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: 1775851
Sex: F
Age: 32
State: KY

Vax Date: 03/19/2021
Onset Date: 03/29/2021
Rec V Date: 10/10/2021
Hospital: Y

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

Lab Data: I was hospitalized for 3 nights beginning 4/26/2021 after blacking-out from walking a few feet. I had a lumbar puncture to test for MS, GBS and Miller Fisher. I wore a heart monitor. I had an MRI with and without contrast showing new lesions on my brain. Lesions were not present during an MRI performed in December of 2020. I received standard blood panels. One abnormality was my liver function. Otherwise the tests were normal. I was also checked for West Nile.

Allergies: Compazine; Codeine

Symptom List: Dysphagia, Epiglottitis

Symptoms: 3/29/2021 - Present: Extreme vertigo, lightheadedness, weakness, chest pain, increased migraines, fatigue, night sweats and numbness in extremities. Other sporadic symptoms: Heart palpitations and brain "zaps." I now require use of a walker on most days and cannot stand for more than a few minutes without getting dizzy or feeling as if I will pass-out. I have to attend physical therapy weekly.

Other Meds:

Current Illness:

ID: 1775852
Sex: F
Age: 33
State: IN

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Headache, fatigue, cough

Other Meds: Levothyroxine 88mcg

Current Illness: None

ID: 1775853
Sex: M
Age: 62
State: WA

Vax Date: 04/10/2021
Onset Date: 04/24/2021
Rec V Date: 10/10/2021
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: I've had EKG, CAT Scan, X-ray of chest, echocardiogram, numerous blood tests.

Allergies: Sulpha drugs, Terbinafine

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

Symptoms: This may not be related to vaccination, but about 2 weeks after the vaccination I started to feel a bit sick, stiff neck and muscle pain. The pain became more extreme over the next few weeks turning to very strong continuous chest pain. I still have chest pain, shortness of breath, pain when breathing deeply or moving chest left to right. Also ongoing pain across shoulders and slightly down arms.

Other Meds: Flonase, Vitamin D

Current Illness: None

ID: 1775854
Sex: F
Age: 87
State: CA

Vax Date: 06/19/2021
Onset Date: 09/30/2021
Rec V Date: 10/10/2021
Hospital:

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

Lab Data: NA

Allergies: None.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Herpes and Shingles outbreak simultaneously. Herpes sores on outside of mouth L side and Shingles outbreak on back of L calf.

Other Meds: No pharmaceuticals. Zinc. Vitamin D. Vitamin C.

Current Illness: None.

ID: 1775855
Sex: M
Age: 81
State: WA

Vax Date: 08/28/2021
Onset Date: 09/02/2021
Rec V Date: 10/10/2021
Hospital: Y

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

Lab Data: Records available

Allergies: No.

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

Symptoms: Day 3 post vaccine: muscle soreness all over body, and beginnings of severe lower right back/upper thigh pain and fever/chills. On Sept 9th through 15th I experienced a massive headache that culminated in blinding, disorienting headache unresponsive to acetaminophin and aspirin combinations. Simultaneously with the headache, fever of up to 101.7 (up from a normal of 97.7) spiked and severe, uncontrollable chills and shaking persisted. On 9/16 awoke unable to walk with EXCRUCIATING PAIN in right hip/lower back and right thigh. Could not get out of bed or move for ANY reason without crying out in pain. Could not get out of bed for any reason. Any body movement (including arms) triggered massive stabbing, electric shock down right leg and was so terrible it caused screams of pain. Was told to take Tylenol at max dosage, which did nothing, and toughed it out for next 7 days. Prednizone and Tramadol were prescribed about 24th, and incredible pain persisted despite these drugs. Called 911 and was transported by medics to Allenmore hospital in Tacoma on . Blood work showed slightly elevated white blood cell counts. Doxicycline was prescribed. Continues to be bedridden currently and in excrutiating pain still, 4 weeks and 2 days later.

Other Meds: None except multivitamins. No prescriptions medications.

Current Illness: None

ID: 1775856
Sex: F
Age: 44
State: UT

Vax Date: 06/23/2021
Onset Date: 10/03/2021
Rec V Date: 10/10/2021
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: Comprehensive blood tests and CT scan with contrast dye.

