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: 1772973
Sex: M
Age: 60
State: WA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: AFIB: 3 trips to the ER in 8 day period following the initial Moderna vax. 2 of the 3 ER visits had to have his heart shocked back into rhythm due to AFIB. PERICARDITIS: Within 2 weeks diagnosed with pericarditis and treated with colchicine.

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: After being highly recommended/guilted by his cardiologist and PCP, he got his first covid vax at just 3 weeks post open heart surgery (CABG) - quadruple bypass and closure of hole in heart. He left the hospital after 1 week and was recovering normally, no issues. On 8/27 he got his 1st dose of Moderna. The following morning, he went into AFIB. Needed heart to be shocked back to normal rhythm. Happened again 2 more times. 3 trips to the ER within the 8 days following the first vaccination. Then, at the 2 week mark, he developed pericarditis (C Reactive Prot was 8.23mg/dl) and treated with colchicine for that for 2 weeks.

Other Meds: Lisinopril, Toprol XL, Eliquis, 81mg aspirin, Imdur, Crestor

Current Illness: Vaccination #1 Moderna given 3 weeks post CABG surgery (quadruple bypass)

ID: 1772974
Sex: F
Age: 73
State: KS

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
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: penecillin

Symptom List: Anxiety, Dyspnoea

Symptoms: headache for 2 days, severe diarrhea for 3 days

Other Meds: lisinopril, rosuvastatin, januvia, furosemide, diltiazem, repaglinide sodium bicar, iron, wal-flex, vitamin d3

Current Illness: none

ID: 1772975
Sex: F
Age: 71
State: MD

Vax Date: 04/04/2021
Onset Date:
Rec V Date: 10/08/2021
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: Dairy (lactose)

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

Symptoms: severe tremors in legs & arms, fever, mild flu-like symptoms (symptoms occurred on the next day (4/5) & only lasted 24 hours)

Other Meds: Met Formin, Glipizide, Sertraline, Atovastatin, Furosemide, Atenalol, multi vitamin/mineral, D3, CoQ 10

Current Illness: none

ID: 1772976
Sex: F
Age: 84
State:

Vax Date: 09/22/2020
Onset Date: 09/24/2020
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Paralysis on left side of her body (patient reports that she could not move the left side of her body -arms and legs). Patient noticed in the morning upon waking up two days after her vaccination. As a result, she fell and broke her right foot.

Other Meds:

Current Illness:

ID: 1772977
Sex: F
Age: 24
State: IN

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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 listed

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

Symptoms: Patient experienced dizziness and tingling in extremities shortly after vaccination (within approximately 5 minutes of injection). Stated shortly after, she was also having trouble breathing at the time. Patient sat down in the waiting room with feet raised for several minutes after experiencing side effects. After approximately 5 minutes of resting patient stated symptoms were abating. Tingling in the extremities and dizziness seemed to resolve completely approximately 15 to 20 minutes after vaccine administration. Patient did not describe any issues with breathing. At 30 to 45 minutes after vaccination, patient stated she was no longer experiencing any side effects and she felt safe taking herself home.

Other Meds:

Current Illness:

ID: 1772979
Sex: F
Age: 39
State:

Vax Date: 09/24/2021
Onset Date: 10/01/2021
Rec V Date: 10/08/2021
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: Bruising (Fri- Wed.), welts (Fri - Wed), itching arm (Thurs), pain in shoulder (Thurs - Sat.), and a blotch of redness (Fri 1 Oct - Sun) at site. Treatment was antihistamines and zyrtec.

Other Meds:

Current Illness:

ID: 1772980
Sex: M
Age: 15
State: AK

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Allergy to molds

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: scleral injection of one eye morning after vaccination, following day bilateral injection but slowly improving throughout the day

Other Meds: none

Current Illness: Covid + 9/15/2021

ID: 1772981
Sex: M
Age: 65
State: CA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: The second dose was actually due on 10/14/2021, but as the date on the card for the 1st dose was written wrong, the 2nd dose was given 6 days earlier than the actual due date.

Other Meds:

Current Illness:

ID: 1772982
Sex: M
Age: 66
State: WV

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient was given the Pfizer-BioNTech vaccines for his Booster shot but patient wanted the Moderna vaccines to complete his 3 series. At the time of call on 10/07/21, patient does not appear to show any adverse effects.

