At the time of the report, EAR INFECTION (pike on ear infections), DIZZINESS (dizziness), VERTIGO (always spinning) and BALANCE DISORDER (affected equilibrium) had not resolved. Concomitant medicine reported as a lot of medication Most recent FOLLOW-UP information incorporated above includes: On 20-Sep-2021: Follow up received on 20-Sep-2021 contains no new information.; Reporter's Comments: Med Info CASE CROSSLINKED MOD-2021-145591 HCP of the patient stated he had seen a pike on ear infections

Other Meds:

Current Illness:

ID: 1740582
Sex: F
Age:
State: NC

Vax Date:
Onset Date:
Rec V Date: 09/28/2021
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: Diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DIARRHOEA (Diarrhea). At the time of the report, DIARRHOEA (Diarrhea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1740583
Sex: M
Age: 53
State: AR

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Test Date: 20210820; Test Name: Fever; Result Unstructured Data: had a high fever of 101? F

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: couldn't breathe; had a high fever of 101? F; passed out at work; got really sick; irregular heartbeat; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (passed out at work), ILLNESS (got really sick), HEART RATE IRREGULAR (irregular heartbeat), DYSPNOEA (couldn't breathe) and PYREXIA (had a high fever of 101? F) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E_IA) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Aug-2021, the patient experienced LOSS OF CONSCIOUSNESS (passed out at work), ILLNESS (got really sick), HEART RATE IRREGULAR (irregular heartbeat) and PYREXIA (had a high fever of 101? F). On an unknown date, the patient experienced DYSPNOEA (couldn't breathe). At the time of the report, LOSS OF CONSCIOUSNESS (passed out at work), ILLNESS (got really sick), HEART RATE IRREGULAR (irregular heartbeat), DYSPNOEA (couldn't breathe) and PYREXIA (had a high fever of 101? F) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 20-Aug-2021, Body temperature: 101? f (High) had a high fever of 101? F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was provided. Treatment information was not provided. The symptoms started on 20-Aug-2021 at about 11 am. the patient "got really sick" and passed out at work, had a high fever of 101? F and started noticing an irregular heartbeat. The patient went to the doctor and they put him on a heart monitor for 48 hours. The patient also stated that he couldn't breathe.; Sender's Comments: This case concerns a 53 year old male with no medical history who experienced the unexpected events of Illness, Loss of consciousness, Heart rate irregular and Dyspnoea and the expected event of Pyrexia 1 day after the first dose of Moderna COVID-19 vaccine. No re-chalenge has been note and no causality reported. The benefit-risk relationship of Moderna COVID-19 is not affected by this report. The event Loss of consciousness was automatically upgraded to serious as per IME; however, based on medical judgement and the information available the event is assessed as non-serious.

Other Meds:

Current Illness:

ID: 1740584
Sex: M
Age:
State: AK

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
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: Incorrect product storage; A patient received 2nd dose of vaccine from an expired vial; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (A patient received 2nd dose of vaccine from an expired vial) and PRODUCT STORAGE ERROR (Incorrect product storage) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048B21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (A patient received 2nd dose of vaccine from an expired vial). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (Incorrect product storage). On 20-Sep-2021, EXPIRED PRODUCT ADMINISTERED (A patient received 2nd dose of vaccine from an expired vial) had resolved. At the time of the report, PRODUCT STORAGE ERROR (Incorrect product storage) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was provided. No treatment medication was provided. The vial was punctured on 17-Sep-2021. The vial was kept in refrigerator at 39 degree F until 20-Sep-2021. The reporter did not had exact excursion time it was within 72 hours.

Other Meds:

Current Illness:

ID: 1740585
Sex: M
Age:
State:

Vax Date: 08/21/2021
Onset Date:
Rec V Date: 09/28/2021
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: Got shaky; Dizzy; Was burning up; Sleepy; Bacterial infection; Viral infection; Talking kind of delirious; Fever; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Got shaky), DIZZINESS (Dizzy), BURNING SENSATION (Was burning up), SOMNOLENCE (Sleepy) and BACTERIAL INFECTION (Bacterial infection) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048F21A and 008C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included COVID-19 (He had Covid on April and may), Wound and Surgery. Concurrent medical conditions included Fibrillation, COPD and Lung cancer. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Sep-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 TREMOR (Got shaky), DIZZINESS (Dizzy), BURNING SENSATION (Was burning up), SOMNOLENCE (Sleepy), BACTERIAL INFECTION (Bacterial infection), VIRAL INFECTION (Viral infection), CONFUSIONAL STATE (Talking kind of delirious) and PYREXIA (Fever). At the time of the report, TREMOR (Got shaky), DIZZINESS (Dizzy), BURNING SENSATION (Was burning up), SOMNOLENCE (Sleepy), BACTERIAL INFECTION (Bacterial infection), VIRAL INFECTION (Viral infection), CONFUSIONAL STATE (Talking kind of delirious) and PYREXIA (Fever) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications include Blood thinner. Patient was prescribed with antibiotics and tylenol for a bacterial infection or a viral infection, is not sure. Patient had radiation therapy for lung cancer. Treatment medications were not reported.