Allergies: Penicillin

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

Symptoms: Pulmonary embolism. Treated with morphine and Xeralto.

Other Meds: Spironolactone, birth control pill, sertraline

Current Illness: None

ID: 1775857
Sex: F
Age: 48
State: OR

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

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

Lab Data: Dental X-rays: no issues found. MRI: no issues found. Thryoid levels: normal. Blood tests: high levels of systemic inflammatory responses found (I am not the doctor so I don't know the specific tests and their specific results). Other tests also done by the physician but I do not have the details.

Allergies: adverse response to minocycline

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: In the first 36 hours: high fever, intense nerve pain in entire arm, shoulder, and left side of neck, and inability to lift or move left arm. In the following 6 months (and continuing): daily migraines, daily intense pain in one tooth but no source found by dental experts, intense intermittent nerve pain in different parts of the body, brain fog/confusion, daily deep fatigue, blurred vision, occasional episodes of dizziness. Migraines are often paired with an intense emotional reaction (crying, anger) that does not connect to life circumstances, is not a reaction to pain, and subsides immediately when pain medicine (tramadol) takes effect.

Other Meds: None

Current Illness: none/unknown

ID: 1775858
Sex: F
Age: 70
State: SC

Vax Date: 01/30/2021
Onset Date: 01/31/2021
Rec V Date: 10/10/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin, Celian Antibiotic, Crab meat

Symptom List: Pharyngeal swelling

Symptoms: Rash that started on stomach and spread to extremities, I took a. prescribed medication and Benadryl for 10 days and then it cleared up. The same thing happened after the second dose Lot # EN6200 on 02/20/2021

Other Meds: Black Elderberry with zinc & vitamin C, Vitamin D-3, Rosavistatin 10 mg, Montilukast (Singulair) 10mg

Current Illness: None

ID: 1775859
Sex: F
Age: 32
State: CA

Vax Date: 09/29/2021
Onset Date: 10/04/2021
Rec V Date: 10/10/2021
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: Heart flutters all day long

Other Meds: None

Current Illness: Common cold

ID: 1775860
Sex: F
Age: 37
State: IL

Vax Date: 10/10/2021
Onset Date: 10/10/2021
Rec V Date: 10/10/2021
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: none reported

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was hyperventilating after shot. Passed out for about a minute and came to. EMS was called BP 120/72 and hr 110. Patient refused going to hospital.

Other Meds:

Current Illness:

ID: 1775861
Sex: F
Age: 66
State: MN

Vax Date: 02/13/2021
Onset Date: 02/21/2021
Rec V Date: 10/10/2021
Hospital: Y

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

Lab Data: Chest x-ray negative, ECG showed a sinus rhythm with a left anterior fascicular block and generalized ST-T wave changes. Coronary angiography showed no significant narrowing. 4/23/21 MR Cardiac W Contrast showed normal LV chamber size no evidence of MI fibrosis or infiltrative disease. No significant valvular disease. Clinical picture consistent either with myoericarditis or pleuritis. Medications prescribed 0.5 colchicine and ibuprofen. 7/27/21 NM Lung Scan Perfusion Particulate.

Allergies: amoxicillin

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

Symptoms: About two weeks after vaccine symptoms began, fatigue, shortness of breath. Second dose 3/14/21. Body aches began about 7 hours after vaccine for the next 24 hours. Fatigue and shortness of breath continued and began to have pain when taking deep breaths. 3/23/21 went to Urgent Care and had chest x-ray which was negative. Feeling worse later that night went to the Emergency Room. Had EKG , blood work up and covid test. Covid test was negative. Troponin levels elevated 0.74, 0.130, 0.97. I was admitted to the hospital for observation and further tests.

Other Meds: Multivitamin, Claritin, aspirin, omeprazole 20mg, Flonase, Lisinopril 10mg, progesterone 200mg, estradiol 0.0375mg

Current Illness: none

ID: 1775862
Sex: M
Age: 33
State: HI

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/10/2021
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: Milk (lactose intolerance)

Symptom List: Rash, Urticaria

Symptoms: Headache, body ache, sensitive muscles, low-grade fever (99.2), fatigue, chills.