Other Meds: Rosuvastatin 40mg tablets, Lisinopril 10mg tablets, Fenofibrate 145mg tablet, Carvedilol 3.125mg tablet

Current Illness:

ID: 1772983
Sex: F
Age: 35
State: CO

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient had nausea and vomiting about 5 minutes after receiving her second dose of Moderna COVID 19 vaccine. It lasted about 20 minutes, then she felt fine and left the pharmacy.

Other Meds:

Current Illness:

ID: 1772984
Sex: F
Age: 49
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: Morphine

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

Symptoms: Fever up to 102.5, chills, muscle and joint pain all over body, headache, tremor

Other Meds: Gabapentin, tamoxifen

Current Illness:

ID: 1772985
Sex: F
Age: 78
State: CO

Vax Date: 10/05/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: Sulfa antibiotics

Symptom List: Rash, Urticaria

Symptoms: Morning of 10/8/21, patient noticed pronounced flushing of face, neck and chest although no itching.

Other Meds: Metoprolol ER 25mg 1/2 tab QD Dicyclomine 10mg 1-2 q 6 hours PRN

Current Illness:

ID: 1772986
Sex: F
Age: 19
State: WV

Vax Date: 06/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: Potassium 3.4 BUN 5 ALT 43 Neutrophil % 78 Neutrophil # 8.70 SARS-CoV-2 Not Detected MRI Brain- unremarkable MRA Head- unremarkable intracranial vasculature Multiple mucosal retention cysts/polyps noted in the maxillary sinuses. Ct angio head- no stenosis or occlusion and no sinus thrombosis. Erythrocyte Sedimentation Rate- 26

Allergies: No known allergies

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

Symptoms: 3rd Moderna dose recorded in system on 6/6/21 (no lot number documented) ER note by Dr: History of Present Illness: The patient is a 19 y.o. female who presents to the ED with Double Vision Yesterday onset with diplopia with lateral vision to each side but normal when looking forward. No previous episodes. Mild headache with some tingling to the neck fingers and both arms. Vision otherwise not impaired. Also with back pain over the past 2 days. No recent neck injury or head injury in the last week. Also with speech issues with difficulty saying certain words. Also with recent cold symptoms with cough, runny nose and muscle. No exposure to covid and had negative COVID test. Positive BCP. No fever documented. Feels she has forgotten how to walk and knees are giving out. BP- 108/87, 99/55, 99/62 SpO2- 97%, 97%, 97%, 97% Constitutional: Appears well-developed in no acute distress. Hair is significantly impaired where she needs assistance from her mother to walk to the examination room. Eyes: Pupils are equal, round, and reactive to light. With extraocular movements she does demonstrate some significant abnormalities with each eye demonstrating some impairment with medial gaze causing strabismus with lateral gaze that is much more severe to both sides. Neurological: The patient is alert, she has no focal sensory or motor deficits to the extremities, she does have cranial nerve deficits as described previously there is no facial droop. She does have a gait disturbance. Given aspirin, but will start on heparin if thrombus noted. ER note by Ernesto Nunez, RN: Reporting double vision since waking up this morning, dizziness since yesterday, and pain to the back of the head that has been going on for about a week. States that she has been feeling ill for a few days but tested negative for COVID. Unsteady gait, requires someone to help balance to help her stay upright. H&P note by Dr: Information obtained from: patient, mother and history review via medical record. Chief Complaint: Double vision. History of Present Illness: Patient is a 19 y.o., White female right-handed student who presents with sudden onset of diplopia, disequilibrium, tingling of extremities, posterior neck and lower back discomfort, and distorted speech. She states that last evening she began with diffuse odd feeling of dizziness and tingling in her hands and throughout her extremities but was otherwise normal. She and her mother felt that this was likely due to vertigo from recent URI. However, upon arising this morning she noticed considerable diplopia and progressive worsening of symptoms. Has also noted difficulty with ambulation, feeling unsteady and mother describes significant stepping, unsure gait. She denies significant headache, chest pain, shortness of breath, nausea, vomiting, fever, chills, dysuria, incontinence or visual field cuts. She has not had previous similar symptoms. She is up-to-date on her childhood vaccines and has received 2 doses of Moderna COVID-19 vaccine completed on 4/24/21. ED evaluation revealed what appeared to be significant bilateral abducens paralysis. Imaging was pursued with MRA of the brain, MRI of the brain and CT angiogram of the head and neck which have revealed no significant pathology. Case was discussed with the on-call neurologist who felt the patient should be admitted for further evaluation and would like an MRI of the brain with contrast for further investigation. She will be admitted with internuclear opthalmoplegia and other neurologic symptoms for further evaluation and treatment. Vaccinations: Pneumovax- Does not meet criteria to receive. Influenza- Will order influenza vaccine. COVID- Yes Moderna 2nd 4/24/21. Family History: Brother, 17 y.o., being evaluated for possible seizure disorder HTN--father No family history of clotting disorder Social History: Occasional ETOH Denies marijuana or other illicit drugs No tobacco Student at WVU Temp- 37.1 ?C (98.7 ?F), HR- 104, BP- 145/86, RR- 20, SpO2- 98% Neurologic: Pt has "full" mouth voice, some mild dysarthria, obvious dysconjugate gaze, difficulty with abduction of eyes bilaterally, few beats nystagmus on extreme lateral gaze, ? Bilateral 3rd CN palsy, MM strength 5/5 thru-out exam, no dysdiadochokinesia, heel to shin normal, no past pointing. No truncal ataxia in seated position. Ataxia with standing, unsteady, steppage gait. No major sensory deficit. Internuclear opthalmoplegia, bilateral --examination of EOM has been somewhat inconsistent and difficult due to significant diplopia and provoked dizziness --patient has other symptoms including ataxia, steppage gait and paresthesias --etiologies would would include multiple sclerosis, ischemic injury, Miller-Fisher syndrome, MG or infectious/inflammatory process --will check MRI of brain with contrast in a.m. with MS protocol --chexk Lyme titer, ANA, dsDNA, CRP, ESR, hypercoagulability studies --may require LP for further investigation and to rule out meningoencephalitis or demyelinating process --consult neurology to direct further investigation and treatment --serial Neuro exam --monitor closely for development of muscle weakness --assess for VAERS reporting if inflammatory etiology discovered Note by RN: ? double vision, eyes crossed and unable to focus, dizziness, talking "different" (nasally sound to voice, and "weird" feeling when swallowing.