Other Meds:

Current Illness: COPD; Fibrillation; Lung cancer

ID: 1740586
Sex: F
Age: 16
State: CA

Vax Date: 07/31/2021
Onset Date:
Rec V Date: 09/28/2021
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: a 16 year old patient got her both doses; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (a 16 year old patient got her both doses) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 066D21A) for COVID-19 vaccination. No Medical History information was reported. On 31-Jul-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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) at an unspecified dose. On an unknown date, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (a 16 year old patient got her both doses). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (a 16 year old patient got her both doses) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product information was not provided. Treatment information was not provided. This case was linked to MOD-2021-328274 (Patient Link).

Other Meds:

Current Illness:

ID: 1740587
Sex: F
Age: 77
State: CA

Vax Date: 01/01/2021
Onset Date: 02/22/2021
Rec V Date: 09/28/2021
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: slept all day; very tired; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (slept all day) and FATIGUE (very tired) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 001A21A and unknown) for COVID-19 vaccination. The patient's past medical history included Chemotherapy (The patient has received chemotherapy with her last chemotherapy treatment in July.). In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 22-Feb-2021, the patient experienced SOMNOLENCE (slept all day) and FATIGUE (very tired). At the time of the report, SOMNOLENCE (slept all day) and FATIGUE (very tired) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1740588
Sex: M
Age: 73
State: IL

Vax Date: 08/03/2021
Onset Date:
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Test Name: body temperature; Result Unstructured Data: around 100 F

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: he has elevated body temperature, continued fever every day that does not seem to go away/It is not a high fever, it is around 100 F at the most.; swollen glands on injection site; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (he has elevated body temperature, continued fever every day that does not seem to go away/It is not a high fever, it is around 100 F at the most.) and VACCINATION SITE LYMPHADENOPATHY (swollen glands on injection site) in a 73-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058C21A and 050C21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure. Concomitant products included METOPROLOL TARTRATE for Blood pressure. On 03-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 an unknown date, the patient experienced PYREXIA (he has elevated body temperature, continued fever every day that does not seem to go away/It is not a high fever, it is around 100 F at the most.) and VACCINATION SITE LYMPHADENOPATHY (swollen glands on injection site). At the time of the report, PYREXIA (he has elevated body temperature, continued fever every day that does not seem to go away/It is not a high fever, it is around 100 F at the most.) and VACCINATION SITE LYMPHADENOPATHY (swollen glands on injection site) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: high (High) around 100 F. No treatment information was provided. This case was linked to MOD-2021-325338 (Patient Link).

Other Meds: METOPROLOL TARTRATE

Current Illness: Blood pressure

ID: 1740589
Sex: F
Age: 73
State: TX

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Test Date: 20210316; Test Name: Antibody test; Test Result: Positive ; Result Unstructured Data: She did three antibody tests three times. The first had antibodies; Test Date: 20210316; Test Name: Antibody test; Test Result: Positive ; Result Unstructured Data: The Second had antibodies; Test Date: 202109; Test Name: Antibody test; Test Result: Negative ; Result Unstructured Data: 3rd time zero antibodies; Test Date: 20210302; Test Name: Fever; Result Unstructured Data: Fever 101 Fahrenheit; Test Date: 20201215; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: She finally got a negative COVID-19 test

