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
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0984831
Sex: F
Age: 32
State: OH

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data: none

Allergies: Cephalosporins

Symptoms: Evening of shot-sore left arm. Next day-chills, fever up to 101.5, body aches and headache. Last 24 hours.

Other Meds: Norvasc, Prozac

Current Illness: None

ID: 0984832
Sex: F
Age: 29
State: PA

Vax Date: 12/26/2020
Onset Date: 12/28/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data: urgent care visit

Allergies: none

Symptoms: right eye pain - started 2 days after first vaccine, foreign body sensation, urgent care visit to r/o corneal abrasian (negative), using topical eye drops, advil - self resolved after 5 days similar symptoms after 2nd dose, started 24hours after second dose, resolved within 48 hours of second dose

Other Meds: over the counter eye drops urgent care visit to r/o corneal abrasian

Current Illness: none

ID: 0984833
Sex: F
Age: 31
State: FL

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Febrile temp of >103, nausea, vomiting, diarrhea, HA, body aches, chills, Injection site pain, redness, and swelling.

Other Meds: none

Current Illness: none

ID: 0984834
Sex: M
Age: 70
State: NJ

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: na

Allergies: scallops

Symptoms: Brought on exacerbation of the PMD which had gotten better over the past 5 weeks, to a point where all progress made had been lost. Lasted 2.5 days so far

Other Meds: Losartan 100/hctz12.5; Levothyroxine .88mcg; Atorvastatin 20mg; Ambien 10mg, Prednisone 5mg

Current Illness: polymyositis rheumatica

ID: 0984835
Sex: F
Age: 60
State: WI

Vax Date: 01/20/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: gluten intolerance

Symptoms: The first day I had pain in left arm around injection. Couldn't sleep on it. Next day it was itchy but pain had subsided. Next day itching was almost gone. By Wednesday January 27 I thought everything was gone. Getting dressed that night I noticed a red rash developed around or near injection site. About 1 inch by 2 inch oval, slightly raised, slightly warm, slightly itchy. This morning January 29, it is still there less itchy and less red, but still visible outline. I was being followed by vsafe up to wednesday afternoon the 27th. I thought I shouldn't wait til next week for the vsafe check in.

Other Meds: multi vitamin, ribocene, bromelain, noni juice

Current Illness: head cold

ID: 0984836
Sex: F
Age: 32
State: OH

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: None

Allergies: Cephalosporins

Symptoms: 1/27/2021-0200-chills, fever up to 102.6, body aches, nausea, headache, dizziness. Relieved with Tylenol. Resolved approx 24 hours later

Other Meds: Norvasc, Prozac

Current Illness: None

ID: 0984837
Sex: F
Age: 70
State: PR

Vax Date: 01/01/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Severe muscle pain, Headache, Gastric discomfort, Light fever, Severe Chills, Dizziness.

Other Meds: Multivitamins

Current Illness: Benign positional vertigo, Diverticulitis

ID: 0984839
Sex: F
Age: 39
State: OH

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: n/a

Allergies: Latex (itching, rash, hives)

Symptoms: Fever (Tmax = 101.6), aches, chills, fatigue, nausea - sx began 1/26/21 Amenorrhea x1 month - r/t first dose of vaccine?

Other Meds: Effexor, Metoprolol, Lisinopril, Zyrtec, Simvastatin, Co-Q10, multi-vitamin

Current Illness: None

ID: 0984840
Sex: F
Age: 73
State: FL

Vax Date: 01/13/2021
Onset Date: 01/22/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: none

Allergies: sulfa drugs

Symptoms: Rash at vaccination site occurred 10 days after vaccination. Itchy, red bumps. Still some itching today with dried, red, bumps (Jan. 29) raised on arm similar to dry skin bumps, maybe red because of being scratched.

Other Meds: statin, meloxicam, estrogen fish oil, CoQ10, vitamin B complex, one a day vitamin

Current Illness: none

ID: 0984841
Sex: F
Age: 60
State: PR

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: PENICILLIN

Symptoms: FLU LIKE SYMPTOMS STARTED 3AM 1/29/2021 WITH GENERALIZED BODYACHE, LEFT AXILLARY PAIN, TENDER LEFT CERVICAL NODES, HOT AND COLD FLASHES AND HEADACHE. NASAL CONGESTION.