Other Meds: Lo Loestrin OCP

Current Illness: None

ID: 1772987
Sex: F
Age: 43
State: TX

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: Penicillin; Contrast dye

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

Symptoms: Itching, rash.

Other Meds: SYMBICORT; VENTOLIN; ZYRTEC; SYNTHROID

Current Illness: None

ID: 1772988
Sex: M
Age: 28
State: WA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: nkda

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

Symptoms: After getting the shot pt became light headed and passed out. We laid him down and elevated his feet and he came back immediately. We had him rest on the ground for about 5 minutes then sat him in a chair for about 20 more minutes at which time pt said he felt fine and wished to go home. We advised for him to have a driver take him but he declined. Pt was very sure he was fine. Prior to the shot he expressed anxiety and hesitation about the shot but wanted to proceed. The adverse effect was most likely anxiety related. We followed up with him at home approx 1 hour later and he was fine. We advised he discuss reaction with MD.

Other Meds:

Current Illness:

ID: 1772989
Sex: F
Age: 31
State: IL

Vax Date: 06/18/2021
Onset Date: 07/02/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: ANA/9 C-IGG ANA/9

Allergies: None before the vaccine, it was noticed after vaccine I am allergic to hydroxychloroquine

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

Symptoms: Weakness, joint pain which lead to Lupus diagnosis

Other Meds: No prescriptions, protein shakes, food supplements

Current Illness: None

ID: 1772990
Sex: M
Age: 59
State: AL

Vax Date: 07/30/2021
Onset Date: 08/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Eeg 8/26 and mri found nothing irregular

Allergies: None

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

Symptoms: Severe brain fog, confusion, memory loss, cognitive decline, constant headaches. Primary care dr referred to neurologist that ran eeg and mri, found no problems. Prescribed prednisone which had no effect. Have taken otc aleve, excedrin which also has no effect. Still experiencing constant headaches and brain fog to date

Other Meds: Pravastatin, fenofibrate, atenolol

Current Illness: None

ID: 1772991
Sex: M
Age: 59
State:

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Left shoulder pain and weakness - 2 weeks Chest tightness and pain - randomly for 2 weeks