Other Meds: None

Current Illness: None

ID: 1775863
Sex: F
Age: 54
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Possibly causing stroke 5 months after receiving Moderna Covid-19 vaccine

Other Meds: Losartan 50mg HYDROCHLOROTHIAZIDE 25MG LOESTRIN FE 1.5/30 1.5-30

Current Illness: Hypertension

ID: 1775864
Sex: F
Age: 32
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: Shingles on left side of the body after 4 to 5 days after vaccination.

Other Meds:

Current Illness:

ID: 1775865
Sex: F
Age: 54
State: WA

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: CT Scan & blood tests 10/04/2021 all negative; Hearing test scheduled 10/11/2021; ENT appointment scheduled 10/15/2021; Follow up with Doctor scheduled 10/27/2021

Allergies: none

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

Symptoms: Extremely loud ear ringing/pain/pressure; headache and pressure; constant thirst; nausea (nausea ended 10/09/2021); blurry vision that shifted from eye to eye (vision issues ended 10/10/2021); lightheadedness (this ended 10/08/2021); fatigue; weight loss(6 lbs. by 10/03/2021); pain and skin irritation in injected arm that radiates down arm and into shoulder (this began 10/09/2021); Was told by a nurse to take Zyrtec-D 9/25/2021 to help with ear and head issues. Was given a shot & 6 day dose of methylPREDNISolone 9/26/2021 to fix the ear issues. These did not relieve the adverse issues. All issues that do not have an end date are still ongoing

Other Meds: Melatonin 1 mg; Magnesium 500 mg; L-Tryptophan 500 mg; Acetyl-L-Carnitine

Current Illness: Seasonal Allergies

ID: 1775866
Sex: F
Age: 39
State: ID

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: I developed hives one week after second shot. They were random in location and intermittent. They eventually stopped after approximately five months. I received my booster on Friday and was covered in hives again 24 hours later after having not had them for two months. I cannot know for sure if there is a connection between the shot and the hives but thought I should report it just in case.

Other Meds: Occasional ibuprofen for headaches.

Current Illness: N/a

ID: 1775867
Sex: M
Age: 55
State: OR

Vax Date: 02/19/2021
Onset Date: 03/01/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: MRI of face (May 4, 2021), MRI of cervical spine (June 9, 2021), tried Gabapentin, currently taking Oxcarbazepine

Allergies: Sulfa, tape

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

Symptoms: It started with "electrical shocks" in right side of face, occasionally. It has progressed to "shocks" non-stop in the right side of my face, skull, down both sides of neck, both ears and other various parts of body.

Other Meds: Flax seed oil Vitamin D Ibuprofen

Current Illness: None

ID: 1775868
Sex: F
Age: 32
State: NY

Vax Date: 09/30/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: Not available

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Welts around injection site, headache, muscle pain, stomach ache.

Other Meds: Not available

Current Illness: Not available

ID: 1775869
Sex: F
Age: 34
State: WA

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: None

Allergies: Clarithromycin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Itchy, pink/red welts on bilateral lower extremities (below knee to ankle) that appeared approximately 24 hours after 3rd dose. Transitioned to itchy, red, macular papular rash, that has yet to resolve over one week later

Other Meds: Asprin, amlodipine, Zoloft, multivitamin, fiber supplement, vitamin D

Current Illness: None

ID: 1775870
Sex: F
Age: 36
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Menstruation delayed two weeks after first dose. Arm rash itchy and painful to the touch, five inches across and joint pain, headache after second vaccine dose.

Other Meds:

Current Illness:

ID: 1775871
Sex: F
Age: 81
State: MN

Vax Date: 09/26/2021
Onset Date: 09/27/2021
Rec V Date: 10/11/2021
Hospital: Y

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: Admission to hospital October 10. Laboratory work and clinical monitoring. CRP elevation. Chest XR raising concern for large plerual effusion, verified on echocardiogram with pericardiocentesis

Allergies: Ampicillin

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

Symptoms: Pericarditis with pleural effusion

Other Meds: Cardizem, lisinopril, naproxen PRN, omeprazole, maxide

Current Illness:

ID: 1775872
Sex: F
Age: 56
State: OR

Vax Date: 09/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: EKG, lab draw (CBC, CMP, MAGNESIUM, TROPONIN), chest x-ray. All done on 10/3/21 Echocardiogram done on 10/5/21. Follow up with PCP on 10/7/21. Still waiting to see a cardiologist

Allergies: None

Symptom List: Unevaluable event

Symptoms: Rapid, irregular heart rate, diagnosed as atrial fibrillation. Unresolved.