Other Meds: TYLENOL, NEURONTIN, SYNTHROID

Current Illness: DENIED

ID: 0984842
Sex: F
Age:
State: GA

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

Lab Data:

Allergies: Idine

Symptoms: None stated.

Other Meds: Aml_offline 5mg. Lpixaban5mg. Levothyroxine150mcg liberation 20mg. Metoprolol25mg. Pollutant 15mg.

Current Illness: Diebetic

ID: 0984843
Sex: F
Age: 59
State: MI

Vax Date: 01/21/2021
Onset Date: 01/23/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: Negative Covid Test

Allergies: Ampicillin

Symptoms: Developed a persisten fever2 days after vaccination

Other Meds: Omeprazole Famotidine

Current Illness:

ID: 0984844
Sex: F
Age: 57
State: CT

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Nka

Symptoms: Extreme weakness and fatigue fever headache loss of taste Unable to eat or drink due to extreme weakness I literally couldn?t move out of bed since Wednesday night still in bed as of this morning with extreme weakness headache loss of appetite loss of taste

Other Meds: Multivitamin Otezla

Current Illness: None

ID: 0984845
Sex: M
Age: 54
State: KY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: Medtronics CGM and 5x daily finger sticks have shown a trend of elevated levels. Prior to vaccination avg. daily total insulin distribution levels (TDD) was 74.4U following the vaccination TDD has increased to 89.2U. Average Time Above Range (<200mg/dL) for glucose levels prior to vaccine was 11%. Since vaccination this Time Above Range average has increased to 47%. This has resulted in increased insulin required and higher glucose reading, ultimately leading to higher A1C hemoglobin. Test numbers are not available as the time has been 6 days since onset and A1C is reflective of 3 month average.

Allergies: N/A

Symptoms: Glucose levels are elevated as compared to normal after receiving the in 2nd dose of the vaccine. Additional insulin is required to keep Glucose levels at steady level, which is still above desired target range

Other Meds: INSULIN,ASPART,HUMAN 100 UNIT/ML INJ INJECT PER INSULIN PUMP PARAMETERS UNDER THE SKIN AS DIRECTED FOR BLOOD SUGAR **INSULIN PUMP, AVERAGE 75 UNITS PER DAY** Testosterone CYP 1ML 200MG/ML IM .75ML once every 10 days Vitamin D3, 100 Soft

Current Illness: N/A

ID: 0984846
Sex: F
Age: 49
State: IN

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Severe Headache, sore throat, sinus drainage, fatigue

Other Meds: None

Current Illness: None

ID: 0984847
Sex: F
Age: 63
State: CT

Vax Date: 01/17/2021
Onset Date: 01/25/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: None

Allergies: Pcn

Symptoms: Muscle had severe burning sensation along with a peculiar feeling, like shards of glass embedded comes and goes but enough to interfere with daily living and movement

Other Meds: Celexa, lisinipril, norvac,

Current Illness: None

ID: 0984848
Sex: F
Age: 65
State: TX

Vax Date: 01/21/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 8 days later hard knot and soreness at shot site

Other Meds: Levothyroxine Dott hormone patch

Current Illness:

ID: 0984849
Sex: M
Age: 76
State: OH

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: fever, chills, shaking, aches, pain, fatigue

Other Meds:

Current Illness:

ID: 0984850
Sex: F
Age: 63
State: GA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: UA and C+S 1/21/21, 1/22/21 and 1/25/21. Pelvic exam 1/21/2020, Abdominal and transvaginal ultrasounds and CT of abdomen 1/22/2021. CBC and CMP 1/21/2021.

Allergies: none

Symptoms: dysuria, abdominal, pelvic, left flank, upper and lower back pain. bladder spasms, urinary frequency, headache, vision changes, loss of appetite, dysphagia and fatigue

Other Meds: vitamin d and b complex vitamin

Current Illness: none

ID: 0984851
Sex: M
Age: 37
State: MI

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: N/A

Allergies: Cephalosporin

Symptoms: Chills, nausea, and fever started approximately 12 hours after the injection and continued for about 6 hours. Treating the fever with Tylenol and resting led to a recovery.