Other Meds: Levoxil - 25 mcg

Current Illness: None

ID: 1772992
Sex: M
Age: 36
State: AZ

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Chest X-ray

Allergies: NKDA, No know food allergies.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The patient began to vomit about 15 minutes after the first Moderna vaccination on 4/22/21. On 4/29/21, he was still c/o feeling "weird" from the vaccination, feeling hot, then cold and coughing. He also complained of bilateral lower lung pain. He was seen multiple times over the next 6 months and his symptoms progressed and persisted with chronic wheezing and congestion. He had no prior history of lung disease and now has to use both an albuterol inhaler and occasional nebulizer treatments. He also states that he was able to play basketball for 3 hours straight without difficulty until he got the first Moderna vaccine. After that, he hasn't been able to breathe as well and this became much worse after the second Moderna vaccine on 5/20/21. Now he can play basketball for about 45 minutes but is limited by shortness of breath. He says the breathing and decreased energy became much worse after the second Moderna vaccine.

Other Meds: The patient was not taking any medications, supplements, or herbal remedies.

Current Illness: None, healthy male at time of vaccination. He had prior COVID-19 infection in 12/2020 from which he had very mild symptoms and completely recovered.

ID: 1772994
Sex: F
Age: 40
State: AR

Vax Date: 10/05/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: strength test

Allergies: none

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

Symptoms: right hand and fingers tingling

Other Meds: Mucinex and benzonatate

Current Illness: active covid 19

ID: 1772995
Sex: F
Age: 71
State: WA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: Allergy to food but unknown what caused anaphylaxis

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

Symptoms: Patient was given Fluad. She had no history of adverse events with flu shots. Within 3 minutes of administration, patient was hot, felt nausea/vomiting, could not see well, and also had tightness in her chest.

Other Meds: N/A

Current Illness: none

ID: 1772996
Sex: F
Age: 51
State: SC

Vax Date: 09/12/2021
Onset Date: 09/15/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: 10/04/2021 MRI - no findings

Allergies: Penicillin, Tetracycline, Sulfa

Symptom List: Unevaluable event

Symptoms: Within 2 to 5 days of 2nd dose, I began having an increase in eye floaters which graduated to seeing three dimensional shapes like orbs in various colors. Over a period of a week, these became full blown hallucinations of objects floating or moving in and out of walls. This has continued on through today, increasing in intensity. Have seen visions of people and objects. Occurs while lying down either trying to go to sleep or after waking up. Also having chills off and on, predominantly in my legs. Have also been experiencing a sensation of bed shaking / vibrating for over 1.5 years. Unsure if related.

Other Meds: Metoprolol ER 50 mg, Meloxicam 15mg, Venlafaxine ER 75mg, Euthyrox 200mcg

Current Illness: N/A

ID: 1772997
Sex: M
Age: 32
State: OR

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: None

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

Symptoms: Moderately painful (6/10) intermittent headache from 05:30 am to 3:00 pm. Pain was across the back of my head starting at the back of each ear, and across the back. Back of the head and ears were tender to palpation. Headache felt like an electrical shock across the back of my head, happening about 5-10 times per hour. Only treatment I tried was Excedrin, without benefit. Pain succeeded on its own approx. 3 hours after Excedrin was taken by mouth. I rarely have headaches <6 times per year.

Other Meds: None

Current Illness: None

ID: 1772998
Sex: M
Age: 65
State: VA

Vax Date: 08/20/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Ultrasound Right Leg Venous Doppler DVT Deep vein thrombosis present in veins

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Diagnosis Blood Clot Blood Thinner

Other Meds: Lipitor, Myrbetriq, Tamsulosin, wixela, Methocarbamol

Current Illness: none

ID: 1773146
Sex: F
Age: 63
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient under 65 years old received high dose vaccine

Other Meds: N/A

Current Illness: NA

ID: 1773147
Sex: F
Age: 41
State: TX

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 10/08/2021
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: Day 1- Dizzyness, over the following weeks, developed ear fullness,, tinnitus, extreme vertigo (immobile), exercise induced migraine . Symptoms continue.

Other Meds:

Current Illness:

ID: 1773148
Sex: F
Age: 64
State: PR

Vax Date: 09/02/2021
Onset Date: 09/09/2021
Rec V Date: 10/08/2021
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: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The day of Sept 9, an itching began in the belly from the navel to the left side. The itch was all the time and not controlled. It formed a few hives. I went to the doctor Sept 15 and was diagnosed with Shingles. They medicated me with ZOVIRAX 800mg for 7 days.

Other Meds: ATACAND; TRILIPIX; PLAQUENIL; Folic acid; WELLBUTRIN; LOVAZA.