Other Meds: Fosamax

Current Illness: None

ID: 1775873
Sex: F
Age: 52
State: AZ

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
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: Fever and chills Nausea and diarrhea

Other Meds: Zoloft (generic) Bystolic

Current Illness: None

ID: 1775874
Sex: F
Age: 50
State: HI

Vax Date: 04/22/2021
Onset Date: 04/27/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Holter monitor: 5/3-5/17 PVCs, PACs, PSVT 4/29: Echocardiogram: left and right atrium enlargement, Right ventricle enlargement and pericardial effusion.

Allergies: dairy, mold, dust

Symptom List: Injection site pain, Pain

Symptoms: Chest pain, palpitations, tachycardia extreme fatigue, exercise and heat intolerance, anxiety.

Other Meds: ventolin, estradiol, progesterone, probiotics

Current Illness: positive ANA

ID: 1775875
Sex: M
Age: 38
State: TX

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

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

Lab Data: I have not gone to get checked but I will be going to be checked soon. For now that is all I know.

Allergies: HCTZ (not an allergy, it just works too well and drops blood pressure too much) CT Dye (actual allergy to the dye NOT IODINE. Symptoms include rash which starts on chest and back, nausea, vomiting, burning in veins, feeling like I have been poisoned, flu like aches for up to 3 days following CT Dye Infusion)

Symptom List: Injection site pain, Menorrhagia

Symptoms: Widespread Rash, began on back within 60-90 min of administration. Has continued to spread and change. Does not itch very much, started as wide finger print sized splotches on back, with tiny red dots the size of the ball on a ball point pen spread around and in between. The small head of a pen sized one's have spread to chest and arms. Again no itching really or pain. But it has been there without even fading a little bit sinceI got the vaccine. I did not go for the second or 3rd dose because of the reaction.it has been approximately 45 days since the vaccine with no signs of fading or going away.

Other Meds: None

Current Illness: None

ID: 1775877
Sex: M
Age: 34
State: MS

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/11/2021
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: None

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Diarrhea progressing to Black and bloody diarrhea starting within 6h post injection and resolving 48h-72h later. Additionally fevers, chills and body aches were present 12h post injection and lasted for ~24h duration.

Other Meds: None

Current Illness: None

ID: 1775878
Sex: F
Age: 43
State: CA

Vax Date: 09/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Late menstrual cycle after 2nd dose. Currently 7 days late. No chance of pregnancy. No treatment. Outcome is that I?m still waiting for my cycle. This is totally irregular.

Other Meds: None

Current Illness: None

ID: 1775879
Sex: F
Age: 42
State: AK

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: severe upper left abdominal pain for 2 days

Other Meds: adderall, multivitamin

Current Illness: none

ID: 1775880
Sex: F
Age: 54
State: VA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 10/11/2021
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: Stiffening of left leg within ten minutes. Fever of 103 for three days. Involuntary stretching. Reappearance of HPV wart.

Other Meds:

Current Illness:

ID: 1775881
Sex: F
Age: 37
State: WV

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

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

Lab Data:

Allergies: Penicillin

Symptom List: Nausea

Symptoms: Redness, swollen lump under skin at injection site; swollen lymph node in left armpit

Other Meds:

Current Illness: None

ID: 1775882
Sex: F
Age: 41
State: AK

Vax Date: 02/02/2021
Onset Date: 02/04/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Injection site pain

Symptoms: severe upper left abdominal pain

Other Meds: adderall, multivitamin

Current Illness: none

ID: 1775883
Sex: F
Age: 44
State: NC

Vax Date: 10/06/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: Flu vaccine, MMR

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

Symptoms: Large red hard swollen spot at injection site. Itchy, hot to touch, painful, swollen and hard feeling

Other Meds: Zoloft

Current Illness: Covid

ID: 1775884
Sex: F
Age: 32
State: AK

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/11/2021
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: 2 Ulcers formed in mouth, still swollen and not healed 7 days later. Painful and swollen. No history of canker sores, cold sore, or ulcers in the mouth until after 2nd shot of the vaccination.

