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: 1752822
Sex: F
Age:
State: NY

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Test Name: Fever; Result Unstructured Data: Test Result:101.1; Test Name: Fever; Result Unstructured Data: Test Result:100.9

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever 101.1; Chills; Body aches; Sinus infection; This is a spontaneous report from a contactable consumer or other non-hcp (patient herself). A 56-years-old female patient received bnt162b2 (BNT162B2, Formulation: Solution for injection) via intramuscularly administered in Arm Left on 26Feb2021, 08:30 (Lot Number: EM9809, Expiry date: Unknown) as dose 2, single for COVID-19 immunisation, metoprolol (METOPROLOL), via an unspecified route of administration from an unspecified date (Lot number was not reported) and ongoing, at unspecified dose for an unspecified indication, have been taking for a couple of years. The patient medical history and concomitant medications were not reported. The patient previously received bnt162b2 (BNT162B2, Formulation: Solution for injection) via intramuscularly administered in Arm Left on 05Feb2021, 09:30 (Lot Number: EL9264, Expiry date: Unknown) as dose 1, single for COVID-19 immunisation and experienced red inflamed/very little redness when I got the vaccine/very red, itchy circle where vaccine was given, swelling on site, runny nose and stuffed nose. On 26Feb2021, the patient experienced fever 101.1, chills, body aches and sinus infection. The patient underwent lab tests and procedures which included body temperature: 101.1 and body temperature: 100.9. Therapeutic measures were not taken as a result of events fever, chills and body aches. Therapeutic measures were taken for the event sinus infections. The outcome of events fever, chills and body aches recovered on an unspecified date in 2021 and event sinus infection was not recovered. No follow up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1752823
Sex: F
Age:
State: MD

Vax Date: 02/28/2021
Onset Date:
Rec V Date: 10/01/2021
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: Fatigue; Nausea; Joint pain; This is a spontaneous report from a contactable consumer (patient). A 26-year-old non pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: EN6198), via an unspecified route administration in the left arm on 28Feb2021 at 11:00 at the age of 26-years-old as a single dose for COVID-19 immunisation. Medical history included Crohn's disease and allergic to dairy and shellfish. The patient received unspecified medication within 2 weeks of vaccination. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient did not receive any other vaccine within 4 weeks prior to the COVID-19 vaccine. On an unspecified date in 2021, the patient experienced fatigue, nausea and joint pain. The patient did not receive any treatment for the reported events. The adverse event did not result in a visit to the doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. The outcomes of the events was recovering. No follow-up attempts are needed. No further information is expected.

Other Meds:

Current Illness:

ID: 1752833
Sex: M
Age: 38
State: GU

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 10/01/2021
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: NONE

Allergies: Shellfish

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Bells Palsy on right side of face.

Other Meds: Mobic Wellbutrin Claratin

Current Illness:

ID: 1752834
Sex: M
Age: 44
State:

Vax Date: 05/01/2021
Onset Date: 05/05/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: White blood cell count 9.7 3.4?9.6 ? 10(9)/L Sedimentation rate 12 2?2?mm/h C-reactive protein 63.5 ?8.0?mg/L Peak troponin T, 5th generation 847 ?15?ng/L NT-proBNP 1059 ?51?pg/mL Eosinophils 0.04 0.03?0.48 ? 10(9)/L Laboratory blood test confirmed evidence of myocardial injury and systemic inflammation (Table 1). Troponin T levels decreased to 675?ng/L the day after admission. COVID-19 nasal swab testing using polymerase chain reaction was negative. Chest X-ray showed findings consistent with mild pulmonary oedema (Figure 3). Transthoracic Echocardiogram demonstrated borderline enlarged left ventricle with an estimated ejection fraction of 40?45%, mild-moderate generalized left ventricular hypokinesis, slightly worse at the apex, borderline enlarged right ventricle with mildly-moderately decreased systolic function, and no significant valve disease. Cardiac magnetic resonance imaging was compatible with acute myocarditis with patchy linear mid-myocardial enhancement of the septum and inferior walls at the base to mid-ventricle, sub-epicardial/mid-myocardial enhancement of the lateral wall at the mid-ventricle and apical lateral wall (Figure 4). There was associated myocardial oedema involving most of the myocardium and mild pericardial enhancement.

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: A 44-year-old man presented with chest pain and ST-segment elevation 4 days after receiving the second dose of mRNA-1273 SARS-CoV-2 Vaccine. Emergent coronary angiogram showed minimal coronary artery disease. Cardiac magnetic resonance imaging confirmed acute myocarditis. Diagnosis of vaccine-associated myocarditis was made given the temporal relationship and supportive treatment initiated. The patient was started on supportive therapy for his symptoms, including a brief course of intravenous diuretics for mild symptoms of congestion. Angiotensin-converting enzyme inhibitor and a beta-blocker therapy were commenced to treat systolic dysfunction. He was also initiated on colchicine to treat mild persistent chest pain, which was thought to be related to pericardial inflammation that resolved 4?5?days after presentation. He was discharged home after 5?days of monitoring without evidence of electrical or haemodynamic instability and with NYHA Class I symptoms. One month later, repeat echocardiogram showed normalization of the left ventricular ejection fraction (56%) and size, no regional wall motion abnormalities, and normal longitudinal peak systolic strain. He remained asymptomatic and off diuretics.

Other Meds: albuterol and fluticasone-salmeterol

Current Illness: None

ID: 1752835
Sex: F
Age: 42
State: GU

Vax Date: 02/07/2021
Onset Date: 08/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow. Patient bled heavily and was sent to ER. The curettage was done in the ER. Patient was devastated and recovering.