Other Meds: Metroprolol (beta blocker) Magnesium supplement Vitamin D supplement

Current Illness: None

ID: 0984852
Sex: M
Age: 61
State: WV

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: N/A

Allergies: NKDA

Symptoms: Injection site pain, Tiredness, Headache, Muscle cramps & pain, Chills, Joint pain (extreme), Fever, Feeling Unwell.

Other Meds: None

Current Illness: None

ID: 0984853
Sex: F
Age: 29
State:

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

Lab Data:

Allergies:

Symptoms: Syncope versus seizure with urinary incontinence and shaking. Transported to ED via EMS.

Other Meds:

Current Illness:

ID: 0984854
Sex: F
Age: 42
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: body aches throughout the day on 1/28 that turned to rigors, chills and worsened body aches at 5 PM on 1/29/2021. Felt like a bad flu. I woke up 1/29/2021 feeling back to normal

Other Meds: Took Advil 400 mg on 1/27/2021 at 9 AM, 5 PM and 10 PM and took 400 mg on 1/28/2021 at 0700

Current Illness: None

ID: 0984855
Sex: F
Age: 63
State: MI

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Penicillin, bees & wasps, Sulfites

Symptoms: My face got red and warm. A single hive developed on my left jaw. After a few minutes later my throat and tongue started to feel numb like I had gone to the dentist and gotten a novacaine shot. We went to a pharmacy immediately and got some Bennedryl which took the symptoms away within the hour.

Other Meds: Thyroid medication Blood pressure medication Milk Thistle Vitamin D3 Krill Oil Cherry Flex Aspirin Osteoprema Water Pill Red Yeast Rice Tumeric

Current Illness: PVA - Posterior Vitreous Detachment

ID: 0984856
Sex: F
Age: 30
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Apples and avocados (shortness of breath), penicillin (shortness of breath, rash)

Symptoms: Post covid vaccine administration, while sitting for 10 minute time frame, complained of numbness and tingling in mouth and tongue. States she is allergic to apples and avacodos and this is the type of reaction she normally has after eating this type of food. Patient evaluated by facilitator. No difficulty breathing or shortness of breath noted, patient not in distress. Numbness and tinging continued past 10 minutes observation time not improving. ERT called to evaluate patient. No distress noted. Taken to pharmacy and received oral diphenhydramine. Sitting in clinic for additional time frame - total approximately 70 minutes post vaccine. Complaints of feeling some nausea. No distress again noted. Continues to complain of tingling and numbness in mouth and tongue at 1800 which is approximately 40 minutes post medication. Additionally complaints of feeling more numbness around mouth. VS taken: T - 37.1, P - 68, BP - 128/80, R- 18, pulse ox - 100%. No difficulty breathing. States situation unchanged from previous. ERT notified again. Patient evaluated by team. Options discussed with patient by team nurse - can be seen in ED or go home and take additional dose of antihistamine in 4 hrs from time of first dose. Encouraged to get a ride home and leave car at hospital. Husband called by patient. Waiting for ride. Encouraged to seek additional medical care if not feeling improved after 2nd dose of medication at home. Also encouraged to discuss 2nd vaccine dose with PCP prior to taking 2nd dose. Discussed with patient to utilize vaccine app to document post vaccine effects. Escorted to hospital lobby for ride at 1830.

Other Meds:

Current Illness:

ID: 0984857
Sex: F
Age: 60
State: FL

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: NA

Allergies: Sulfa Di Alpha Tocopherol Fragrance mix Iodopropynl Butylcarbonate

Symptoms: Moderate Swelling and pain under right axilla Redness swelling at site Nausea Aches Abdominal pain Headache

Other Meds: Synthroid 100mcg po daily Turmeric Dermatrophin Krill oil Glucasomine

Current Illness: None

ID: 0984858
Sex: F
Age: 53
State: NJ

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: none

Allergies: gluten

Symptoms: red swollen upper left arm, warm, painful, tender to touch. started about 1 week after injection. became slightly raised red itchy rash. lasted about a week.