Other Meds: Vitamin C

Current Illness: None

ID: 1775885
Sex: F
Age: 45
State: MS

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
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: Swollen(knot) , itching, injection site warm to touch

Other Meds: None

Current Illness: None

ID: 1775916
Sex: M
Age: 59
State: FL

Vax Date: 09/14/2021
Onset Date: 09/01/2021
Rec V Date: 10/11/2021
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: dry lips; rash on arms and torso; swelling in limbs; overall itching; This case was reported by a pharmacist via call center representative and described the occurrence of lip dry in a 59-year-old male patient who received Herpes zoster (Shingrix) (batch number 7742z, expiry date 25th March 2023) for prophylaxis. Co-suspect products included INFLUENZA VACCINE for prophylaxis. On 14th September 2021, the patient received Shingrix (intramuscular) and INFLUENZA VACCINE. In September 2021, 2 weeks after receiving Shingrix, the patient experienced lip dry, rash, swelling of limb and generalized pruritus. On an unknown date, the outcome of the lip dry, rash, swelling of limb and generalized pruritus were unknown. It was unknown if the reporter considered the lip dry, rash, swelling of limb and generalized pruritus to be related to Shingrix. Additional details were provided as follows: The pharmacist reported that the patient received the Shingrix and a non-GSK flu vaccine on the same day and experienced dry lips, rash on arms and torso, swelling in limbs, and overall itching. The patient did not have any symptoms until 2 weeks after his vaccines. The reporter spoke per content and referred patient to healthcare professional. The reporter did not consent to follow-up.

Other Meds:

Current Illness:

ID: 1775924
Sex: F
Age:
State:

Vax Date:
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
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: Test Date: 20211005; Test Name: COVID-19 virus test; Result Unstructured Data: Positive

Allergies:

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

Symptoms: MEDICATION ERROR; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION (BREAKTHROUGH); SEVERE REACTION TO JNJ VACCINE; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age, race and ethnic origin. The patient's height, and weight were not reported. The patient's pre-existing medical conditions included: Patient was needed to take steroids. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry date: unknown) dose was not reported, 1 total, administered on APR-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch and lot numbers. Concomitant medications included mrna 1273 for covid-19 vaccine. On 05-OCT-2021, the patient experienced suspected clinical vaccination failure, suspected covid-19 infection (breakthrough) and severe reaction to JNJ vaccine. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On an unspecified date, the patient experienced medication error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection (breakthrough), and the outcome of severe reaction to JNJ vaccine, suspected clinical vaccination failure and medication error was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint 90000196555.; Sender's Comments: V0: 20211010258-covid-19 vaccine ad26.cov2.s-suspected clinical vaccination 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: MRNA

Current Illness:

ID: 1775925
Sex: M
Age:
State: FL

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

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

Lab Data: Test Name: Platelet count; Result Unstructured Data: Decreased

Allergies:

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

Symptoms: DECREASED PLATELET COUNT; This spontaneous report received from a consumer concerned a male of unspecified age. The patient's height, and weight were not reported. The patient's past medical history included: liver transplant, and concurrent conditions included: chemotherapy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced decreased platelet count. Laboratory data (dates unspecified) included: Platelet count (NR: not provided) Decreased. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of decreased platelet count was not reported. This report was non-serious. This case, from the same reporter is linked to 20211011824.; Sender's Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non-serious.