Current Illness:

ID: 1773149
Sex: F
Age: 87
State: IL

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

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

Lab Data:

Allergies: Codeine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient described Arm pain that persisted for at least a week which has resolved. However, the patient has now reported neck pain after the resolution of the arm pain.

Other Meds: Levothyroxine, Rosuvastatin, Lisinopril, Naproxen

Current Illness:

ID: 1773150
Sex: F
Age: 22
State: MO

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 10/08/2021
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: Burning sensation in hands, chronic on and off. Lump in neck/clavicle area.

Other Meds:

Current Illness:

ID: 1773151
Sex: F
Age: 71
State: OR

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: Pt was at the pharmacy to receive third dose Moderna for immunocompromised. She was inadvertantly given Pfizer.

Other Meds:

Current Illness:

ID: 1773153
Sex: F
Age: 36
State: WV

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

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

Lab Data: ER visit at hospital, additional tests WVU internal medicine.

Allergies: No

Symptom List: Injection site pain

Symptoms: Racing heart that night (150bpm recorded at home), went to ER, had low grade fever avg 99.5. Sunday- Wed, began having heart palpitations Tuesday and ongoing as of today (Friday).

Other Meds: Alive chewable vitamin

Current Illness: Abdominal pain/ bloating

ID: 1773155
Sex: M
Age: 70
State: CA

Vax Date: 01/26/2021
Onset Date: 03/21/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: EKG performed at Dr office after experiencing 7 or 9 episodes and was told the Bradycardia showed on the EKG. Currently wearing a heart monitor for a couple weeks (results unknown) and will mail the device to the lab for analysis 10/14/2021

Allergies: None

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

Symptoms: 2nd dose of Moderna lot 103M20A. Beginning in March continuing through the beginning of August I began having episodes of Bradycardia approximately 2-3 weeks apart for a total of 21 episodes. Have not experienced an episode since mid August.

Other Meds: Loser tan, Atenolol, Simvistatin, Asprin, Omeprazole Turmeric, Fish Oil, E, D3, B12, Acidophilus & Probiotic complex

Current Illness: None

ID: 1773156
Sex: F
Age: 58
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 10/08/2021
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: none

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

Symptoms: A few days after receiving the vaccination started experiencing ringing in my left ear which I continue to suffer from to this day. Had nausea, headache and heart palpitation that lasted for about 4 weeks after the vaccination.

Other Meds: none

Current Illness: none

ID: 1773157
Sex: M
Age: 56
State: VA

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: I went to an ENT and had a hearing test. My hearing had not changed that much since it was last tested. They were not able to do anything about the tinnitus.

Allergies:

Symptom List: Tremor

Symptoms: I noticed that my existing tinnitus became much louder two days after the second dose. Since then the tinnitus has stayed loud and has not come down in volume to this day.

Other Meds: Losartan 50mg/day

Current Illness:

ID: 1773158
Sex: F
Age: 16
State: AZ

Vax Date: 03/10/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: none

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: there was no adverse reaction to any dose. Patient was given a third booster dose in error. She is only 16 and does not qualify. system will not let me enter this on subsequent page, but patient received the Afluria quadravalent flu vaccine, lot #P100352313 on 9/18/2021 (within one month prior to 3rd COVID dose)

Other Meds: unknown

Current Illness: unknown

ID: 1773159
Sex: F
Age: 44
State: IN

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/08/2021
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: Na

Allergies: None

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

Symptoms: Left ancillary lymph node swelling

Other Meds: Vyvanse, clonazepam, nuvaring

Current Illness: None

ID: 1773160
Sex: M
Age: 17
State: AZ

Vax Date: 03/10/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: ketorolac - unknown reaction

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

Symptoms: there was no adverse reaction to any dose of vaccine. This was an administration error of a 3rd Pfizer dose in a patient who was too young (17). Pfizer lot # of 3rd dose = FF2590, given on 10/7/2021 IM in right deltoid. System will not let me enter on next page, but patient also received Flulaval lot #24BM2 intramuscularly in left deltoid on 10/7/2021.

Other Meds: unknown

Current Illness: unknown

ID: 1773161
Sex: F
Age: 53
State: TX

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None - I didn?t go to my doctor. I went home and rested.