Allergies: None

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

Symptoms: EDD: 01/27/2022 Miscarriage, 08/2021

Other Meds: None

Current Illness: None

ID: 1752836
Sex: F
Age: 73
State: TX

Vax Date: 09/01/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: none noted

Allergies: none noted

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

Symptoms: I had my 3rd Moderna vaccination on Monday, October 27, 2021. Tonight (9/30/21) around 8 pm I noticed a smooth red patch on my vaccinated arm. It was not hot to the touch, it did not itch and it was not raised. Now at 11:30 pm if appears to be "spreading/growing" in size. It is be down from the vaccination site and is starting to circle the upper arm and has some "burning"......still not particularly warm to the touch, or raised. It has not reached the inside of the arm. At what may be the injection site (I can't see that part of my arm) is a raised "bump". I did 1.5 hours of exercise with weights (working with a trainer).....so I have used the arm all day, without difficulty or pain. On Tue/Wed after the shot, I did experience significant "chills" which I treated with hot showers and Tylenol/Advil (alternating).

Other Meds: Spironolactone 25 mg Alprazolam 2MG Vitamin D3 125 mcg Atorvastatin 20 mg Venlafaxine HCl Er 37.5 Mg Omeprazole 20 mg Amlodipine Besylate 5 MG

Current Illness: none noted

ID: 1752837
Sex: M
Age: 22
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: none

Allergies: Carbocaine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 18:10- patient vaccinated and at 18:14 patient states that he got a rush feeling to the head, hearing is going out, and shaky. At this time we laid out the yoga mat and transferred patient from chair to mat and immediately elevated his legs. Vital signs at 18:15 SP02 98%, HR 55, BP 100/62, diaphoretic. He couldn't respond for the first 20 seconds, but then said he felt much better and can see and hear fine again. Water bottle provided. At 18:20, vital signs: SP02 99%, HR 65, BP 114/60 RR 16. At this time he states he feels like he can sit on a chair, but we had him sit against the wall on the yoga mat. He stated he could use a snack and small bag of gold fish provided. He requested to sit on a chair, so we slowly stood him up and sat him on a chair. He said he felt "normal again" and we requested to stay an additional 15 minutes after to ensure he did not experience another adverse reaction. 18:30 Vital signs at 18:30, SP02 99%, HR 88, RR 18, BP 118/75. 18:35, patient requested to go home since he feels fine.

Other Meds: None.

Current Illness: none

ID: 1752838
Sex: M
Age: 73
State: CA

Vax Date: 09/09/2021
Onset Date: 09/11/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: COVID PCR test, September 14, 2021.

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Sore throat, fatigue. This began 2 days after the injection; I woke up with the sore throat.

Other Meds: Aspirin 81 mg daily; Atorvastatin 20 mg daily; Losartan-HCTZ 50-12.5 daIly; Lumigan 0.01% 1 drop in left eye daily; Melatonin 5 mg daily; Timolol maleate 0.5% 1 drop daily in left eye; Tamsulosin 0.4 mg daily; Turmeric 1500 mg daily; Magnes

Current Illness: None

ID: 1752839
Sex: F
Age: 41
State: WA

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore arm, sore throat for 5 days, headaches ongoing

Other Meds: Melatonin 5mg, norethindrone acetate and ethical estradiol 1/0.02mg

Current Illness: None

ID: 1752840
Sex: F
Age: 40
State: GU

Vax Date: 03/24/2021
Onset Date: 08/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow. Patient had D&C.

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Miscarriage, 08/2021

Other Meds: None

Current Illness: None

ID: 1752841
Sex: F
Age: 36
State: LA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: 9/23 I had blood drawn for a COVID antibody test that was negative. My white blood cell count was 10. something, the doctor said it said it was most likely from me being sick with a bacterial infection that I thought was a cold.

Allergies: Iodine, Kelp, shellfish, fin fish

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: I can't say it is from the vaccine, but since getting the shot my resting heart rate has been high. It was 120 resting when I first started checking on 10/8 when I was checking my pulse ox levels when I got sick with a cold since I didn't know if it was COVID. The illness resolved within 3 days and got antibodies testing for COVID after the fact since after the fact I found out I had exposure to COVID prior to getting sick. The COVID antibodies test showed no antibodies. Anyway, about 10/10 my resting heart rate was 120 and walking around my house or up the stairs would raise my heart rate to 150. I am now a month out and my resting heart rate is now down to 90-100. My resting heart rate remained elevated until about 9/25 then it started to return to normal slowly. It still goes up faster than normal. As I said, I am not sure if it was the vaccine or the illness since I had not taken my pulse from 10/1 to 10/8 when I first starting getting sick with what felt like a mild cold. But I do normally take my pulse, especially pre exercising and exercising and all the heart rates I have got during that time have never been in that range except for one time in 12/2020 that prompted an ER trip with a rapid pulse and constant vomiting (ultimately diagnosed as a virus- non covid).

Other Meds: Flexeral 10 mg as needed, advil as needed, Metformin 500 ER, Vitamin D 50000 IU 1x weekly, synthroid 88 mg, daily multivitamin, daily folate, daily 5000 IU Vitamin D

Current Illness: Jaw pain from clenching jaw/grinding teeth at night. Hashimotos Thyroid Vitamin D Deficiency

ID: 1752842
Sex: M
Age: 12
State:

Vax Date: 07/17/2021
Onset Date: 08/03/2021
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: lipase 4,883, CT abdomen with findings of uncomplicated acute interstitial pancreatitis.

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Patient admitted with pancreatitis 2 weeks after first covid vaccine. Discharged home after 2 day hospitalization for IV fluids and pain control. ***VAERs report should have ALREADY been filed by family in August 2021. Filing additional report given that I am unable to verify if reported

Other Meds: none

Current Illness: none

ID: 1752843
Sex: F
Age: 39
State: MA

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Redness on arm, slight itching

Other Meds: None

Current Illness: None

ID: 1752844
Sex: F
Age: 23
State: GU

Vax Date: 04/17/2021
Onset Date: 05/01/2021
Rec V Date: 10/01/2021
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: First trimester miscarriage confirmed post vaccine by ultrasound and Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow.

Allergies: None

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

Symptoms: Miscarriage on 05/2021.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1752845
Sex: F
Age: 22
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: N/A

Allergies:

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Medical Assistant accidentally gave patient a dose from a Janssen vial that was no longer viable. Vial was initially punctured on 9/29/21, and thus should not have been used today (date of service was 9/30/21). Medical director did call and speak with patient. Patient is aware that she was given a Janssen dose that was no longer viable. Patient denied adverse effects at time of this call between patient and medical director.

Other Meds:

Current Illness:

ID: 1752846
Sex: F
Age: 43
State: AL

Vax Date: 09/01/2021
Onset Date: 09/21/2021
Rec V Date: 10/01/2021
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: Gluten

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

Symptoms: Two and a half weeks after the second shot (around September 21st) I started getting red spots on my back and back of thighs. The spots have spread and turned dark. They do not itch nor hurt as of yet. They are predominately on my upper back legs and all over my back. A few spots are now appearing under left breast stomach region. I called a dermatologist and my primary care physician this week. My primary care physician told me over the phone I should go to the emergency room. Since I am not in pain, I told them an emergency clinic would be a better option. This evening around 5:00p.m I visited a clinic and the physician explained to me that he?s seen such skin eruptions before as a result of the Covid vaccine but never on dark skin as of yet. He explained that the research is limited as of now as to why some have this reaction. The timer is running out and I am not able to finish this report, but can explain more details if needed later.

Other Meds:

Current Illness: None

ID: 1752847
Sex: F
Age: 55
State: MD

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Developed moderate fever and whole body muscle sore as well as fatigue after about 10 hours of getting both the third (booster) dose of the Moderna Covid vaccine (left arm) and flu vaccine (right arm). Also significant red swelling and pain at the injection site of Covid vaccine, but the flu vaccine injection site has minimal redness/pain. Took 2 aspirin around 12:30 mid night and fever continued (not getting worse ) about an hour after taking aspirin pills.

Other Meds: Statin, met formal, melatonin, zanax

Current Illness: None

ID: 1752848
Sex: F
Age: 39
State: GU

Vax Date: 12/29/2020
Onset Date: 07/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow. Bled heavily, did not need D&C.

Allergies: Zofran

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Miscarriage / heavy bleeding, 07/2021 LMP, 08/12/2021

Other Meds: Fish oil, Via D3, Orthotricyclin-20

Current Illness: None

ID: 1752849
Sex: F
Age: 43
State: MA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 10/01/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: 2 ekgs tons of bloodwork I am supposed to wear a holtor monitor at home, haven?t gotten it yet (am waiting for it in mail)

Allergies: Nsaids, opiates, iv contrast, gadolinium, shellfish, vancomycin, levaquin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Immediate reaction: hives, flushing, tachycardia, swelling of tongue (did not need epi) Prolonged reaction: tachycardia and hypertension am now on calcium channel blockers which I was not previously on. Extensive cardiac work ups have shown no issue possibly mast cell related but again drastically different than how my heart behaved prior to vaccine. Menstrual irregularities: period started 5 days early on 9/6 and lasted until 9/15, very heavy lots of clotting. I had a colonoscopy during this time and all the doctors and nurses noted concern that my period was extremely heavy, I can provide their names. Menstrual irregularities pt 2: on sept 30th, two weeks after my previous menstrual cycle I began another period. Again heavy and clotty.

Other Meds: Garlic, quercitin, hydroxyzine, gastrocrom, klonopin, ketotifen, Benadryl

Current Illness: Kidney stone

ID: 1752850
Sex: F
Age: 47
State: OR

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None

Allergies: All Dust, Trees, Grass, Dander, Mold Egg Intolerance , Sulfa intolerance. Chemical intolerance: gas stain bleach

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

Symptoms: While in the shower on Sunday - 2 days after- I started coughing and could not catch my breath for the duration of about an hour. It was scary. Chest tight. Wheezing and coughing. Felt scared I couldn?t breathe. It lessened in about an hour. I didn?t eat anything that night for fear of getting it stuck in my throat and scared of not breathing. I also started crying. The next few days were of severe pain in my jaw and ears and head. The jaw and ear pain was extremely significant. This lasted for 3 days. Kept me awake and ibuprofen did nothing. I also used ice packs. The pain was intense and throbbing for 3 straight days.

Other Meds: Zoloft Advil multi flax oil Loestrin-fe 1/20 D C Iodine Clariton-D

Current Illness: None

ID: 1752851
Sex: F
Age: 36
State: GU

Vax Date: 01/23/2021
Onset Date: 06/20/2021
Rec V Date: 10/01/2021
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: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow.

Allergies: Bactrim

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

Symptoms: Miscarriage, 06/20/2021

Other Meds: OTC multivitamins

Current Illness: None

ID: 1752852
Sex: M
Age: 37
State:

Vax Date: 09/02/2021
Onset Date: 09/09/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Body aches and numbness, nerve pain and jolts.

Other Meds: N/A

Current Illness: N/A

ID: 1752853
Sex: F
Age: 55
State: FL

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/01/2021
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: None

Allergies: Iodine, mercury, sulfites, tropical fruits, seafood, colorants and preservatives, artificial sweeteners, stevia, sucralose, rebaudioside

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

Symptoms: Arthritis flair, pretty bad.

Other Meds: Vitamin D3, magnesium, vinegar gummies,

Current Illness: None

ID: 1752855
Sex: M
Age: 33
State: UT

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: After receiving the shot at noon, I began to feel shortness of breath and chest pain by evening, and by night time, I was experiencing fever. I was shivering and sweating at the same time in my bed that night. The following day (today) the shortness of breath and chest pain are still present, although less intense.

Other Meds:

Current Illness:

ID: 1752857
Sex: F
Age: 49
State: FL

Vax Date: 09/29/2021
Onset Date: 10/01/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: Kiwi, penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chills, fever of 101.2, body aches, skin sensitivity, inability to sleep,arm, where bad was given was very sore, restlessness started the night received the third booster shot

Other Meds: None

Current Illness: None

ID: 1752859
Sex: F
Age: 31
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/01/2021
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: Nausea, headache, weakness, stuffy nose, body aches

Other Meds: Suboxone film

Current Illness:

ID: 1752861
Sex: M
Age: 69
State: NJ

Vax Date: 02/03/2021
Onset Date: 02/07/2021
Rec V Date: 10/01/2021
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: NONE

Allergies: LATEX AND SOME ADHESEVES

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: EXTREME SWELLING OF BOTH ANKLES AND BOTH LEGS, PURPULISH PATCH NER TOES OR RIGHT LEG

Other Meds: PREDNISONE, CELL CEPT, PROGRAF, TAMSULOSIN, VITAMIN D3 5000, PQQ, MULTIVITAMINS

Current Illness: NONE

ID: 1752862
Sex: F
Age: 38
State: CA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Low WBC count

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Started bleeding heavily bloody thick clots since day 1. I have been changing my tampon AND pad 2-3 times daily. I feel more fatigued and cannot exercise as well as I did before. More foggy sometimes blurry vision and edema and swelling in legs

Other Meds:

Current Illness:

ID: 1752863
Sex: F
Age: 43
State: OH

Vax Date: 09/04/2021
Onset Date: 09/12/2021
Rec V Date: 10/01/2021
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: None

Allergies: Latex/adhesive skin reactions only

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Rash on bilateral shins. Started as 5 red spots, Progressed over 48 hours to form one large area of redness to right distal knee/shin and one small area of redness on left ankle.

Other Meds: Fluoxetine, Mydayis

Current Illness: None

ID: 1752864
Sex: F
Age: 42
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: Not that aware of

Symptom List: Nausea

Symptoms: Became extremely tired a few hours after administration of the Jansen. At approximately 12am, 10/1, I was woken up w body aches, headache, stuffy nose, sore left arm & sore shoulder blade, burning eyes, inability to sleep due to overall discomfort.

Other Meds: Probiotics

Current Illness: None that aware of

ID: 1752865
Sex: M
Age: 50
State: TN

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Too sick to seek treatment yet , reported to primary physician and pharmacy where shots received Had similar reaction on 1st dose which took 5 days to resolve 2nd dose problems materialized more quickly with symptoms being greater in intensity

Allergies: None

Symptom List: Injection site pain

Symptoms: Sudden onset right arm pain, runny nose, knot at injection site, body aches, fever, shortness of breath, wheezing , sore eyes / eye pain; weakness, extreme fatigue , chest pain

Other Meds: Have not taken any

Current Illness: None

Date Died:

ID: 1752991
Sex: F
Age:
State: MT

Vax Date:
Onset Date: 05/07/2021
Rec V Date: 10/01/2021
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: patient was diseased; a dose from the recalled batch was meant to be administrated; pharmacy dispensed a dose from the recall batch; This case was reported by a pharmacist via call center representative and described the occurrence of unknown cause of death in a 65-year-old female patient who received Herpes zoster (Shingrix) (batch number 9lh3y, expiry date 7th February 2022) for prophylaxis. On an unknown date, the patient received Shingrix. On 7th May 2021, unknown after receiving Shingrix, the patient experienced drug dispensing error. On an unknown date, the patient experienced unknown cause of death (serious criteria death and GSK medically significant) and recalled drug administered. On an unknown date, the outcome of the unknown cause of death was fatal and the outcome of the recalled drug administered and drug dispensing error were unknown. The reported cause of death was unknown cause of death. It was unknown if the reporter considered the unknown cause of death to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported. The pharmacist reported that, their pharmacy dispensed on 7th May 2021 a dose of Shingrix from the recall batch. The vaccine was meant to be administrated to a female patient but the facility was unaware of the date of the administration. The health care professional clarified that, the patient was diseased but did not clarify if there was a relationship between the death of the patient and the administration of the vaccine. No further events were reported. The Shingrix doses were administrated in another facility and the reporter did not know when (exact date) or if the vaccines were in fact administrated, they only have the date in which the vaccines were dispensed from the pharmacy which were after the date of the Shingrix recall. The reporter did not know if the patients had adverse events after the administration of the vaccine. The health care professional agreed to be contacted for follow up. This is 1 of the 3 linked cases, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021202998:same reporter US-GLAXOSMITHKLINE-US2021203000:same reporter; Reported Cause(s) of Death: Unknown cause of death

Other Meds:

Current Illness:

ID: 1752994
Sex: F
Age: 49
State: MI

Vax Date: 07/29/2021
Onset Date: 09/05/2021
Rec V Date: 10/01/2021
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: Not able to walk/had a hard time walking unless she held on to something; first dose was given on 29-JUL-2021 and second dose was given on 05-SEP-2021 (more than 35 days); This spontaneous case was reported by a consumer and describes the occurrence of GAIT DISTURBANCE (Not able to walk/had a hard time walking unless she held on to something) in a 50-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 088021A and 006D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 29-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose was given on 29-JUL-2021 and second dose was given on 05-SEP-2021 (more than 35 days)). On 15-Sep-2021, the patient experienced GAIT DISTURBANCE (Not able to walk/had a hard time walking unless she held on to something) (seriousness criterion disability). On 05-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose was given on 29-JUL-2021 and second dose was given on 05-SEP-2021 (more than 35 days)) had resolved. At the time of the report, GAIT DISTURBANCE (Not able to walk/had a hard time walking unless she held on to something) outcome was unknown. Concomitant medication use information was not provided by reporter. Treatment medication use information was not provided by reporter. About 10 days after the second dose of vaccination, patient found herself not able to walk. When she got up, she had a hard time walking unless she held on to something. Company comment: This report concerns a 50 year old female patient with no relevant medical history who experienced an unexpected serious event of gait disturbance (reported as not able to walk or have hard time walking). The event was reported with a seriousness criteria of disability. The event occurred approximately 10 days after vaccination with second dose of mRNA-1273. Based on the current available information, inappropriate schedule of vaccine administration (as the latency between the 2 vaccine doses is more than 35 days) was considered as an additional event. The rechallenge was assessed as not applicable as the event happened after the second dose of the vaccine. The outcome of the event was reported as unknown at the time of the report. The benefit-risk relationship of mRNA-1273 is not affected by this report. The onset date for the event of gait disturbance was found to be discrepant in the SD, however it was captured as per the reported information in the SD narrative.; Sender's Comments: This report concerns a 50 year old female patient with no relevant medical history who experienced an unexpected serious event of gait disturbance (reported as not able to walk or have hard time walking). The event was reported with a seriousness criteria of disability. The event occurred approximately 10 days after vaccination with second dose of mRNA-1273. Based on the current available information, inappropriate schedule of vaccine administration (as the latency between the 2 vaccine doses is more than 35 days) was considered as an additional event. The rechallenge was assessed as not applicable as the event happened after the second dose of the vaccine. The outcome of the event was reported as unknown at the time of the report. The benefit-risk relationship of mRNA-1273 is not affected by this report. The onset date for the event of gait disturbance was found to be discrepant in the , however it was captured as per the reported information in the narrative.

Other Meds:

Current Illness:

ID: 1752995
Sex: F
Age: 43
State: OH

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 10/01/2021
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: None

Symptom List: Tremor

Symptoms: Severe chest congestion and shortness of breath for 2.5 weeks at this point. For 2 days after I had server headache, back pain, chills.

Other Meds: Birth control, iron supplements

Current Illness: None

ID: 1752996
Sex: M
Age: 66
State:

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 10/01/2021
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: Paralysis

Other Meds:

Current Illness:

ID: 1752997
Sex: M
Age: 45
State: MD

Vax Date: 05/20/2021
Onset Date: 05/30/2021
Rec V Date: 10/01/2021
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: Bee stings

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

Symptoms: Sleeplessness, hives, headaches

Other Meds: None

Current Illness: None

ID: 1752998
Sex: F
Age: 28
State: MA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: None

Allergies: Bees Mulberries

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

Symptoms: Fever, chills, migraine, hot flashes, slurred speech all night after receiving dose. Next morning deep, painful cough.

Other Meds:

Current Illness: None

ID: 1752999
Sex: M
Age: 71
State: MI

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient was erroneously given undiluted vial of Pfizer COVID vaccine, equivalent to 5-6 doses. Was monitored in clinic for 1.5 hours afterward with stable q15m vitals. Patient felt clammy but otherwise no side effects.

Other Meds: aspirin, atenolol, dulcolax, fenofibrate, lasix, PRN neurontin, glimepiride, ketoconazole cream, lisiniopril, lovastatin, metformin XR, PRN nitroglycerin, omeprazole, zofran, K-dur, flomax, kenalog cream, maxzide

Current Illness:

ID: 1753000
Sex: F
Age: 46
State: MA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: Site: Itching at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Chest Tightness / Heaviness / Pain-Severe, Additional Details: pt had vaccine rxn about 20 min after receiving moderna. itching then swelling, then hives, asked for epi I called 911, Watched pt but she went pale and said had difficulty breathing. gave epinepherine 30 mins after vaccine. ambulance came and took her to hospital.

Other Meds:

Current Illness:

ID: 1753001
Sex: M
Age: 52
State: CA

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 10/01/2021
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: None

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

Symptoms: One day following administration, developed leg pain. 10/1/21, diagnosed with extensive left leg DVT extending from superficial femoral vein to proximal tibial vein

Other Meds: None

Current Illness: Unknown

ID: 1753002
Sex: M
Age: 84
State: NC

Vax Date: 09/23/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Pain in extremity

Symptoms: Resident received Moderna on 9/23 and Janssen on 9/30

Other Meds:

Current Illness:

ID: 1753003
Sex: M
Age: 54
State: WI

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: PCR test for COVID Sept 9, 2021 positive result Sept 11, 2021

Allergies: none

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

Symptoms: I started to feel sick on Sept 7, 2021. I was tested for COVID-19 on Sept 9, 2021, and received a positive PCR test result on Sept 11, 2021. I quarantined until Sept 20, 2021. My symptoms were congestion, headache, loss of taste and smell, and tiredness. The congestion and headaches lasted about 4 days. Tiredness lasted about 14 days. I still have a loss of taste and smell today, which is about 3 weeks from the start.

Other Meds: none

Current Illness: none

ID: 1753004
Sex: M
Age: 34
State: NV

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient was sitting upright then fell over to floor unconscious for 5 seconds, he slowly recovered Paramedics checked on him but he didn't want to go. He was fine

Other Meds:

Current Illness:

ID: 1753005
Sex: F
Age: 43
State: SC

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 10/01/2021
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: Systemic: Blood Disorder (diagnosed by MD)-Medium

Other Meds:

Current Illness:

ID: 1753006
Sex: F
Age: 59
State: TX

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Systemic: Allergic: Rash Generalized-Medium, Additional Details: pt had full body rash

Other Meds:

Current Illness:

ID: 1753007
Sex: F
Age: 15
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/01/2021
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: Systemic: Abdominal Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Additional Details: Patient recieved the vaccine and said it hurt when she got the injection and was crying. Patient was with her mom. Patient requested to go to the bathroom and her mother went with her. Patient then stated she was dizzy and laid down. After a few minutes patient stated she was feeling better and sat in a chair. After a few more minutes the patient went home with her mother. Rph talked to mom and told her to have patient seen by a doctor if symptoms progess or get worse.

Other Meds:

Current Illness:

ID: 1753008
Sex: M
Age: 43
State: IN

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 10/01/2021
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: None

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

Symptoms: Vertigo

Other Meds: Amatriptyline, loperamide, Zantac, Gemfibrozil

Current Illness: None

ID: 1753009
Sex: F
Age:
State:

Vax Date:
Onset Date: 03/31/2021
Rec V Date: 10/01/2021
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: GESTATIONAL DIABETES; DIARRHEA; VOMITING; MATERNAL EXPOSURE DURING PREGNANCY; COULD NOT SLEEP; CHILLS; FEELING UNWELL; HEADACHE; FATIGUE; This solicited pregnancy report received from a consumer concerned a 35 year old female of unknown ethnicity. The patient was enrolled in a non-company sponsored study. The patient's weight was 67.12 kilograms, and height was not reported. The patient's past medical history included: miscarriage, and recreational drug use, and concurrent conditions included: anxiety, non smoker, and non alcohol user, and other pre-existing medical conditions included: The patient had no history of exposure to tobacco. The patient was gravida 3, para 1, abortion 1. Patient was pregnant at the time of vaccination. Patient's last menstrual period was on 26-DEC-2020. The estimated delivery date (EDD) was reported to be 02-OCT-2021. It was reported that this was singleton pregnancy. The patient initiated treatment with covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808980 and expiry: UNKNOWN) dose was not reported, 1 total administered on 31-MAR-2021 (gestational age 13 weeks and 4 days) for prevention of covid-19 (covid-19 immunisation). Concomitant medications included Prenatal vitamins, and Zoloft (sertraline hydrochloride). On the same day, after receiving the vaccine, the patient experienced chills, fatigue, headache, vomiting, was feeling unwell and couldn't sleep from chills. Vomiting resolved during the same day, as the patient reportedly threw up only once, in the evening after getting the vaccine. On 01-APR-2021, the patient experienced diarrhea. On the same day, the patient recovered from chills, difficulty sleeping and diarrhea. On 02-APR-2021, the patient recovered from fatigue, feeling unwell and headache. On 30-JUL-2021, at gestational age of 30 weeks and 6 days, the patient developed gestational diabetes. On 12-SEP-2021, at gestational age of 37 weeks and 1 day, the patient delivered vaginally live male neonate. The patient spent one day in the hospital for the delivery. The neonate's birth weight was 2.57 kilograms, body length 18 inches. On an unspecified date in 2021, the patient recovered from gestational diabetes. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from gestational diabetes on 2021, could not sleep, chills, and diarrhea on 01-APR-2021, feeling unwell, headache, and fatigue on 02-APR-2021, and vomiting on 31-MAR-2021, and the outcome of maternal exposure during pregnancy was not reported. The reporter provided no causality assessment. Company causality between covid-19 vaccine ad26.cov2.s, and gestational diabetes, could not sleep, chills, feeling unwell, headache, fatigue, diarrhea, and vomiting was related, and between covid-19 vaccine ad26.cov2.s, and maternal exposure during pregnancy was not related. This report was serious (Other Medically Important Condition). Additional information was received from consumer on 29-SEP-2021. The following information was updated and incorporated into the case narrative: Pregnancy details added (outcome, gravida, para, EOP date, expected delivery date, number of abortions and child information), Event added (gestational diabetes), updated onset of event (diarrhea), added cessation and updated outcome for events (could not sleep, chills, diarrhea, feeling unwell, headache, vomiting and fatigue).; Sender's Comments: V1- 20210760467- covid-19 vaccine ad26.cov2.s ?Gestational diabetes. Follow-up received regarding Clinical Details. This event(s) is considered related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210760467- covid-19 vaccine ad26.cov2.s ? Maternal exposure during pregnancy. Follow-up received regarding Clinical Details. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS

Other Meds: ZOLOFT

Current Illness: Abstains from alcohol; Anxiety; Non-smoker

ID: 1753010
Sex: F
Age:
State: PA

Vax Date:
Onset Date: 08/25/2021
Rec V Date: 10/01/2021
Hospital:

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

Lab Data: Test Date: 20210922; Test Name: Electrocardiogram; Result Unstructured Data: Result not reported; Test Date: 20210923; Test Name: Echocardiogram; Result Unstructured Data: Normal; Comments: Normal; Test Date: 20210923; Test Name: Complete blood count; Result Unstructured Data: Normal; Test Date: 20210923; Test Name: Basic metabolic panel; Result Unstructured Data: Normal; Test Date: 20210923; Test Name: Blood test; Result Unstructured Data: Normal; Test Date: 20210923; Test Name: C-reactive protein; Result Unstructured Data: Normal

Allergies:

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

Symptoms: INFLAMMATORY RESPONSE TO THE VACCINE; VACCINE PROVOKED ARRHYTHMIA; SWOLLEN LYMPH NODES UNDER ARMS; FLU-LIKE SYMPTOMS; This spontaneous report received from a patient (who is a Nurse) concerned a 59 year old female. Initial information received on 25-Aug-2021 was processed with additional information received on 14-Sep-2021. This case was reassessed as serious based upon new information received from patient (nurse) on 14-Sep-2021. The patient's weight was 139 pounds, and height was 62 inches. The patient's past medical history included: two cardiac ablations, and concurrent conditions included: accelerated idioventricular rhythm, shellfish allergy, penicillin allergy, non alcohol user, and non smoker, and other pre-existing medical conditions included: The patient did not have any history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 21-SEP-2021) dose was not reported,1 total, administered on 25-AUG-2021 to left arm for prophylactic vaccination. Concomitant medications included metoprolol for vaccine provoked arrhythmia, accelerated idioventricular rhythm, and inflammatory response to the vaccine. On 25-AUG-2021, twelve hours after the vaccination, the patient experienced flu-like symptoms that were not severe, and resolved in 24-48 hours. On 11-SEP-2021, the patient experienced swollen lymph nodes under arms that went away in a day or two, and this happened multiple times where one swollen lymph node would resolve, and another would become swollen. On 14-SEP-2021, the patient noticed that had some skipped beats and this became more frequent. On 22-SEP-2021, the patient visited cardiologist because symptoms were not going away and the cardiologist suspected that the patient is experiencing an inflammatory response to the vaccine and had Electrocardiogram (NR: not provided) Result not reported and done and metoprolol was increased from 25mg twice a day to 100 mg/day. On 23-SEP-2021,the patient visited to family doctor. On 23-SEP-2021 had blood work done (NR: not provided) including a, basic metabolic panel (NR: not provided), C-reactive protein (NR: not provided), Complete blood count (NR: not provided), and Echocardiogram (NR: not provided), which resulted all normal and was prescribed an anti-inflammatory. The patient stated that symptoms are not getting any better, despite the increased dosage of metoprolol for 1 week. The patient will be following-up with a physician at the end of the week and stated that the vaccine seems to have provoked arrhythmia. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from flu-like symptoms on AUG-2021, and swollen lymph nodes under arms on SEP-2021, and had not recovered from inflammatory response to the vaccine, and vaccine provoked arrhythmia. This report was serious (Other Medically Important Condition).; Sender's Comments: V0 20210956440-COVID-19 VACCINE AD26.COV2.S-vaccine provoked arrhythmia. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY.

Other Meds: METOPROLOL

Current Illness: Abstains from alcohol; Accelerated idioventricular rhythm; Non-smoker; Penicillin allergy; Shellfish allergy

ID: 1753011
Sex: F
Age:
State: MA

Vax Date:
Onset Date:
Rec V Date: 10/01/2021
Hospital: Y

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

Lab Data: Test Name: CT angiography; Result Unstructured Data: cerebral artery occlusion; Test Name: Heparin-induced platelet antibody; Result Unstructured Data: Negative; Test Name: MRI brain; Result Unstructured Data: acute right MCA infarct; Test Name: Platelet count; Result Unstructured Data: 121000 /uL; Test Name: Platelet count; Result Unstructured Data: 30000 /uL; Test Name: Blood smear test; Result Unstructured Data: Confirmed thrombocytopenia and rare schistocytes; Test Name: Fibrin D dimer; Result Unstructured Data: 2960 ng/mL, Elevated; Test Name: Fibrin D dimer; Result Unstructured Data: 40000 ng/mL, Elevated; Test Name: INR; Result Unstructured Data: Normal; Test Name: Partial prothrombin time; Result Unstructured Data: Normal; Test Name: Fibrinogen; Result Unstructured Data: Normal; Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: SARS-CoV-2 RNA was not detected; Test Name: SARS-CoV-2 IgM antibody test; Result Unstructured Data: Negative; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: Negative; Test Name: Doppler ultrasound; Result Unstructured Data: Revealed right common femoral vein partially occlusive thrombosis; Test Name: Transthoracic echocardiogram; Result Unstructured Data: Negative for right-to-left shunt; Test Name: Coagulation factor V level; Result Unstructured Data: Negative; Test Name: Gene mutation identification test; Result Unstructured Data: Negative; Test Name: Hepatitis viral test; Result Unstructured Data: Non Reactive Negative; Test Name: HIV infection; Result Unstructured Data: Negative; Test Name: Syphilis test; Result Unstructured Data: Negative; Test Name: ANA; Result Unstructured Data: Negative; Test Name: ANCA; Result Unstructured Data: Negative; Test Name: Double stranded DNA antibody; Result Unstructured Data: Negative; Test Name: Anticardiolipin antibodies; Result Unstructured Data: Negative; Test Name: Beta-2 glycoprotein antibody; Result Unstructured Data: Negative; Test Name: Lupus anticoagulant; Result Unstructured Data: Negative; Test Name: Enzyme-linked immunosorbent assay; Result Unstructured Data: Positive; Test Name: Head CT; Result Unstructured Data: THE ALBERTA STROKE PROGRAM EARLY CT SCORE (ASPECTS) was 9