Other Meds:

Current Illness: Chemotherapy

ID: 1775926
Sex: F
Age:
State: CA

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

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

Lab Data: Test Name: Spinal tap; Result Unstructured Data: negative for meningitis; Test Name: C-reactive protein; Result Unstructured Data: Normal

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: CHOKED ON DRINKS; DIFFICULTY SWALLOWING, EVEN LIQUIDS; BOUTS OF SLURRED SPEECH; MUSCLE CRAMPS; MAKING IT DIFFICULT TO STAND, BEING OFF BALANCE; DIFFICULT TO WORK; WEAK MUSCLES IN NECK AND SPINE; This spontaneous report received from a patient concerned of an adult female. The patient's height, and weight were not reported. The patient's pre-existing medical conditions included: Patient was healthy before vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982 expiry: UNKNOWN) dose was not reported, 1 total administered on 10-APR-2021 on left arm for prophylactic vaccination. No concomitant medications were reported. After receiving the vaccine, the patient experienced deteriorating health. On an unspecified date, the patient had muscle cramps, being off balance, made it difficult to stand, as well as weakness in the muscles in her neck and around the spine. She also noted that lately, the muscle cramping was worse and she had bouts of slurred speech. She had difficulty swallowing, even liquids, noting she choked on her drinks. It was reported that it made difficult for her to work. She had numerous healthcare professionals (HCPs), including rheumatologists and neurologists. On unspecified date she visited Emergency room and Physician office for events difficulty swallowing even liquids, weak muscles in neck and spine, bouts of slurred speech, muscle cramps and making it difficult to stand. On unspecified date she had numerous tests done, including C-reactive protein test (CRP) and it was normal and a spinal tap was negative for meningitis. She felt that she was declining rapidly. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from difficulty swallowing, even liquids, weak muscles in neck and spine, bouts of slurred speech, muscle cramps, making it difficult to stand, being off balance, and difficult to work, and the outcome of choked on drinks was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0 20211011611-COVID-19 VACCINE AD26.COV2.S-choked on drinks. 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).

Other Meds:

Current Illness:

ID: 1775927
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: SLIGHTLY PARALYZED ON INJECTION SIDE; NUMBNESS IN ARM AND HAND; This spontaneous report received from a patient via social media concerned a patient of unspecified age, sex, race and ethnicity The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. As per the report, the patient commented that "My first JJ Vaccine caused me to be slightly paralyzed on my injection side. Numbness in my arm and hand lasted 2 weeks, the para lasted about 2 hours" (dates not specified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from slightly paralyzed on injection side, and numbness in arm and hand. This report was serious (Other Medically Important Condition).; Sender's Comments: V0: 20211014451-Covid-19 vaccine ad26.cov2.s -Slightly paralyzed on injection side. 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).

Other Meds:

Current Illness:

Date Died:

ID: 1775928
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: DEAD; This spontaneous report received from a consumer concerned a 24 year old female with an unspecified race and ethnic origin. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown) dose, with frequency time 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, reporter said that after vaccination his cousin was dead. It was unknown, if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died from an unknown cause of death. This report was serious (Death). This case, from the same reporter is linked to 20211014628 and 20211014652.; Sender's Comments: V0:20211014552-covid-19 vaccine ad26.cov2.s-dead. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH

Other Meds:

Current Illness:

ID: 1775929
Sex: F
Age:
State: NJ

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

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: SKIN FEELS WET (WHEN GETS IN BED, GOTTEN WORSE); HANDS HYPERSENSITIVE TO COLD AND HOT (LIKE WHEN WASHES, ALMOST LIKE DAGGERS); STRANGE AND UNCOMFORTABLE (NOT LIFE THREATENING); LEG, BACK, ARMS, FEET ARE SENSITIVE (WHEN WALKS, IF WALKS BAREFOOT FEETS ARE SENSITIVE TO TEMPERATURE)/ EXTREMITIES SENSITIVE; ODD SENSATION ON SKIN (LIKE A MENTHOL COOLING SENSATION)/SKIN FEELS COLD(WHEN GETS IN BED, GOTTEN WORSE); WARM SENSATION ON LEGS,THIGHS TO CALVES, AND SPREAD TO BACK AND ARMS (NOT ALL HAPPEN AT THE SAME TIME AND FEELS EXTREMELY SENSITIVE WHEN TOUCHES LIKE HER GRANITE COUNTERTOP); This spontaneous report received from a patient concerned a 57 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. 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, administered on 30-AUG-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On SEP-2021, the patient experienced odd sensation on skin (like a menthol cooling sensation) /skin feels cold (when gets in bed, gotten worse). On SEP-2021, the patient experienced warm sensation on legs, thighs to calves, and spread to back and arms (not all happen at the same time and feels extremely sensitive when touches like her granite countertop). On an unspecified date, the patient experienced skin feels wet (when gets in bed, gotten worse), hands hypersensitive to cold and hot (like when washes, almost like daggers), strange and uncomfortable (not life threatening), and leg, back, arms, feet are sensitive (when walks, if walks barefoot feets are sensitive to temperature) / extremities sensitive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the odd sensation on skin (like a menthol cooling sensation)/skin feels cold(when gets in bed, gotten worse), warm sensation on legs,thighs to calves, and spread to back and arms (not all happen at the same time and feels extremely sensitive when touches like her granite countertop), skin feels wet (when gets in bed, gotten worse), hands hypersensitive to cold and hot (like when washes, almost like daggers), strange and uncomfortable (not life threatening) and leg, back, arms, feet are sensitive (when walks, if walks barefoot feets are sensitive to temperature)/ extremities sensitive was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775930
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 09/24/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Test Date: 20210924; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive for Covid-19 infection; Test Date: 20210924; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive for delta variant