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Explosive diarrhea without any warning 24 hours after booster shot. It happened in two seconds and was down my jeans pant leg and on the floor before I could do anything. This is very embarrassing, but nothing like that has happened to me before. I had really bad muscle pain and headache, but took Tylenol and felt better. I went to work and then this happened.

Other Meds: Sertraline 200mg, Ropinerole 4mg, Tylenol

Current Illness: None

ID: 1773162
Sex: M
Age: 32
State: OR

Vax Date: 10/04/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: Blood test came back for increased levels of troponin. CT scan, X-rays, heart ultrasound, and covid test all came back negative

Allergies: None

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

Symptoms: Acute Myopericarditis - started having a tight chest and numb arm after second vaccine dose. Then had a stabbing sharp pain to my heart and couldn?t breathe. Had to rush to hospital and be put in emergency room for 2 days with medication to treat pain and the myopericarditis

Other Meds: None

Current Illness: None

ID: 1773447
Sex: F
Age: 51
State: ID

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

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

Lab Data:

Allergies:

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

Symptoms: Aches chills fever nausea tiredness

Other Meds:

Current Illness:

ID: 1773448
Sex: F
Age: 30
State: KY

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: NKA

Symptom List: Pain in extremity

Symptoms: Fever, night sweats, chills, fatigue, pain and soreness for two days post vaccine.

Other Meds: None

Current Illness: N/A

ID: 1773449
Sex: M
Age: 36
State: IL

Vax Date: 03/11/2021
Onset Date: 08/26/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: To numerous to report here, can provide upon follow-up

Allergies: None

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

Symptoms: Extensive IVC and renal vein thrombus, multiple PEs, hospitalized for 5 days. Experienced syncopal episode due to decreased preload secondary to thrombus. Emergent evaluation in the ED. CTs revealed extensive clotting and PE. Required emergent cath procedure now on lifelong anti coagulation. Plan for further evaluation and additional cath procedures.

Other Meds: None

Current Illness: None

ID: 1773451
Sex: M
Age: 54
State: AR

Vax Date: 01/13/2021
Onset Date: 03/01/2021
Rec V Date: 10/08/2021
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: Brazilian nuts

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

Symptoms: Transient bradycardia with exhaustion. I am a physician and this resolved. I wear a fitness watch, which indicted the bradycardia. It resolved completely at some point without treatment. Additionally, after the first shot (12/20/20), I had a headache lasting days. After the second shot, (01/13/2021) I had another headache lasting days.

Other Meds: none

Current Illness: none

ID: 1773293
Sex: F
Age:
State: PR

Vax Date: 01/08/2021
Onset Date: 01/01/2021
Rec V Date: 10/09/2021
Hospital:

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

Lab Data: Test Date: 202101; Test Name: Covid-19 test; Result Unstructured Data: Test Result:Negative

Allergies:

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

Symptoms: hives; I have a dermatitis that covers almost all my body and it does not go away with any of the medicines I have been; This is a spontaneous report from a contactable other hcp (patient). A female patient of an unspecified age received BNT162b2 (CONMINTARY, Solution for injection, Lot No: EJ1686), via an unspecified route of administration, administered in Arm Left on 08Jan2021 14:30 as 1stdose, single for covid-19 immunisation (age at vaccination was 54 years). Medical history included hypertension from an unknown date and unknown if ongoing. Concomitant medication(s) included paracetamol (PANADOL) taken for an unspecified indication, start and stop date were not reported. The patient previously took Zyrtec allergy. Allergies to medications, food, or other products was no. The patient experienced hives, i have a dermatitis that covers almost all my body, and it does not go away with any of the medicines i have been on Jan2021. The patient underwent lab tests and procedures which included sars-cov-2 test negative on Jan2021.Therapeutic measures were taken as a result of hives, i have a dermatitis that covers almost all my body, and it does not go away with any of the medicines i have been. Treatment received was yes (various topical and oral medications, such as Zyrtec) and there was physician office visit also. Prior to vaccination, was the patient diagnosed with COVID-19 was no. Upon follow-up on 23Apr2021 new information has been updated. This is a follow-up spontaneous report received from a contactable other HCP. This 54-Year-old female other HCP reported for herself about reaction(s)/events, treatment received. The clinical outcome of the events was not recovered. Follow-up (23Apr2021): This is a follow-up spontaneous report received from a contactable other HCP. This 54-Year-old female other HCP reported for herself about reaction(s)/events, treatment received. No follow-up attempts are needed; information about lot/batch number cannot be obtained.