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: she got very sick; Nausea; Fever 101 F; Vomiting; Has not received the second dose; This spontaneous case was reported by a patient and describes the occurrence of ILLNESS (she got very sick), NAUSEA (Nausea), PYREXIA (Fever 101 F), VOMITING (Vomiting) and PRODUCT DOSE OMISSION ISSUE (Has not received the second dose) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013A2119) for COVID-19 vaccination. The patient's past medical history included COVID-19 (She had COVID-19 disease in 2020) in 2020. On 02-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Mar-2021, the patient experienced ILLNESS (she got very sick), NAUSEA (Nausea), PYREXIA (Fever 101 F), VOMITING (Vomiting) and PRODUCT DOSE OMISSION ISSUE (Has not received the second dose). On 02-Mar-2021, PRODUCT DOSE OMISSION ISSUE (Has not received the second dose) had resolved. At the time of the report, ILLNESS (she got very sick), NAUSEA (Nausea), PYREXIA (Fever 101 F) and VOMITING (Vomiting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 15-Dec-2020, SARS-CoV-2 test: negative (Negative) She finally got a negative COVID-19 test. On 02-Mar-2021, Body temperature: 101 f (High) Fever 101 Fahrenheit. On 16-Mar-2021, Antibody test: positive (Positive) She did three antibody tests three times. The first had antibodies and positive (Positive) The Second had antibodies. In September 2021, Antibody test: zero (Negative) 3rd time zero antibodies. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was withdrawn on an unknown date. No concomitant medications were reported. No treatment details were reported. Patient's doctor told her not to get the second vaccine.

Other Meds:

Current Illness:

ID: 1740590
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 09/28/2021
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: 90% of the people she knows were wiped out by their second Moderna Covid-19 vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (90% of the people she knows were wiped out by their second Moderna Covid-19 vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received 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 FATIGUE (90% of the people she knows were wiped out by their second Moderna Covid-19 vaccine). At the time of the report, FATIGUE (90% of the people she knows were wiped out by their second Moderna Covid-19 vaccine) outcome was unknown. Concomitant medication information was not provided by the reporter. Treatment information was not provided by the reporter.

Other Meds:

Current Illness:

ID: 1740591
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 09/28/2021
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: Felt like he had been run over by a "Roller that grooms the beach; Felt Drunk; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Felt like he had been run over by a "Roller that grooms the beach) and FEELING DRUNK (Felt Drunk) in a 41-year-old male patient 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) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced FEELING ABNORMAL (Felt like he had been run over by a "Roller that grooms the beach) and FEELING DRUNK (Felt Drunk). At the time of the report, FEELING ABNORMAL (Felt like he had been run over by a "Roller that grooms the beach) and FEELING DRUNK (Felt Drunk) outcome was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided by the reporter.

Other Meds:

Current Illness:

ID: 1740592
Sex: F
Age: 82
State: MI

Vax Date: 01/22/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient received a dose of Moderna that had expired the day before; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a dose of Moderna that had expired the day before) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 025B21A, 023M20A and 029L20A) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 20-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (patient received a dose of Moderna that had expired the day before). On 20-Sep-2021, EXPIRED PRODUCT ADMINISTERED (patient received a dose of Moderna that had expired the day before) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. It was reported that dose was administered around 1 pm on 20 Sep 2021. Vial was punctured around 11 am and the vial's expiration date was 19 Sep 2021. No list of Concomitant medications were provided. No Treatment medications were reported.

Other Meds:

Current Illness: Immunocompromised

ID: 1740593
Sex: M
Age: 74
State: MA

Vax Date: 01/12/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: haven't felt really good; right leg started to collapse ; lost balance; patient went down; Patient felt like leg was made of lead; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (haven't felt really good), BALANCE DISORDER (right leg started to collapse ; lost balance), GAIT DISTURBANCE (patient went down) and LIMB DISCOMFORT (Patient felt like leg was made of lead) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A, 012M20A and 011L20A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension, Cholesterol and Arrhythmia (Heart rhythm). On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Sep-2021, the patient experienced VACCINATION COMPLICATION (haven't felt really good), BALANCE DISORDER (right leg started to collapse ; lost balance), GAIT DISTURBANCE (patient went down) and LIMB DISCOMFORT (Patient felt like leg was made of lead). At the time of the report, VACCINATION COMPLICATION (haven't felt really good), BALANCE DISORDER (right leg started to collapse ; lost balance), GAIT DISTURBANCE (patient went down) and LIMB DISCOMFORT (Patient felt like leg was made of lead) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient is on concomitant medications for bloodthinners, hypertension, cholesterol, heart rhythm. The Patient received the COVID vaccine and flu shot on the same day. No treatment drugs were provided This case was linked to MOD-2021-012826, MOD-2021-287056 (Patient Link).