Allergies:

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

Symptoms: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 63 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: unknown) dose was not reported, 1 total administered to left arm on 08-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-SEP-2021, the patient underwent reverse transcription?polymerase chain reaction (RT PCR) test and result found to be positive for delta variant (confirmed covid-19 infection) (confirmed clinical vaccination failure). On the same date she also had COVID-19 antigen test and result found to be positive for Covid-19 infection. It was also reported that on an unspecified date she had a high fever, cough, muscles and joint pain terrible pain that lasted for 6 or 7 days. She had no other respiratory symptoms and her oxygen level was ok. It was mild Covid but symptomatic. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the confirmed clinical vaccination failure and confirmed covid-19 infection was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.; Sender's Comments: V0: 20211015754 -Covid-19 vaccine ad26.cov2.s -Confirmed clinical vaccination 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:

ID: 1775931
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: ITCHINESS; RASH TO ARMS, LEGS AND SHOULDERS THAT WAS SPREADING; This spontaneous report received from a patient concerned an elderly female. The patient's height, and weight were not reported. The patient's past medical history included: rash. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 01-MAR-2021 for covid-19 vaccination. Non-company suspect drugs included: adalimumab (solution for injection in pre-filled pen, subcutaneous, batch number was not reported) dose, frequency, and therapy dates were not reported for moderate to severe rheumatoid arthritis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced itchiness, and rash to arms, legs and shoulders that was spreading. The action taken with covid-19 vaccine ad26.cov2.s was not applicable; and action taken with adalimumab was not reported. The patient was recovering from itchiness, and had not recovered from rash to arms, legs and shoulders that was spreading. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775932
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: SEVERE MUSCLE SPASMS; SEVERE MUSCLE PAIN; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced severe muscle spasms, and severe muscle pain. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the severe muscle pain and severe muscle spasms was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775933
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: HIGH FEVER; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced high fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from high fever. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775934
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: ALWAYS FEEL HOT; CONSTANT ITCHING ALL OVER; BRAIN FOG DAILY; LOSS OF ENERGY; EXHAUSTED; INTENSE HEADACHE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced always feel hot, constant itching all over, brain fog daily, loss of energy, exhausted, and intense headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the intense headache, loss of energy, exhausted, always feel hot, constant itching all over and brain fog daily was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775935
Sex: M
Age:
State: SD

Vax Date:
Onset Date: 10/01/2021
Rec V Date: 10/11/2021
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: NOSE BLEEDS; NORMAL BODY ACHING; This spontaneous report received from a patient via a company representative concerned an adult male. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On OCT-2021, the patient experienced nose bleeds. On OCT-2021, the patient experienced normal body aching. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the nose bleeds and normal body aching was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775936
Sex: F
Age:
State: OK

Vax Date:
Onset Date:
Rec V Date: 10/11/2021
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: TIRED; This spontaneous report received from a consumer concerned a 58 year old female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient experienced tired. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tired. This report was non-serious.