Other Meds: Dexilant, Myrbetric, Zyrtec

Current Illness: none

ID: 0984859
Sex: F
Age: 42
State: MI

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: None

Allergies: Tylenol, mint, Thai, topical NSAIDs,

Symptoms: 1/28/21 5am headache and dizzy, 1/28/21 7am whole body aches, fatigue, unable to get warm. Tried to sleep and drink water throughout the day. 1/29/21 7am woke up feeling better with just a massive headache.

Other Meds: Levothyroxine, Linzess , serterline, vitamin D

Current Illness: None

ID: 0984860
Sex: F
Age: 62
State: IN

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Bactrim and Lodine

Symptoms: Red itchy patch at injection site. the area measures approximately 3 x 4 inches

Other Meds: Amour thyroid 120 mg, multi vitamin, D3, ASA 81mg, Vitamin C

Current Illness:

ID: 0984862
Sex: M
Age: 57
State: MI

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Armpit lymph node swelling and tender after vaccine. Submandibular and neck lymph node also swollen on left side, persisting for several days.

Other Meds:

Current Illness:

ID: 0984865
Sex: M
Age: 37
State: PA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: N/A

Allergies: No true allergies but don?t tolerate codeine well, causes nausea without analgesia

Symptoms: There is blue discoloration at the center of my tongue. It is painless, I would not even know it was there were it not for sticking my tongue out to brush it in the mornings. It only happens overnight, now 2 consecutive mornings since the 2nd dose of moderna. No edema, sore throat, or swelling. I have photos that I can send. It looks like I ate a blue colored candy, but I didn?t. I wake up like this from sleep.

Other Meds: Ritalin, Tylenol prn, Ibuprofen prn, daily multivitamin

Current Illness: None

ID: 0984868
Sex: F
Age: 70
State: IA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: keflex, sulfa

Symptoms: Soreness at the injection site, 48 hours, rapidly decreasing pain

Other Meds:

Current Illness: none

ID: 0984869
Sex: F
Age: 56
State: WI

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: EKG which was normal (01/14/2021) EMG today (01/29/2021) at 0900 cst

Allergies: Pcn

Symptoms: Chills, fever of 103.4, tingling/ numbness in the opposite arm of the injection. This lasted for 36 hours. However, obvious left arm muscle weakness and mild cramping in same arm is still present. Maybe a coincidence? Getting an EMG test today to evaluate the extent of nerve involvement and check for signs of muscle atrophy.

Other Meds: Vyvanse one 70mg tab daily

Current Illness: None

ID: 0984870
Sex: F
Age: 58
State: NJ

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: none

Allergies: None

Symptoms: low grade fever, headache, body aches, chills, redness & swelling of the injection site, general fatigue.

Other Meds: Calcium, Vit D, Multivitamin

Current Illness: None

ID: 0984871
Sex: F
Age: 39
State: NY

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Penicillin

Symptoms: Arm swelling, redness, swollen axillary lymph nodes. All presenting on injection arm

Other Meds: Vitamin D, Adderall, Ashwagandha

Current Illness: n/a

ID: 0984872
Sex: F
Age:
State: PA

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

Lab Data:

Allergies:

Symptoms: Injection site hurt; Red rash covered her arm and groin area; This case was reported by a pharmacist and described the occurrence of injection site pain in a female patient who received Herpes zoster (Shingrix) for prophylaxis. In October 2020, the patient received the 1st dose of Shingrix. On an unknown date, less than 3 months after receiving Shingrix, the patient experienced injection site pain and red rash. On an unknown date, the outcome of the injection site pain and red rash were recovered/resolved. It was unknown if the reporter considered the injection site pain and red rash to be related to Shingrix. Additional information was provided as follows: The age at vaccination was not reported. The patient received the 1st dose of Shingrix at the beginning of October and then her injection site hurt and she developed a red rash that covered her arm and groin that only lasted for 2 days. Pharmacist said that the patient experienced it after the 1st dose and just told her day before reporting. She did not have many details because she called from home but agreed to follow up via email. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0984873
Sex: F
Age: 81
State: PA