Other Meds:

Current Illness: Arrhythmia (Heart rhythm); Cholesterol; Hypertension

ID: 1740594
Sex: F
Age: 35
State: TX

Vax Date: 08/17/2021
Onset Date:
Rec V Date: 09/28/2021
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: arm got a little bit swollen; feels like ever since has been a bit sick; runny nose; sneezing; a little bit of body aches; had been running a fever; headaches; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (arm got a little bit swollen), ILLNESS (feels like ever since has been a bit sick), RHINORRHOEA (runny nose), SNEEZING (sneezing) and MYALGIA (a little bit of body aches) in a 35-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017E21A and 062E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-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 PERIPHERAL SWELLING (arm got a little bit swollen), ILLNESS (feels like ever since has been a bit sick), RHINORRHOEA (runny nose), SNEEZING (sneezing), MYALGIA (a little bit of body aches), PYREXIA (had been running a fever) and HEADACHE (headaches). At the time of the report, PERIPHERAL SWELLING (arm got a little bit swollen), ILLNESS (feels like ever since has been a bit sick), RHINORRHOEA (runny nose), SNEEZING (sneezing), MYALGIA (a little bit of body aches), PYREXIA (had been running a fever) and HEADACHE (headaches) outcome was unknown. No concomitant medication is reported No treatement of medication is reported

Other Meds:

Current Illness:

ID: 1740595
Sex: U
Age:
State: HI

Vax Date:
Onset Date:
Rec V Date: 09/28/2021
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: neurological side effects; cold and flu symptoms; cold and flu symptoms; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an occupational therapist and describes the occurrence of NERVOUS SYSTEM DISORDER (neurological side effects), NASOPHARYNGITIS (cold and flu symptoms) and INFLUENZA (cold and flu symptoms) 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 NERVOUS SYSTEM DISORDER (neurological side effects), NASOPHARYNGITIS (cold and flu symptoms) and INFLUENZA (cold and flu symptoms). At the time of the report, NERVOUS SYSTEM DISORDER (neurological side effects), NASOPHARYNGITIS (cold and flu symptoms) and INFLUENZA (cold and flu symptoms) 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. No relevant concomitant medications were reported. Treatment medication was not provided by the reporter. Batch Number: Unknown manufacturer(s). Occupational Therapist reporting that a lot of people are reporting neurological side effects online lasting up to 6 months and some are reporting cold and flu symptoms.

Other Meds:

Current Illness:

ID: 1740596
Sex: F
Age: 31
State: CA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
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: Dose was administered to patients after the 30 days use by date; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose was administered to patients after the 30 days use by date) in a 31-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose was administered to patients after the 30 days use by date). On 20-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Dose was administered to patients after the 30 days use by date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication information was not provided. Nurse stated that patients received the first dose of the Moderna COVID 19 vaccine on 20-Sep-2021 between 8:10-9:10am. The dose was administered to patients after the 30 days use by date. Treatment information was not provided by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 23-Sep-2021: Follow up received. Dose 1 anatomical location was added.

Other Meds:

Current Illness:

ID: 1740597
Sex: F
Age: 80
State: AZ

Vax Date: 08/11/2021
Onset Date:
Rec V Date: 09/28/2021
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: her arm was hurting; ear hurt; experience headache one side of head (1st dose); arm feverish; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (her arm was hurting), EAR PAIN (ear hurt), HEADACHE (experience headache one side of head (1st dose)) and PYREXIA (arm feverish) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 9399D2) for COVID-19 vaccination. Concurrent medical conditions included Immune disorder (Patient has a lot of immune disorders and probably should not have gotten the vaccine). Concomitant products included THYROID and ESCITALOPRAM OXALATE (LEXAPRO) for an unknown indication. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (her arm was hurting), EAR PAIN (ear hurt), HEADACHE (experience headache one side of head (1st dose)) and PYREXIA (arm feverish). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at a dose of every 4 hours. At the time of the report, PAIN IN EXTREMITY (her arm was hurting), EAR PAIN (ear hurt), HEADACHE (experience headache one side of head (1st dose)) and PYREXIA (arm feverish) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. This case was linked to MOD-2021-325358.

Other Meds: THYROID; LEXAPRO

Current Illness: Immune disorder (NOS) (Patient has a lot of immune disorders and probably should not have gotten the vaccine)

ID: 1740598
Sex: M
Age: 28
State: HI

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/28/2021
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: whole left side paresthesia,tingling,His left index finder is the worst right now with the pins & needles; numbness; neurological side effects; This spontaneous case was reported by an other health care professional and describes the occurrence of NERVOUS SYSTEM DISORDER (neurological side effects), PARAESTHESIA (whole left side paresthesia,tingling,His left index finder is the worst right now with the pins & needles) and HYPOAESTHESIA (numbness) in a 28-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Sep-2021, the patient experienced NERVOUS SYSTEM DISORDER (neurological side effects). On an unknown date, the patient experienced PARAESTHESIA (whole left side paresthesia,tingling,His left index finder is the worst right now with the pins & needles) and HYPOAESTHESIA (numbness). At the time of the report, NERVOUS SYSTEM DISORDER (neurological side effects), PARAESTHESIA (whole left side paresthesia,tingling,His left index finder is the worst right now with the pins & needles) and HYPOAESTHESIA (numbness) 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. No concomitant medication was reported by the reporter. No treatment was reported by the reporter.