Other Meds: PANADOL

Current Illness:

ID: 1773349
Sex: F
Age: 54
State: MO

Vax Date: 10/17/2016
Onset Date: 10/25/2017
Rec V Date: 10/09/2021
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: Shingles; Information has been received from a lawyer regarding a case in litigation, concerning a 55-year-old female patient. The patient's pertinent medical history, concurrent conditions, drug reactions/allergies and concomitant medications were not provided. On 17-OCT-2016, the patient received a dose of Zoster Vaccine Live (ZOSTAVAX) (dosage information, lot number and expiration date were not provided) for its intended purpose: the prevention of shingles (herpes zoster). Subsequently on 25-OCT-2017, the patient suffered shingles, including any and all of its sequelae. As a result of the receipt of the vaccination, the patient experienced sustained severe and permanent personal injuries, as well as significant pain, suffering, and emotional distress. The reporter considered the event of shingles to be related to suspect therapy. At the time of the report, the patient's outcome was not recovered. Upon internal review, shingles was considered a disabling event.

Other Meds:

Current Illness:

ID: 1773353
Sex: U
Age:
State: MN

Vax Date: 08/12/2014
Onset Date:
Rec V Date: 10/09/2021
Hospital: Y

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: zoster-related inkuries; shingles; This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to a patient of unknown age and gender. The patient's concurrent conditions, medical history and concomitant medication were not provided. On or about 12-AUG-2014, the patient was vaccinated with a dose of zoster vaccine live (ZOSTAVAX) (dosage regimen was not reported) for the long-term prevention of herpes zoster or shingles. Subsequent to zoster vaccine live (ZOSTAVAX) inoculation, the patient was treated by a healthcare provider for shingles or zoster-related injuries. As a direct and proximate result of the use of the zoster vaccine live (ZOSTAVAX), the patient had and would continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; significant medical and related expenses as a result of these injuries, including but not limited to costs for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages. The reporter considered the events to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1773360
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: got shot and shingles hurt/ suspected vaccination failure; shingles; shingles hurt; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant), shingles and pain. On an unknown date, the outcome of the vaccination failure, shingles and pain were unknown. It was unknown if the reporter considered the vaccination failure, shingles and pain to be related to Shingles vaccine. Additional details were provided as follows: The patient self-reported this case. The age at vaccination was not reported. The patient got the shingle shot and then the shingles hurt. This case was considered as suspected vaccination failure since the details regarding completion of primary immunization schedule, time to onset and laboratory test confirming shingles were unknown at the time of reporting.

Other Meds:

Current Illness:

ID: 1773362
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/09/2021
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: have received Shingrix vaccines. Why am I still getting shingles?/suspected vaccination failure; shingles; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix and the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix and Shingrix, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingrix and Shingrix. Additional details were provided as follows: The patient self-reported this case. The age at vaccination was not reported. The patient had received Shingrix vaccines and still got shingles. This case was considered as suspected vaccination failure since the details regarding time to onset and laboratory test confirming shingles were unknown at the time of reporting.

Other Meds:

Current Illness:

ID: 1773363
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: received both shingles vaccines but i am still getting shingles/ suspected vaccination failure; shingles; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Co-suspect products included Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingles vaccine and the 2nd dose of Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine and Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine and Shingles vaccine. Additional details were provided as follows: The patient self-reported this case. The age at vaccination was not reported. The patient reported that he/she received both the shingles vaccine and still got shingles. This case was considered as suspected vaccination failure as details regarding time to onset and laboratory test confirming herpes zoster were unknown at the time of reporting.

Other Meds:

Current Illness:

ID: 1773364
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: got GBS; This case was reported by a consumer via interactive digital media and described the occurrence of guillain barre syndrome in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced guillain barre syndrome (serious criteria GSK medically significant). On an unknown date, the outcome of the guillain barre syndrome was unknown. The reporter considered the guillain barre syndrome to be possibly related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The reporter stated that they would tell you Guillain Barre syndrome was very rare, but the reporter knows the patient who had Guillain Barre syndrome. The reporter stated that he/she would never take the Shingles shot because it could cause Guillain Barre syndrome (GBS). The shot tells you that in the fine print. This case was 1 of the 4 linked cases reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR208072:same reporter US-GLAXOSMITHKLINE-US2021AMR208073:same reporter US-GLAXOSMITHKLINE-US2021AMR208069:same reporter

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am