Allergies:

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

Symptoms: SEVERE THROMBOCYTOPENIA; ACUTE RIGHT MCA INFARCT; CEREBRAL EDEMA; HEMORRHAGIC TRANSFORMATION; ARTERIAL THROMBOSIS; VENOUS THROMBOSIS; SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report was received from literature: This report concerned a 37 year old female of an unspecified race and ethnic origin. The objective of this study was to describe, surfacing of rare severe thrombotic complications associated with thrombocytopenia within the first 3 weeks of vaccine. The patient's height, and weight were not reported. The patient's concurrent conditions included: migraines, and the patient received oral contraceptives. The patient received Covid-19 vaccine (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, 10 days post vaccination, the patient experienced acute onset of headache, dense left-sided hemiparesis with hemineglect and right gaze deviation. The Stroke Scale was 15. Acute computer tomography (CT) angiogram of head and neck showed occlusion of the right internal carotid artery terminus, segmental occlusions of the right middle cerebral artery (M1) and anterior cerebral arteries (A1 and A2). On head CT, the Alberta Stroke Program Early CT Score (ASPECTS) was 9. Intravenous tPA (Alteplase) was not administered given unknown last known well. The patient underwent mechanical thrombectomy, where modified treatment in cerebral ischemia (mTICI) score 2b recanalization was achieved after two passes. Brain MRI post-thrombectomy demonstrated an acute right middle cerebral artery (MCA) infarct with associated edema and hemorrhagic transformation. On admission (hospitalization), the platelet count was 121000/ul (reference range: 150-400000/ul) and rapidly declined reaching a nadir of 30000/ul within the next 24 h. A peripheral blood smear confirmed thrombocytopenia and rare schistocytes. Additional studies showed elevated d-dimer level (2960 ng/ml, peaking at over 40,000 ng/ml; reference range: <230ng/ml) normal international normalised ratio (INR), partial thromboplastin time (PTT), and fibrinogen. SARS-CoV-2 RNA was not detected on reverse-transcriptase polymerase-chain-reaction assay of nasopharyngeal swab. SARS-CoV-2 IgM/IgG was negative (suspected immunological vaccine failure). Doppler ultrasound revealed right common femoral vein partially occlusive thrombosis, acute deep vein thrombosis of the left brachial vein and bilateral cephalic veins. A transthoracic echocardiogram was negative for right-to-left shunt. Other testing included negative HemosIL Heparin-induced Thrombocytopenia platelet factor 4 antibody (HTI-Ab (PF4-H)) assay, factor V Leiden, prothrombin gene mutation, non-reactive hepatitis, human immunodeficiency virus (HIV), syphilis panels, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), and double stranded DNA antibody (dsDNA) antibodies. Given the rapid onset of concurrent arterial and venous thrombosis, there was suspicion for catastrophic antiphospholipid syndrome, however, anti-cardiolipin, anti-B2 glycoprotein and lupus anticoagulant were negative. The patient was empirically treated with two doses of intravenous immune globulin (IVIG) 1 gr/Kg (for 50 kg) and pulse intravenous (IV) dexamethasone 40mg for 4 days. Worsening midline shift on imaging and clinical deterioration prompted urgent decompression hemicraniectomy. The treatment with IVIG was followed by relative platelet count stabilization during a 7-day period. The enzyme-linked immunosorbent assay for antibodies against PF4 came back positive (1.986 optical-density units; normal range reference, 0.300), and argatroban drip was started (therapeutic target of 1.5 x base PTT). The action taken with Covid-19 vaccine was not applicable. The outcome of the severe thrombocytopenia, acute right MCA infarct, venous thrombosis, arterial thrombosis, suspected immunological vaccine failure, cerebral edema, and hemorrhagic transformation was not reported. The authors concluded, high index of suspicion in recently vaccinated people for COVID-19 and rapid recognition of VITT (which should include an approved PF4 ELISA) has important relevance for optimal management1 involving: IVIG,5 high-dose glucocorticoids, non-heparin anticoagulants and avoiding platelet transfusion (given the consumptive nature of this thrombotic phenomenon). This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender's Comments: V0: 20210957986-Covid-19 vaccine -arterial thrombosis, venous thrombosis, severe thrombocytopenia. This event(s) is labeled per and is therefore considered potentially related. 20210957986-Covid-19 vaccine ad26.cov2.s-acute right MCA infarct, cerebral edema, and hemorrhagic transformation. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210957986-Covid-19 vaccine ad26.cov2.s-suspected immunological vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS

Other Meds:

Current Illness: Migraine

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am