Other Meds:

Current Illness:

ID: 1740599
Sex: F
Age:
State: PA

Vax Date:
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
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: Fourth dose of vaccine administered to one patient; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 20-Sep-2021 and was forwarded to Moderna on 20-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of EXTRA DOSE ADMINISTERED (Fourth dose of vaccine administered to one patient) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012M20A) 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 20-Sep-2021, the patient experienced EXTRA DOSE ADMINISTERED (Fourth dose of vaccine administered to one patient). At the time of the report, EXTRA DOSE ADMINISTERED (Fourth dose of vaccine administered to one patient) had resolved. Concomitant medication was not reported. Treatment information was not reported.

Other Meds:

Current Illness:

ID: 1740600
Sex: F
Age: 58
State: CA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: I started having intense migraines; I felt off balance, like when I 1st get out of bed, I would fall against the wall.; I felt nauseous; I felt horrible for the 1st 5 days./ felt so heavy, like liquid cement/felt like water in my head; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (I felt horrible for the 1st 5 days./ felt so heavy, like liquid cement/felt like water in my head), MIGRAINE (I started having intense migraines), BALANCE DISORDER (I felt off balance, like when I 1st get out of bed, I would fall against the wall.) and NAUSEA (I felt nauseous) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. Concomitant products included PARACETAMOL (TYLENOL) for an unknown indication. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Aug-2021, the patient experienced FEELING ABNORMAL (I felt horrible for the 1st 5 days./ felt so heavy, like liquid cement/felt like water in my head). On 11-Aug-2021, the patient experienced MIGRAINE (I started having intense migraines), BALANCE DISORDER (I felt off balance, like when I 1st get out of bed, I would fall against the wall.) and NAUSEA (I felt nauseous). At the time of the report, FEELING ABNORMAL (I felt horrible for the 1st 5 days./ felt so heavy, like liquid cement/felt like water in my head), MIGRAINE (I started having intense migraines), BALANCE DISORDER (I felt off balance, like when I 1st get out of bed, I would fall against the wall.) and NAUSEA (I felt nauseous) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) dosing remained unchanged. No treatment medication provided This case was linked to MOD-2021-326700 (Patient Link).

Other Meds: TYLENOL

Current Illness:

ID: 1740601
Sex: F
Age:
State: NY

Vax Date: 03/13/2021
Onset Date:
Rec V Date: 09/28/2021
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: "Negligible side effects" after all the doses, except for her arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included Arthritis. Concurrent medical conditions included Blood pressure high. On 13-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm). At the time of the report, VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm) outcome was unknown. Patient used to take an immunosuppressant drug for a long time but stopped after the pandemic started. No treatment medications were not provided. This case was linked to MOD-2021-325478, MOD-2021-325512 (Patient Link).

Other Meds:

Current Illness: Blood pressure high.

ID: 1740602
Sex: F
Age:
State: NY

Vax Date: 03/13/2021
Onset Date:
Rec V Date: 09/28/2021
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: "Negligible side effects" after all the doses, except for her arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Arthritis and Hypertension. On 13-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm). At the time of the report, VACCINATION COMPLICATION ("Negligible side effects" after all the doses, except for her arm) outcome was unknown. patient took an immunosuppressant drug for a long time but stopped after the pandemic started. Concomitant medication was not provided. Treatment information was not provided. This case was linked to MOD-2021-325511, MOD-2021-325478 (Patient Link).

Other Meds:

Current Illness: Arthritis; Hypertension.

Date Died:

ID: 1740603
Sex: U
Age:
State: CA

Vax Date: 02/05/2021
Onset Date:
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: Test Name: Oxygen level; Result Unstructured Data: low

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Developed pneumonia after the vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Developed pneumonia after the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026B21A and 042L20A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.). On 05-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Mar-2021, received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PNEUMONIA (Developed pneumonia after the vaccine) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized for 8 days due to PNEUMONIA. The patient was treated with ZOLEDRONIC ACID (RECLAST) for Adverse event, at an unspecified dose and frequency. The reported cause of death was Pneumonia. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Oxygen saturation: low (Low) low. No concomitant medications were reported. Company Comment: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report. This case was linked to MOD-2021-325775, MOD-2021-325636 (Patient Link).; Sender's Comments: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: Pneumonia

Other Meds:

Current Illness: Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.)

ID: 1740604
Sex: M
Age: 58
State: IL

Vax Date: 08/20/2021
Onset Date:
Rec V Date: 09/28/2021
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: Tiredness; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Tiredness) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No medical history was reported. On 20-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced FATIGUE (Tiredness). The patient was treated with IBUPROFEN for Adverse event, at an unspecified dose and frequency and PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, FATIGUE (Tiredness) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant product use was provided by the reporter. This case was linked to MOD-2021-325991 (Patient Link).

Other Meds:

Current Illness:

ID: 1740605
Sex: F
Age: 77
State: AZ

Vax Date: 09/16/2021
Onset Date:
Rec V Date: 09/28/2021
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: Hives; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Hives) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised (mild immunocompromise.). On 16-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced URTICARIA (Hives). At the time of the report, URTICARIA (Hives) was resolving. No concomitant treatment was provided. No treatment medication was provided. Patient had experienced hives after 48 hours of getting her third dose and still experiencing them, but patient said that hives presently are not as bad as before. Patient had stated that she was mild immunocompromised, and so she got her third dose of Moderna Covid-19 Vaccine. This case was linked to MOD-2021-211489, MOD-2021-293610 (Patient Link).

Other Meds:

Current Illness: Immunocompromised (mild immunocompromise.)

ID: 1740606
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 09/28/2021
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: made her sick for a week; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (made her sick for a week) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ILLNESS (made her sick for a week). At the time of the report, ILLNESS (made her sick for a week) had resolved. No concomitant medications were reported. No treatment medications were reported.

Other Meds:

Current Illness:

ID: 1740607
Sex: F
Age: 55
State: MA

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Test Date: 20210920; Test Name: body temperature; Result Unstructured Data: fever 99 Fahrenheit

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: She has a fever 99 Fahrenheit; Had a fever on the vaccination day; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (She has a fever 99 Fahrenheit) and PYREXIA (Had a fever on the vaccination day) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Sep-2021, the patient experienced PYREXIA (Had a fever on the vaccination day). On 20-Sep-2021, the patient experienced PYREXIA (She has a fever 99 Fahrenheit). At the time of the report, PYREXIA (She has a fever 99 Fahrenheit) had not resolved and PYREXIA (Had a fever on the vaccination day) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 20-Sep-2021, Body temperature: 99 (High) fever 99 Fahrenheit. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1740608
Sex: F
Age: 75
State: CO

Vax Date: 02/06/2021
Onset Date:
Rec V Date: 09/28/2021
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: Sore arm; Headache; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012M20A and 036A21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure high, COPD, Anxiety and Tremor. On 06-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Mar-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 IN EXTREMITY (Sore arm) and HEADACHE (Headache). At the time of the report, PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache) outcome was unknown. Concomitant medications included high blood pressure medication, COPD medication, anxiety medication, medication for tremors. No treatment medications were reported. This case was linked to MOD-2021-325611 (Patient Link).

Other Meds:

Current Illness: Anxiety; Blood pressure high; COPD; Tremor

ID: 1740609
Sex: F
Age: 63
State: CA

Vax Date: 04/01/2021
Onset Date:
Rec V Date: 09/28/2021
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: Injection site was uncomfortable; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE DISCOMFORT (Injection site was uncomfortable) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026B21A) for COVID-19 vaccination. No Medical History information was reported. Concomitant products included CALCIUM, FISH OIL and MAGNESIUM for an unknown indication. On 01-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE DISCOMFORT (Injection site was uncomfortable). At the time of the report, VACCINATION SITE DISCOMFORT (Injection site was uncomfortable) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient has no health conditions. Treatment information was not provided. This case was linked to MOD-2021-325608 (Patient Link).

Other Meds: CALCIUM; FISH OIL; MAGNESIUM.

Current Illness:

ID: 1740610
Sex: F
Age:
State: TN

Vax Date: 08/10/2021
Onset Date:
Rec V Date: 09/28/2021
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: sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 059E21A) for COVID-19 vaccination. The patient's past medical history included Sinus infection (was treated with steroids and antibiotics.) in 2017, Leishmaniasis (infection spread to her kidneys, intestines, lungs.), Fungal infection (After 7 doses the patient had a hyperinfection : fungus), Mole of skin (After 7 doses the patient had a hyperinfection : mole), Candida infection (After 7 doses the patient had a hyperinfection : Candida ), Hair loss (lost all the hair), Skin loss (lost the skin in nose, skin looked like decaying), Skin disorder (Wholes in the skin, whole in the forehead), Kidney infection (Six months ago, the infection spread to her kidneys, intestines, lungs, treated with infusion), Gastrointestinal infection (Six months ago, the infection spread to her kidneys, intestines, lungs,treated with infusion) and Lung infection (Six months ago, the infection spread to her kidneys, intestines, lungs, treated with infusion). On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (sore arm). At the time of the report, PAIN IN EXTREMITY (sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication use was reported. After the first dose, the patient's hair started to grow in forehead and the forehead started to close. This case was linked to MOD-2021-325750 (Patient Link).