Vax Date: 12/09/2020
Onset Date: 12/10/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pain at the injection site; The pain in the arm; This case was reported by a consumer and described the occurrence of injection site pain in a 81-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of no adverse event (1st dose received on an unknown date, there were no events associated with dose 1 of Shingrix). On 9th December 2020, the patient received the 2nd dose of Shingrix. On 10th December 2020, 1 days after receiving Shingrix, the patient experienced injection site pain and pain in arm. On an unknown date, the outcome of the injection site pain and pain in arm were not recovered/not resolved. It was unknown if the reporter considered the injection site pain and pain in arm to be related to Shingrix. Additional information was provided as follows: The case was reported by patient's husband. The next day of receiving vaccine, the patient experienced pain at the injection site. The pain in the arm had become worse over the last two days of reporting. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0984874
Sex: F
Age: 43
State: NY

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Humira Levothyroxine Norethindrone Lupron

Symptoms: Moderna COVID-19 Vaccine EUA Under left arm/lymph nodes swollen and tender

Other Meds:

Current Illness: None

ID: 0984875
Sex: F
Age:
State: NY

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

Lab Data:

Allergies:

Symptoms: Swollen circle at injection site; Swollen glands under arm pit; Developed a black and blue arm; This case was reported by a consumer and described the occurrence of injection site swelling in a female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced injection site swelling, axillary lymph nodes enlarged and skin discoloration. On an unknown date, the outcome of the injection site swelling, axillary lymph nodes enlarged and skin discoloration were unknown. It was unknown if the reporter considered the injection site swelling, axillary lymph nodes enlarged and skin discoloration to be related to Shingrix. Additional details were provided as follows: The reporter was patient's brother-in law. The patient received 1st dose of Shingrix and she developed a black and blue arm, a swollen circle at the injection site, and swollen glands under her arm pit. The reporter declined to provide any additional information about the patient and her adverse event. The reporter stated that he would tell the patient to contact if she would like to provide more information. The reporter did not consent to follow-up. This is 1 of 5 cases reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020248587:same reporter US-GLAXOSMITHKLINE-US2020248569:Same reporter US-GLAXOSMITHKLINE-US2020248574:Same reporter US-GLAXOSMITHKLINE-US2020248583:Same reporter

Other Meds:

Current Illness:

ID: 0984876
Sex: M
Age:
State: NY

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

Lab Data:

Allergies:

Symptoms: flu like symptoms; more distress; This case was reported by a consumer via and described the occurrence of influenza-like symptoms in a elderly male patient who received Herpes zoster (Shingrix) for prophylaxis. The patient's past medical history included shingles. Previously administered products included Shingrix with an associated reaction of emotional distress (1st dose received on an unknown date, refer case US2020248583). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, less than a day after receiving Shingrix, the patient experienced influenza-like symptoms and emotional distress. Rechallenge with Shingrix was positive. On an unknown date, the outcome of the influenza-like symptoms and emotional distress were recovered/resolved. It was unknown if the reporter considered the influenza-like symptoms and emotional distress to be related to Shingrix. Additional details were provided as follows: The patient reported for himself. The age at vaccination was not reported but could be 65 or 66 years. In 2019, the patient received 2nd dose of Shingrix in the left arm and on the same day, he experienced flu like symptoms and was more distress. The patient stated that this feeling lasted for two days and then fully resolved. No additional information was reported. The reporter consented to follow-up to HCP. This is 1 of 5 cases reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020248580:same reporter (sister?s in law case) US-GLAXOSMITHKLINE-US2020248574:same reporter US-GLAXOSMITHKLINE-US2020248569:same reporter US-GLAXOSMITHKLINE-US2020248583:Same reporter

Other Meds:

Current Illness:

ID: 0984877
Sex: F
Age: 47
State: NM

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: Would have gone to the ER if I wasn't a nurse.

Allergies: Sulfa, Bee stings

Symptoms: Woke up at 07:20 which chest tightness/pain and uncontrollable shaking. Temperature was 102 with hospital grade temporal thermometer. Pulse rate of 140 and POX of 96. At 07:23 took 650mg Tylenol and 50mg oral diphenhydramine with 16 oz water. Chest tightness subsided around 10 minute mark and shaking stopped after one hour. Sleep from 10:00-16:00. Woke up with a headache and mental confusion.