Other Meds:

Current Illness:

ID: 1775937
Sex: M
Age: 48
State: NY

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 10/11/2021
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: refused to get my 2nd shot until I feel better; Headache; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (Headache), FATIGUE (Fatigue) and INTENTIONAL DOSE OMISSION (refused to get my 2nd shot until I feel better) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 3154818694) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included METFORMIN for an unknown indication. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Aug-2021, the patient experienced HEADACHE (Headache) and FATIGUE (Fatigue). On an unknown date, the patient experienced INTENTIONAL DOSE OMISSION (refused to get my 2nd shot until I feel better). The patient was treated with PARACETAMOL (TYLENOL) ongoing since an unknown date for Headache, at an unspecified dose and frequency. At the time of the report, HEADACHE (Headache) and FATIGUE (Fatigue) outcome was unknown and INTENTIONAL DOSE OMISSION (refused to get my 2nd shot until I feel better) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient refused to get his 2nd shot until he feels better. He already went to his doctor and he did not believe that it was from the vaccine and did not prescribed any medications.

Other Meds: METFORMIN

Current Illness:

ID: 1775938
Sex: F
Age: 38
State: ME

Vax Date: 04/22/2021
Onset Date: 04/20/2021
Rec V Date: 10/11/2021
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: Trouble taking deep breaths; Ribs would move; Winded upon exertion; Pain down the arm; Malaise; Could not run around table due to pain upon exertion; Possible mild fever; Nausea; Headache; Shoulder pain on right arm; Chills after minute first night; Trouble sleeping for three nights; Chest pain/Heart was in pain/Pain upon exertion in chest-heart area; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (Trouble taking deep breaths), MOVEMENT DISORDER (Ribs would move), DYSPNOEA EXERTIONAL (Winded upon exertion), INSOMNIA (Trouble sleeping for three nights) and CHEST PAIN (Chest pain/Heart was in pain/Pain upon exertion in chest-heart area) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Environmental allergy and Exercise induced asthma. On 22-Apr-2021 at 8:45 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Apr-2021 at 8:45 AM, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced CHEST PAIN (Chest pain/Heart was in pain/Pain upon exertion in chest-heart area). On 22-Apr-2021, the patient experienced INSOMNIA (Trouble sleeping for three nights). 22-Apr-2021, the patient experienced CHILLS (Chills after minute first night). On an unknown date, the patient experienced DYSPNOEA (Trouble taking deep breaths), MOVEMENT DISORDER (Ribs would move), DYSPNOEA EXERTIONAL (Winded upon exertion), PAIN IN EXTREMITY (Pain down the arm), MALAISE (Malaise), PAIN (Could not run around table due to pain upon exertion), PYREXIA (Possible mild fever), NAUSEA (Nausea), HEADACHE (Headache) and ARTHRALGIA (Shoulder pain on right arm). On 25-Apr-2021, CHEST PAIN (Chest pain/Heart was in pain/Pain upon exertion in chest-heart area) had resolved. At the time of the report, DYSPNOEA (Trouble taking deep breaths), MOVEMENT DISORDER (Ribs would move), DYSPNOEA EXERTIONAL (Winded upon exertion), INSOMNIA (Trouble sleeping for three nights), PAIN IN EXTREMITY (Pain down the arm), MALAISE (Malaise), PAIN (Could not run around table due to pain upon exertion), PYREXIA (Possible mild fever), CHILLS (Chills after minute first night), NAUSEA (Nausea), HEADACHE (Headache) and ARTHRALGIA (Shoulder pain on right arm) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosing remained unchanged. No concomitant medications provided. No treatment details were reported. Patient didn't receive any treatment for events. It was reported that there were no other potential causes for the event other than suspect drug. Events are: Updated email address , Do not email printable material, Updated her street address, Send printable materials via mail only This case was linked to MOD-2021-280737 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: Non-Significant Follow up- Reporter contact details updated. On 03-Oct-2021: Height, weight and medical history of patient was added. Facility information was added. Time and anatomical location of vaccine administered was added. Event verbatim, coding, onset date (updated to 20-Apr-2021 from 22-Apr-2021), reporter causality and outcome was updated for event chest pain. New events were added.

Other Meds:

Current Illness: Environmental allergy; Exercise induced asthma

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am