Other Meds:

Current Illness:

ID: 1740611
Sex: F
Age:
State:

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/28/2021
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: Swollen arm; Red; Hot; Not unbearable, but uncomfortable; Sore; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Swollen arm), ERYTHEMA (Red), FEELING HOT (Hot), FEELING ABNORMAL (Not unbearable, but uncomfortable) and MYALGIA (Sore) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history were provided by reporter. Concomitant products included THYROID and DENOSUMAB (PROLIA) for an unknown indication. On 10-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced PERIPHERAL SWELLING (Swollen arm), ERYTHEMA (Red), FEELING HOT (Hot), FEELING ABNORMAL (Not unbearable, but uncomfortable) and MYALGIA (Sore). On 14-Sep-2021, PERIPHERAL SWELLING (Swollen arm), ERYTHEMA (Red), FEELING HOT (Hot), FEELING ABNORMAL (Not unbearable, but uncomfortable) and MYALGIA (Sore) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication also include also for blood pressure. (unspecified drug name). Patient stated that no treatment for the adverse events.

Other Meds: THYROID; PROLIA.

Current Illness:

ID: 1740612
Sex: F
Age: 34
State: AK

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
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: administered with an expired dose of the Moderna Covid-19 vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered with an expired dose of the Moderna Covid-19 vaccine) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016B21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with an expired dose of the Moderna Covid-19 vaccine). At the time of the report, EXPIRED PRODUCT ADMINISTERED (administered with an expired dose of the Moderna Covid-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications was not provided by the reporter Treatment information was not provided

Other Meds:

Current Illness:

ID: 1740613
Sex: M
Age: 12
State: DC

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 09/28/2021
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: 12-year-old received vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12-year-old received vaccine) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003F21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Aug-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12-year-old received vaccine). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12-year-old received vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided No relevant treatment medication were provided

Other Meds:

Current Illness:

ID: 1740614
Sex: F
Age: 62
State: WA

Vax Date: 03/20/2021
Onset Date:
Rec V Date: 09/28/2021
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: lost 3 pounds; a little worried; helped with fatigue, depression; This spontaneous case was reported by a consumer and describes the occurrence of WEIGHT DECREASED (lost 3 pounds), ANXIETY (a little worried) and THERAPEUTIC RESPONSE UNEXPECTED (helped with fatigue, depression) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 028A21A and 040A21A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension. Concomitant products included LISINOPRIL for Hypertension. On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Apr-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 WEIGHT DECREASED (lost 3 pounds), ANXIETY (a little worried) and THERAPEUTIC RESPONSE UNEXPECTED (helped with fatigue, depression). At the time of the report, WEIGHT DECREASED (lost 3 pounds), ANXIETY (a little worried) and THERAPEUTIC RESPONSE UNEXPECTED (helped with fatigue, depression) outcome was unknown. No treatment medications were reported. This case was linked to MOD-2021-325352 (Patient Link).

Other Meds: LISINOPRIL.

Current Illness: Hypertension.

ID: 1740615
Sex: F
Age: 28
State: MN

Vax Date: 05/06/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: 9/24/21 SARS/COV-2, Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1740616
Sex: F
Age: 33
State: MN

Vax Date: 03/19/2021
Onset Date: 09/21/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/25 COVID positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1740617
Sex: F
Age: 29
State: OH

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 09/28/2021
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: Appendectomy April 10 2021

Allergies: Bactrum - antibiotic

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Had appendicitis and then an appendectomy 4 days after receiving.

Other Meds: Vitamin C, Prenatal

Current Illness: None

ID: 1740618
Sex: F
Age: 31
State: NY

Vax Date: 09/13/2021
Onset Date: 09/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: None. I have to work. 09/21 went to GYN -Fibrosis has appears. I haven't had any pain until now.

Allergies: Mushrooms

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

Symptoms: Hives and or Shingles, short of breath, fatigue, anxiety, loss of appetite and lethargic with a rapid heart beat and nausea car sick like feeling. Slight chest discomfort.

Other Meds:

Current Illness:

ID: 1740619
Sex: M
Age: 16
State: MN

Vax Date: 06/16/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
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: 9/23 COVID test

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1740620
Sex: M
Age: 85
State: PA

Vax Date: 06/16/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital: Y

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: Patient tested positive 9/27/21

Other Meds:

Current Illness:

ID: 1740621
Sex: M
Age: 76
State: FL

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: Codeine (causes hives) Morphine (causes severe hallucinations)

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

Symptoms: 1215AM, 9/26/2021, moderate heartburn/indigestion, difficulty swallowing hot/cold beverages 1215AM 9/26/2021, moderate to severe joint pain in both knees and both hips, unable to sleep Treated with Tylenol 300PM, 9/26/2021, adverse symptoms began to subside 1030PM, 9/26/2021, severe joint pain in both knees and both hips, difficulty sleeping, difficulty walking Treated with Tylenol 400PM, 9/27/2021, adverse symptoms began to subside 830PM, 9/27/2021, normal sleep pattern

Other Meds: Aspirin 81 mg ec tablet Coenzyme Q10 200 mg capsule Fish oil, oral, 1200 mg Glucosamine Chondroitin, oral, 1500 mg Multivitamin tablet Pravastatin 40 mg tablet Vitamin C 1000 mg taglet

Current Illness: NA

ID: 1740622
Sex: F
Age: 45
State: NY

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: N/A

Allergies: Hazelnut, Plum, birch pollen

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

Symptoms: Severe leg and lower back pain, leg muscle cramping in both legs, inflammation, difficulty standing, walking, sitting and completing everyday task. Treatment prescribed Prednisone for inflammation and then took NSAIDs for another 2 weeks.

Other Meds: Hydroxychloroquine, multivitamin, vitamin D, vitamin c and probiotic

Current Illness: N/A

ID: 1740623
Sex: F
Age: 35
State: MN

Vax Date: 08/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/27 COVID positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1740624
Sex: F
Age: 26
State: TN

Vax Date: 08/02/2021
Onset Date: 08/02/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Vomiting

Symptoms: On the day the vaccine was received, at 1900, patient broke out in hives with itching. In ER, patient was treated with diphenhydramine, famotidine and methylprednisolone with good response. Patient is discharged with a prescription for prednisone and instructions to continue diphenhydramine and famotidine at home.

Other Meds: none

Current Illness: none

ID: 1740625
Sex: F
Age: 32
State: NH

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Extremely sore arm 2 hours after injection. Progressively getting worse. To the point I can?t even lift arm. Body aches and severe migraine at about 5pm. Heart palpitations that entire evening. Chills intermittent. Still experiencing symptoms almost 48 hours later.

Other Meds: Lamictal Vitamin D Zyrtec Omega 3 Calcium Magnesium

Current Illness: None

ID: 1740626
Sex: M
Age: 15
State: ME

Vax Date: 06/15/2021
Onset Date: 09/21/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data: Various, hospital will have to proved those details.

Allergies: none

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

Symptoms: On 9/21 Pt developed Pericardial effusion of chyle. Suspect Chylous pericardium. Well over 1200ml was drained from his heart. Doctors say that this had been building up for weeks. His second dose was administered on 6/15/2021. Surgery was required to drain his heart. A drain was left in for a week and the fluid has stopped producing. Treatment is ongoing and he is still in the hospital, but urgency seems to have subsided. Questions remain as to cause.

Other Meds: none

Current Illness: none

ID: 1740627
Sex: F
Age: 34
State: DC

Vax Date: 04/01/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 7 months pregnant at time of second dose and had normal pregnancy and delivery, with healthy 9lb 3oz and 21in baby at time of birth. Exclusively breastfed baby until 9/26/2021 when he died suddenly and unexpectedly. Cause of death has not been determined but in autopsy they did not find any indication of clotting or other issues; we are waiting on pathology and toxicology results.

Other Meds: N/A

Current Illness: N/A

ID: 1740628
Sex: F
Age: 33
State: NY

Vax Date: 09/23/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Menstrual cramps and vaginal bleeding as if on period, but not due for period. Prior to vaccine, period was extremely regular so this is abnormal.

Other Meds: Prescription Levothyroxine 1x daily for hypothyroid

Current Illness: None

ID: 1740785
Sex: M
Age: 43
State: MN

Vax Date: 04/23/2021
Onset Date: 09/22/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: 9/27 SARS/COV-2, NAAT positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am