Other Meds: 650mg Tylenol, 800mg Motrin at 01:00am on 1/8/2021

Current Illness: none

ID: 0984878
Sex: F
Age: 58
State: TX

Vax Date: 12/11/2020
Onset Date: 12/15/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: injection site infection; injection site swelling measuring 8 inches by 4 inches; injection site hardness; injection site redness; injection site heat; This case was reported by a pharmacist and described the occurrence of injection site infection in a 58-year-old female patient who received Herpes zoster (Shingrix) (batch number 53X42, expiry date 9th September 2022) for prophylaxis. On 11th December 2020, the patient received the 1st dose of Shingrix (intramuscular). On 15th December 2020, 4 days after receiving Shingrix, the patient experienced injection site infection, extensive swelling of vaccinated limb, injection site induration, injection site erythema and injection site warmth. The patient was treated with sulfamethoxazole + trimethoprim (Bactrim). On an unknown date, the outcome of the injection site infection, extensive swelling of vaccinated limb, injection site induration, injection site erythema and injection site warmth were not recovered/not resolved. It was unknown if the reporter considered the injection site infection, extensive swelling of vaccinated limb, injection site induration, injection site erythema and injection site warmth to be related to Shingrix. Additional details were provided as follows: The patient received the 1st dose of Shingrix in the left deltoid and developed injection site redness, heat, hardness, and swelling measuring 8 inches by 4 inches (extensive swelling of vaccinated limb). The patient was examined by her health care provider and diagnosed the patient with an injection site infection and was prescribed Bactrim as treatment. Till the time of reporting, the events were reported as ongoing. The reporter consented to follow-up. This case had been linked with US2020AMR251357, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR251357:Same reporter

Other Meds:

Current Illness:

ID: 0984879
Sex: F
Age: 16
State: NY

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Inadvertently administered 0.5ml dose of Moderna COVID vaccine to a 16 year old female; A spontaneous report was received from a pharmacist. This case concerns a 16 year old female patient who experienced inadvertently administered 0.5ml dose of Moderna COVID vaccine to a 16 year old female with the use of mRNA-1273. There was no medical history provided. There were no concomitant medications provided. On 16 Jan 2021, the patient received the first of two planned doses of mRNA-1273 (Batch # 026L20A), for prophylaxis of COVID-19 infection. On 16 Jan 2021, it was inadvertently administered 0.5ml dose of Moderna COVID vaccine to a 16 year old female. It was noted the patient did not experience any adverse reactions during the 15 minute observation period. There was no treatment information provided. Action taken with mRNA-1273 to the event of inadvertently administered 0.5ml dose of Moderna COVID vaccine to a 16 year old female was not provided. The outcome for the event of inadvertently administered 0.5ml dose of Moderna COVID vaccine to a 16 year old female was resolved on 16 Jan 2021.; Reporter's Comments: This case concerns a 16-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot # 026L20A), reporting Product administered to patient of inappropriate age without any associated adverse events.

Other Meds:

Current Illness:

ID: 0984880
Sex: M
Age:
State: NY

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: some of the product came out and ran down his arm/backflow after administration; some of the product came out and ran down his arm; A spontaneous report was received from a 29-year-old male nurse who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced backflow after the administration, and some of the product came out and ran down his arm. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 on an unknown date. On 21 Jan 20201, the patient received their second of two planned doses of mRNA-1273 (Lot 029L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient reported that there was backflow after the administration, and some of the product came out and ran down his arm. No treatment information was provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. The outcome of the event, experienced backflow after the administration, and some of the product came out and ran down his arm, was considered resolved on 21 Jan 2021.; Reporter's Comments: This case concerns a 29-year old White, male nurse patient. The patient's medical history and concomitant medications were not provided. The patient experienced a non serious event of some of the product came out and ran down his arm/backflow after administration. The event occurred on the same day as the planned second dose of the mRNA-127 administration, with no reported AEs.

Other Meds:

Current Illness:

ID: 0984881
Sex: U
Age:
State: PA

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

Lab Data:

Allergies:

Symptoms: Nurse stated when she administering the second dose of the Moderna vaccine to one of her patients, some of the vaccine leaked out and the patient didn't get full dose.; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273), and vaccine leaked out. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On unknown date, the patient received their second of two planned doses of mRNA-1273 (Lot number 011L20A) intramuscularly for prophylaxis of COVID-19 infection. Nurse stated that while administering the second dose of the Moderna vaccine to one of her patients, some of vaccine leaked out and the patient didn't get full dose. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event vaccine leaked out was not reported.; Reporter's Comments: This report refers to a case of product administration error for mRNA-1273 (Lot number 011L20A), where the vaccine leaked out during administration. There were no reported AEs associated with this case of incomplete dose administered.

Other Meds:

Current Illness:

ID: 0984882
Sex: F
Age: 49
State: SC

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: compazine phenergan tigan

Symptoms: moderna covid 19 vaccine eua fever, chills, terrible headache, body aches, nausea, can barely move my left arm taking acetaminophen and ibuprofen to manage symptoms without much resolution

Other Meds: singulair abilify gabapentin citalopram requip

Current Illness: sinus congestion but not sick

ID: 0984883
Sex: F
Age: 17
State: KS

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Moderna vaccine administration to a 17 year old; A spontaneous report was received from a pharmacist concerning a 17-year-old female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) vaccine given to a 17-year-old patient. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 14 Jan 2021 the patient received their first of two planned doses of mRNA-1273 (Lot 025J20-2A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. The reporter reported the vaccine was given to 17-year-old. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccine given to a 17-year-old, was considered resolved on 14 Jan 2021.; Reporter's Comments: This case concerns a 17-year-old female patient who received their first of two planned doses of mRNA-1273 (t 025J20-2A), reporting Product administered to patient of inappropriate age.

Other Meds:

Current Illness:

ID: 0984884
Sex: U
Age:
State: NY

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

Lab Data:

Allergies:

Symptoms: partial dose of the vaccine was administered; A spontaneous report was received from a physician concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced partial dose of the vaccine was administered. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the arm for prophylaxis of COVID-19 infection. The physician reported a partial dose of the vaccine was administered. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, experienced partial dose of the vaccine was administered, was considered resolved on an unknown date.; Reporter's Comments: This case concerns a patient of an unknown age and gender. The patient's medical history and concomitant medications were not provided. The patient experienced a non serious event of partial dose of the vaccine was administered. The event occurred on the same day the first dose of the mRNA-127 was administered, with no reported AEs.

Other Meds:

Current Illness:

ID: 0984885
Sex: F
Age: 16
State: MN

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: age 16 received vaccine; A spontaneous report was received from a consumer relative, concerning a 16 year-old white female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273). The patient's medical history was not provided. No relevant concomitant medications were reported. On 28 Dec 2020, the patient received the first of two planned doses of mRNA-1273 (Lot number: 026L20A) intramuscularly for COVID-19 infection prophylaxis. On 22 Jan 2021, the patient's mother stated that her daughter received the vaccine, which was required by her employer. No adverse reactions were reported. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, age 16 received vaccine, was considered resolved on 28 Dec 2020.; Reporter's Comments: This case concerns a 16 year-old white female patient, who received the first of two planned doses of mRNA-1273 (Lot number: 026L20A) intramuscularly for COVID-19 infection prophylaxis. No adverse reactions were reported to this event pf product administered to patient of inappropriate age

Other Meds:

Current Illness:

ID: 0984886
Sex: F
Age: 41
State: PA

Vax Date: 12/24/2020
Onset Date: 12/25/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data: n/a

Allergies: Sulfa & doxycycline medication allergy allergy to various molds, completed allergy shots in January 2020 (after 5 years)

Symptoms: About a day after getting the vaccine, I felt a strange sensation of moving up and across the left side of my face. It stopped about half way across my face, with a tingle sensation . My face was then numb for the rest of the day. It only affected half of my face, the left side (I got the vaccine in left arm). The same sensation occurred with the second vaccine dose, but it happened earlier on the day of the vaccine about 5 hours after getting the shot. The same tingle and numbing sensation filled half of my face.

Other Meds: Vitamin C, D, B12, Calcium & Magnesium, vegan multi-vitamin Daily zyrtec

Current Illness: Lyme disease in November 2020

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm