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: 0985590
Sex: F
Age: 60
State: AZ

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

Lab Data:

Allergies: Sulfa and surgical tape

Symptoms: 101 fever, body aches, headache, joint aches

Other Meds: Synthroid 75mg, Liothyronine 5mg, Pravastatin 80 mg, Gabapentin 100mg 2x a day, Pepcid 40 mg, B-12, Benfotinne 100 mg, Calcium / magnesium, vVit-D3, omega, Vit-C, Hizentra 9g.

Current Illness: NO

ID: 0985592
Sex: F
Age: 66
State: CT

Vax Date: 01/19/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: aspirin, clindamycin, hydrochlorothiazide, penicillin

Symptoms: 1/19 had moderna covid vax and small lump developed after 7 days that has now doubled in size over the last 24 hours - no red streak. no fevers, chills, sweats. measured 1.5in x 2in diameter

Other Meds: famotidine, hydroxyzine, losartan, metformin, metoprolol, mirtazapine, vit D3, zolpidem

Current Illness:

ID: 0985594
Sex: F
Age: 39
State: MO

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

Lab Data:

Allergies:

Symptoms: Pt waited her 15 minute timeframe, then returned to work with no adverse reactions. Upon returning to work in the pharmacy, she sat down at her desk and noted her HR to be 159 via her Apple watch. She felt slightly lightheaded, so returned to Auditorium for monitoring. On arrival, she complained only of high HR, no other symptoms. We checked her VS: BP 140/78, HR 132, RR 20, SaO2 94. She denied chest pain or SOB. We monitored her for about 15 minutes, and her HR decreased to 103-110. We monitored her for another 15 minutes or so, at which time her HR spiked again to 132, and she felt heavy in her chest and tight in her throat. At that point, we moved her to a gurney and called a Rapid Response. We administered 50mg of Benadryl IM per protocol, foregoing the Epinephrine, due to her tachycardic state. The Rapid Response team arrived and she was transported to the ED for evaluation. She maintained consciousness and was A&Ox3 the entire time.

Other Meds:

Current Illness:

ID: 0985596
Sex: F
Age: 56
State:

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

Lab Data:

Allergies: Sulfa

Symptoms: Body aches, Temp 100, left arm soreness treated with tylenol and ibuprofen. fever and body aches subsided after 15 hours

Other Meds: vitamin D Estrogen and Progesterone

Current Illness: none

ID: 0985599
Sex: F
Age: 45
State: MI

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

Lab Data:

Allergies:

Symptoms: Very enlarged lymph node near arm pit and clavicle which were very tender and uncomfortable.

Other Meds: Synthroid, isabloom

Current Illness:

ID: 0985601
Sex: F
Age: 37
State: CA

Vax Date: 01/14/2021
Onset Date: 01/19/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: 6-day Predinsone pack (1/20/21), IM Cortisone shot (1/21/21, Allergy panel (1/22/21), use of Benadryl,

Allergies: nkda

Symptoms: Hives focused around waistline and hips, but as far as arms, wrist, face, and ankles. Cyclic in nature appearing between 7:30-9:30 in both the morning and evening. Persisted for 5 days

Other Meds: n/a

Current Illness: n/a

ID: 0985602
Sex: F
Age: 36
State: NJ

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

Lab Data: None

Allergies: Cayenne pepper

Symptoms: Tingling and pins and needles throughout the body (head, arms, neck, back) occurred immediately post vaccination, patient was given 25mg of benadryl after 30 minute wait period and still reported tingling after 15 minutes. 30 minutes after benadryl no more tingling was reported.

Other Meds: None

Current Illness: None

ID: 0985603
Sex: F
Age: 66
State: NY

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

Lab Data:

Allergies: none

Symptoms: Adverse effects began January 28th, the day after the 2nd dose of Moderna was administered. Upon awaking that morning , the first symptoms were extreme fatigue, body aches and fever. This persisted throughout the day, afternoon and evening. . Fever persisted at around 101. The treatment was, sleeping and resting in bed and drinking fluids. When waking on January 29th fever was gone and energy level close to normal, body aches were gone.

Other Meds: vitamin D3 and calcium

Current Illness: none

ID: 0985604
Sex: F
Age: 72
State: VA

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

Lab Data:

Allergies: combigan (eye drops)

Symptoms: "moderna covid-19 vaccine eua" Abdominal pain lasting about 1 hr. Slight chills (not serious)

Other Meds: simvastitin, losartin, baby asprin, magnesium, dexamethasone

Current Illness: ovarian cancer

ID: 0985605
Sex: F
Age: 55
State: MI

Vax Date: 12/08/2020
Onset Date: 12/08/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I have a 55-year-old patient who received the 1st dose of GARDASIL 9 on 12/08/2020 and developed a whelp; She got the 2nd dose on 01/09/2021 and became itchy all over; I have a 55-year-old patient who received the 1st dose of GARDASIL 9; This spontaneous report as received from a physician refers to a 55-year-old female patient. The patient's concurrent conditions included Raynaud's phenomenon, allergy to metals (aluminium), and allergy to bacitracin ointment. Her medical history was not reported. Concomitant therapies included valacyclovir hydrochloride (VALTREX). The physician called to inquire about the contraindications for hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) if a patient has an aluminum allergy. The physician stated "I have a 55-year-old (inappropriate age) patient who received the first dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) on 08-DEC-2020, 0.5 milliliter, intramuscular in the arm (lot #1691180, expiration date 15-NOV-2022) for an abnormal pap smear which showed high risk (HPV) human papillomavirus and developed a welt (urticaria). She got the second dose on 09-JAN-2021 and became itchy all over (pruritus). The physician needed guidance on whether she should receive the third dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9). No treatment was administered for the events. No laboratory tests were performed, and the patient did not seek medical attention. On an unspecified date, the patient recovered from the events. The patient did not die. No product to retrieve. No PQC was reported. No additional adverse events were reported. The causal relationship between the events and hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) was not reported. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: 1691180; expirationdate: 15-NOV-2022; deviceage and unit: 0 ; malfunction: Unknown; productavailableforevaluation: No; deviceusage: Initial; evaluatedbymfr: Not returned to manufacturer; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability

Other Meds: VALTREX; GARDASIL 9 SYRINGE (DEVICE)

Current Illness: Allergy to aluminium; Drug allergy; Papanicolaou smear abnormal; Raynaud's syndrome

ID: 0985606
Sex: F
Age: 50
State: OH

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

Lab Data: None

Allergies: Iodine and reglan

Symptoms: Patient developed hives from the middle of her neck down to the middle portion of her thighs. She also had some present to her entire back. The rash felt like "sunburn" and was not itchy per her report.

Other Meds: Ajovy monthly injection, as needed Maxalt and Zofran

Current Illness: None

ID: 0985607
Sex: F
Age: 67
State: OH

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

Lab Data:

Allergies:

Symptoms: injection site pain; was able to tell if full dose was received or a partial dose / received an under dose; liquid from Shingrix dose in syringe ran down arm; liquid from Shingrix dose in syringe ran down arm; This case was reported by a consumer and described the occurrence of injection site pain in a 67-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of headache (1st dose received on 25th September 2020, 0.5 ml Intramuscularly in left deltoid and the patient experienced injection site pain, nausea, feeling of warmth and fever, for the tolerability of 1st dose, refer case US2020238719 reported for same patient.). On 1st December 2020, the patient received the 2nd dose of Shingrix. On 1st December 2020, less than a day after receiving Shingrix, the patient experienced injection site pain, accidental underdose, exposure via skin contact and inadvertent exposure to vaccine. Rechallenge with Shingrix was positive. On an unknown date, the outcome of the injection site pain was not recovered/not resolved and the outcome of the accidental underdose, exposure via skin contact and inadvertent exposure to vaccine were unknown. It was unknown if the reporter considered the injection site pain to be related to Shingrix. Additional details were provided as follows: After receiving 2nd dose of Shingrix, the patient experienced injection site pain. The consumer reports the liquid from Shingrix dose in syringe ran down arm and the pharmacist or consumer was able to tell if full dose was received or a partial dose, which led to accidental underdose, exposure via skin contact and inadvertent exposure to vaccine. The reporter reported that due to a faulty needle or loose syringe that caused a vaccination error. The reporter consent to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2020238719:Same reporter

Other Meds:

Current Illness:

ID: 0985608
Sex: F
Age: 47
State: WA

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

Lab Data:

Allergies: none

Symptoms: I woke up to a red hard itchy spot at injection site a week after first injection. I am still monitoring for further reaction. My initial reaction the day of the injection was typical; a few hours after I had a sore arm followed by a headache. Headache was intermittent and soreness lasted about 24-30 hours.

Other Meds: none

Current Illness: no

ID: 0985609
Sex: U
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: bilateral itching on inner thigh; posterior neck with raised, red vesicles; posterior neck with raised, red vesicles; This case was reported by a other health professional and described the occurrence of itchy legs in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced itchy legs, vesicles and erythema. On an unknown date, the outcome of the itchy legs, vesicles and erythema were unknown. It was unknown if the reporter considered the itchy legs, vesicles and erythema to be related to Shingrix. Additional details were reported as follows: The age at vaccination was not reported. The age group was not reported but it was captured as adult as per vaccine indication. The patient experienced bilateral itching on inner thigh, posterior neck with raised, red vesicles. This case had been linked with US2020AMR239492 reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR239492:same reporter

Other Meds:

Current Illness:

ID: 0985610
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: haD PCOS; Lower back pain; This case was reported by a consumer via interactive digital media and described the occurrence of polycystic ovarian syndrome in a female patient who received HPV 16-18 (HPV vaccine) for prophylaxis. On an unknown date, the patient received HPV vaccine. On an unknown date, unknown after receiving HPV vaccine, the patient experienced polycystic ovarian syndrome and low back pain. On an unknown date, the outcome of the polycystic ovarian syndrome and low back pain were unknown. It was unknown if the reporter considered the polycystic ovarian syndrome and low back pain to be related to HPV vaccine. Additional information was provided as follows: The patient received HPV vaccine and experienced polycystic ovarian syndrome and lower back pain . The case has been linked with the case number- US2020AMR248063, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR248063:same reporter

Other Meds:

Current Illness:

ID: 0985611
Sex: F
Age: 67
State: LA

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

Lab Data:

Allergies:

Symptoms: 1/28/2021 02:38:41 PM > 1410: Patient c/o numbness and tingling to L arm approximately 7 minutes after receiving injection with no other complaints, nurse added additional 10 minutes to observation time. 1430: Patient states numbness is getting better, nurse encouraged patient to go to nearest ER if problem persisted. RN 1/29/2021 08:55:46 AM > contacted patient to f/u, message left

Other Meds:

Current Illness:

ID: 0985612
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: all of October I had the H1N1 flu; This case was reported by a consumer via interactive digital media and described the occurrence of h1n1 influenza in a female patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2020-2021 season) for prophylaxis. Co-suspect products included PNEUMOCOCCAL VACCINE (PNEUMONIA VACCINE) for prophylaxis. On an unknown date, the patient received Influenza vaccine Quadrivalent 2020-2021 season and PNEUMONIA VACCINE. In October 2020, 1 week after receiving Influenza vaccine Quadrivalent 2020-2021 season, the patient experienced h1n1 influenza. The patient was treated with oseltamivir phosphate (Tamiflu). On an unknown date, the outcome of the h1n1 influenza was recovered/resolved. It was unknown if the reporter considered the h1n1 influenza to be related to Influenza vaccine Quadrivalent 2020-2021 season. Additional details were provided as follows: The age at vaccination was not reported. A week after vaccination, the patient had the H1N1 flu for all October 2020. It wasn't COVID 19 but it was bad enough. The patient had prescription of Tamiflu. No further information was provided.

Other Meds:

Current Illness:

ID: 0985613
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: took the band aid off ant it was red exact length and width of the band aid; took the band aid off ant it was / swollen exact length and width of the band aid; took the band aid off ant it was / hot exact length and width of the band aid; This case was reported by a consumer via interactive and described the occurrence of injection site erythema in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. In November 2020, the patient received the 1st dose of Shingrix. On an unknown date, 1 day after receiving Shingrix, the patient experienced injection site erythema, injection site swelling and injection site warmth. On an unknown date, the outcome of the injection site erythema, injection site swelling and injection site warmth were unknown. It was unknown if the reporter considered the injection site erythema, injection site swelling and injection site warmth to be related to Shingrix. Additional details were provided as follows: The age group was not reported, however it was captured as an adult as per vaccine indication. The age at vaccination was not reported. The next day, the patient took the band aid off and it was red and swollen and hot the exact length and width of the band aid.

Other Meds:

Current Illness:

ID: 0985614
Sex: F
Age:
State: IN

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

Lab Data:

Allergies:

Symptoms: I got cills; low grade fever; achy; arm is still is red; arm is still /swollen; 1st dose given subcutaneously; I did get diarrhea / (have had that for two days); This case was reported by a other health professional and described the occurrence of erythema of extremities in a 52-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. In December 2020, the patient received the 2nd dose of Shingrix (subcutaneous). In December 2020, less than a week after receiving Shingrix, the patient experienced erythema of extremities, swelling arm, pain, diarrhea and intramuscular formulation administered by other route. On 19th December 2020, the patient experienced chills and low grade fever. On an unknown date, the outcome of the erythema of extremities and swelling arm were not recovered/not resolved and the outcome of the chills, low grade fever, pain and intramuscular formulation administered by other route were unknown and the outcome of the diarrhea was recovered/resolved. It was unknown if the reporter considered the erythema of extremities, swelling arm, chills, low grade fever, pain and diarrhea to be related to Shingrix. Additional details were reported as follows: The reporter was an office supervisor. The reporter stated, they found the massage about the patient who got the Shingrix shot subcutaneously instead of intramuscular route, which led to intramuscular formulation administered by other route. On 21st December 2020, the patient contacted through patient satisfaction survey and stated that, the nurse gave Shingrix dose in the back side of arm and said it needed to be in a fatty part of arm and not in the muscle. The patient added, she never got a shot there. The patient searched about this and got to know that, the shingles shot needs to be given in the arm muscle. The patient asked if this shot remain effective since it was not given in the muscle. The patient had side effects like her arm was still red and swollen. On Saturday, she got chills and a low grade fever and was achy. She got diarrhea for two days. The patient stated it might be due to the shot was working.

Other Meds:

Current Illness:

ID: 0985615
Sex: F
Age: 70
State: MI

Vax Date: 01/20/2021
Onset Date: 01/26/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: Erythromycin, fexofenadine

Symptoms: Red rash appeared on upper arm approximately 7 inches by 5 inches in size. It was very itchy and had burning sensation and skin was swollen and warm to touch. It appeared suddenly on 6th day after date of vaccine. Treated with oral antihistamine, cool compresses and hydrocortisone cream. Symptoms have diminished on day 4 of occurence. Consulted with medical professional about it on Jan 29, 2021.

Other Meds: None

Current Illness: None

ID: 0985616
Sex: F
Age: 66
State: FL

Vax Date: 11/28/2020
Onset Date: 11/29/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data: Test Date: 20201129; Test Name: Body temperature; Result Unstructured Data: (Test Result:101,Unit:degree F,Normal Low:,Normal High:)

Allergies:

Symptoms: Dizziness; Dizziness / she fell down as a result; severe vertigo / room is spinning; can't focus her eyes; headache; Fever of 101 degrees F; Nausea; Sweating; This case was reported by a consumer via and described the occurrence of fever in a 66-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of no adverse event (received 1st dose on 15th August 2020 in left arm). On 28th November 2020, the patient received the 2nd dose of Shingrix. On 29th November 2020, 1 days after receiving Shingrix, the patient experienced fever, nausea, sweating and headache. On 30th November 2020, the patient experienced dizziness, fall, vertigo and difficulty focusing eyes. On an unknown date, the outcome of the fever, nausea and sweating were recovered/resolved and the outcome of the dizziness, fall, vertigo and difficulty focusing eyes were not recovered/not resolved and the outcome of the headache was unknown. It was unknown if the reporter considered the fever, nausea, sweating, dizziness, fall, headache, vertigo and difficulty focusing eyes to be related to Shingrix. Additional details were provided as follows: The patient received 2nd dose of shingrix and next day experienced fever of about 101 degree F, nausea and sweating. 2 days after receiving 2nd dose of Shingrix, patient experienced severe vertigo and she was unable to focus her eyes and fell down. The patient experienced spinning room which she had never experienced in her life. The patient saw neurologist and currently was in doctor's office to look at her inner eye. MRI was scheduled 1 week from the time of reporting. On 30th November 2020, patient experienced dizziness and fell down and were not resolved. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0985617
Sex: F
Age: 37
State: KY

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

Lab Data:

Allergies: ceclor

Symptoms: Pain around injection site x 5 days; resolved. Bruising around injection site x15 days; still present. Redness, warm to touch and mild itching around injeciton site x15 days; still present.

Other Meds: none

Current Illness: none

ID: 0985618
Sex: F
Age:
State:

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

Lab Data: Test Name: Epstein-Barr virus; Result Unstructured Data: (Test Result:Epstein-Barr virus test pisitive,Unit:unknown,Normal Low:,Normal High:)

Allergies:

Symptoms: raisised EBV antibodies but no sxs; This case was reported by a pharmacist and described the occurrence of epstein-barr virus antibody positive in a female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, less than a year after receiving Shingrix, the patient experienced epstein-barr virus antibody positive. On an unknown date, the outcome of the epstein-barr virus antibody positive was unknown. It was unknown if the reporter considered the epstein-barr virus antibody positive to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported. The shingrix dose caused raise in Epstein barr antibodies. The patient had raised Epstein-Barr Virus antibodies but no symptoms and had recent Shingrix. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0985619
Sex: F
Age: 10
State: PA

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

Lab Data:

Allergies:

Symptoms: he plunger would not depress; prefilled syringe that would not depress; lightheadedness; patient was stuck twice / considered a possible overdose; This case was reported by a pharmacist via call center representative and described the occurrence of light headedness in a 10-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2020-2021 season) (batch number 373H3, expiry date 30th June 2021) for prophylaxis. This case was associated with a product complaint. Co-suspect products included flu seasonal qiv dresden pre-filled syringe device (Fluarix Tetra Pre-Filled Syringe Device) injection syringe for prophylaxis, Flu Seasonal QIV Dresden (Fluarix Tetra 2020-2021 season) (batch number 5D4H4, expiry date 30th June 2021) for prophylaxis and flu seasonal qiv dresden pre-filled syringe device (Fluarix Tetra Pre-Filled Syringe Device) injection syringe for prophylaxis. On 1st December 2020, the patient received Fluarix Tetra 2020-2021 season (intramuscular), Fluarix Tetra Pre-Filled Syringe Device, Fluarix Tetra 2020-2021 season (intramuscular) and Fluarix Tetra Pre-Filled Syringe Device. On 1st December 2020, less than a day after receiving Fluarix Tetra 2020-2021 season, Fluarix Tetra Pre-Filled Syringe Device, Fluarix Tetra 2020-2021 season and Fluarix Tetra Pre-Filled Syringe Device, the patient experienced light headedness. On an unknown date, the patient experienced overdose, pharmaceutical product complaint and needle issue. On an unknown date, the outcome of the light headedness was recovered/resolved and the outcome of the overdose, pharmaceutical product complaint and needle issue were unknown. The reporter considered the light headedness to be related to Fluarix Tetra 2020-2021 season, Fluarix Tetra Pre-Filled Syringe Device, Fluarix Tetra 2020-2021 season and Fluarix Tetra Pre-Filled Syringe Device. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details and Follow of information received from QA department were provided as follows: The reporter was a pharmacist. She reported that yesterday (1st December 2020) she was injecting Fluarix (to a female pediatric patient) and when trying to inject the prefilled syringe into the patient the plunger would not depress. The reporter said it was difficult to tell but she does not think any medication came out. The reporter also does not know if it could have been an issue with the needle or with the prefilled syringe. The lot number of the prefilled syringe that would not depress was 373H3. It was the last one out of the box of 10. FLU.QIV PRTC 10 CT FS US NH20. Please credit for 1/10th of a box. The prefilled syringe with needle attached was in the sharps container and therefore was not available for return. No picture was taken. Pharmacist got a new prefilled syringe of Fluarix from a new box lot 5D4H4 and put a new needle on and was able to successfully inject the patient. Filing as a related Adverse Event due to the fact that the patient was stuck twice and that if even a drop came out during the 1st injection that would be considered a possible overdose. Both the 1st and 2nd injection were given intramuscularly in the left deltoid but not in the same exact spot on the deltoid. The patient did experience some lightheadedness which did resolved. Difficult to push plunger questions: the plunger eventually push or was unusable, not any blockages visible in the syringe body or barrel, no any abnormal particles observed in the vaccine, yes there was Luer Lok needle used. Summary of the QA statement were received as follows: A customer reported a complaint which falls within the following product technical complaint An investigation had been conducted, including review of the reported defect trends, the retained samples and our production records, which has demonstrated that the subject batch was produced in compliance with the applicable procedures and met all required specifications. Additionally, no deviation which could be related to the reported complaint has been identified and all of applicable verifications confirmed the conformity of the batch to specifications. Given the outcome of its investigation, GSK Biologicals considers the complaint that was the object of this report as unsubstantiated.

Other Meds:

Current Illness:

ID: 0985620
Sex: F
Age: 47
State: MO

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

Lab Data:

Allergies:

Symptoms: Employee reports not being able to sleep night of vaccination, injection site pain.

Other Meds:

Current Illness:

ID: 0985621
Sex: F
Age: 81
State: VA

Vax Date: 06/01/2019
Onset Date: 11/14/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: second has not been administered; Covid-19; This case was reported by a pharmacist and described the occurrence of coronavirus infection in a 83-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Herpes zoster (Shingrix) for prophylaxis. In June 2019, the patient received the 1st dose of Shingrix. On an unknown date, the patient received the 2nd dose of Shingrix. On 14th November 2020, less than 2 years after receiving Shingrix and not applicable after receiving Shingrix, the patient experienced coronavirus infection. On an unknown date, the patient experienced social problem. On an unknown date, the outcome of the coronavirus infection and social problem were unknown. It was unknown if the reporter considered the coronavirus infection to be related to Shingrix. Additional details were reported as follows: The age at vaccination was not applicable for 2nd dose. The patient missed to receive the second dose of Shingrix at appropriate time, probably due to pandemic. It should have received until December 2019. Additionally, the patient was recently diagnosed with Covid-19. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0985622
Sex: F
Age: 62
State: PA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/29/2021
Hospital: Y

Lab Data: Test Date: 20201230; Test Name: COVID-19 test; Test Result: Negative ; Test Date: 20210104; Test Name: COVID-19 test; Test Result: Positive ; Result Unstructured Data: Positive result on 08 Jan 2021

Allergies:

Symptoms: SARS-CoV-2 test positive; Faints; Chills; Headache; A spontaneous report was received from a consumer concerning a 62-year-old, female patient who received Moderna's COVID-19 vaccine and experienced faints, headache, chills, and COVID-19. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 30 Dec 2020 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 026L20A) in the right arm for prophylaxis of COVID-19 infection. On 30 Dec 2020, prior to vaccination, the patient took a COVID-19 test and results were negative. On 31 Dec 2020, the day after vaccination, the patient got instantly sick, she had a headache, chills, and faints. On 03 Jan 2021, the patient went to the emergency room (ER) where she received unspecified treatment for the symptoms she was experiencing. On 04 Jan 2021, the patient received a second COVID-19 test and received a positive result on 08 Jan 2021. On 08 Jan 2021, the patient was hospitalized with reported COVID-19 symptoms of dehydration, cough, no appetite, and no taste. Treatment for the event included fluids, oxygen, and steroids. On 11 Jan 2021, the patient was discharged from the hospital. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome of the events, faints, headache, chills, and COVID-19, was not reported.

Other Meds:

Current Illness:

ID: 0985623
Sex: F
Age: 21
State: NC

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

Lab Data: None

Allergies:

Symptoms: Employee states that later that eveningwhen she got home she began having some lightheadedness and describes feeling loopy. She described seeing stars at times and then her vision would go black. A friend came over to stay with her and did say that at one point she became unresponsive for about 45 sec to 1 minute. The second day she still had the lightheadedness and felt loopy. On the 3rd day she felt completely fine.

Other Meds:

Current Illness:

ID: 0985624
Sex: F
Age: 79
State: GA

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

Lab Data: Test Date: 20210115; Test Name: Blood pressure; Result Unstructured Data: 210/120 mmHg; Comments: Patient's normal reported blood pressure is 127/74; Test Date: 20210115; Test Name: Heart rate; Test Result: Inconclusive ; Result Unstructured Data: 75; Test Date: 20210115; Test Name: oxygen level; Test Result: Inconclusive ; Result Unstructured Data: 100 percent

Allergies:

Symptoms: Blood pressure 210/120; A spontaneous report was received from a consumer concerning a 79-year-old, female patient who received Moderna's COVID-19 Vaccine, and who experienced a hypertensive crisis. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 14-Jan-2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (LOT unknown) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 14-Jan-2021 A patient received the Moderna vaccine. On 15-Jan-2021, the patient experienced a blood pressure of 210/120. The friend reported that the patient's baseline blood pressure is 124/74. Patient's reported heart rate was 75 and her oxygen saturation was 100%. Patient visited the emergency room on 15-Jan-2021. No additional details were provided. Treatment information was not provided. Action taken with mRNA-1273 in response to the event, a hypertensive crisis, was not provided. The outcome of the event, a hypertensive crisis, was not reported.; Reporter's Comments: This case concerns a female patient, who experienced a serious unexpected event of hypertensive crisis. The event of hypertensive crisis occurred 2 days after mRNA-1273 (lot # unknown) administration. Treatment details were not provided. Very limited information regarding the events have been provided at this time. Based on temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 0985625
Sex: F
Age: 59
State: CA

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data: Test Date: 20201230; Test Name: Ultrasound; Result Unstructured Data: Ultrasound showed extravasation of tissues

Allergies:

Symptoms: BIg black thing; Big scar; Felt like chemical burn; Peeling; Cellulitis; Extravasation in tissues; Bruising from upper arm down to elbow; Arm was hot and tender; Swelling from upper arm down to elbow; Arm hot and tender; Bump/clot at injection site; Unsure if it was given intramuscularly; A spontaneous report was received from a physician who was also a 59-year-old female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced a bump/clot at the injection site, swelling, bruising from upper arm to elbow, feeling hot, tenderness, extravasation in tissues, vaccination site cellulitis, a big blackened area, scar, chemical burn, unsure whether it was intramuscular and peeling. The patient's medical history was not provided. Concomitant medication use was not provided by the reporter. On 23 Dec 2020, immediately prior to the onset of symptoms, the patient received the first of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The physician reported that she was injected with the vaccine abruptly and roughly. She noticed a bump at the injection site right away. The nurse applied a cold compress. Later that day, she realized it was a clot. On 24 Dec 2020, she had swelling, bruising from her upper arm to her elbow, and the area was hot and tender. On 30 Dec 2020, she went to the emergency room where an ultrasound showed extravasation in the tissues. She was treated with cephalexin for cellulitis. On 01 Jan 2021, the bump began to subside; however, there was a large black area that started to peel. The reporter stated it looked like a chemical burn. On an undisclosed date, there was a large scar in its place. Treatment for the events included a cold compress and cephalexin. The reporter stated she is unsure whether it was intramuscular. Action taken with mRNA-1273 in response to the events was not provided. The event, scar, was not resolved. The outcome of the events, bump/clot at the injection site, swelling, bruising from upper arm to elbow, feeling hot, tenderness, extravasation in tissues, vaccination site cellulitis, a big blackened area, chemical burn, and peeling, were considered resolving. The event, unsure whether is was intramuscular, was resolved.; Reporter's Comments: This report refers to a case of incorrect route of administration for mRNA-1273 and concerns a 59 year-old, female patient, who experienced the events of bump/clot at the injection site, swelling, bruising from upper arm to elbow, feeling hot, tenderness, extravasation in tissues, vaccination site cellulitis, a big blackened area, scar, chemical burn and peeling. The event of bump/clot at the injection site occurred the same day after the first and only dose of mRNA-1273 vaccine administration. The events of swelling, bruising from upper arm to elbow, feeling hot, tenderness occurred the next day after the vaccine administration. The events of extravasation in tissues, vaccination site cellulitis occurred 7 days after the vaccine administration. The events of a big blackened area, scar, chemical burn and peeling occurred 9 days after the vaccine administration. Based on the current available information and temporal association between the use of the product and the start of the events, a causal relationship cannot be excluded and the events are assessed as possibly related.

Other Meds:

Current Illness:

ID: 0985626
Sex: M
Age: 59
State: CA

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

Lab Data: EKG

Allergies:

Symptoms: Pt developed palpitations, tingling of left sided face, vomiting

Other Meds:

Current Illness:

ID: 0985627
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Unconscious; Turned Pale; Threw up; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and turned pale, threw up, and was unconscious. The patient's medical history was not provided. No concomitant medications were reported. On 12 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025L20A) intramuscularly for prophylaxis of COVID-19 infection. On 12 Jan 2021, the patient turned pale, threw up and was unconscious. The patient was taken to the emergency department (ED). No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome for the events, turned pale, threw up, and unconscious, was unknown.; Reporter's Comments: This spontaneous report refers to a case a patient who experienced events turned pale, threw up and was unconscious on the same day after the administration of the first and only dose of mRNA-127 (Lot number 025L20A, Exp date-unknown). Based on temporal the information provided and the absence of any other etiology factors a causal association between the events and vaccine administration cannot be excluded.

Other Meds:

Current Illness:

ID: 0985628
Sex: F
Age: 52
State: OR

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/29/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Diverticulitis; A spontaneous report was received from a nurse who was an 53-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced serious event of diverticulitis. The patient's medical history was not provided. No concomitant medications were reported. On 22 Dec 2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 011S20G) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On the same day, the patient experienced diverticulitis. She was hospitalized and the treatment of the event given was iv antibiotics. On 15 Jan 2021, the patient reported that the symptoms started again. Action taken with mRNA-1273 in response to the events was not provided. The outcome for the event, diverticulitis, was not resolved.; Reporter's Comments: This case concerns a 53-year-old, female patient. The patient's medical history was not provided. The patient experienced a serious, unexpected event of diverticulitis. The event occurred the same day the patient received the first dose of mRNA-1273 (Lot number: 011S20G). Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 0985629
Sex: M
Age: 42
State: TX

Vax Date: 01/07/2021
Onset Date: 01/09/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data: Test Date: 20210109; Test Name: Blood tests; Test Date: 20210109; Test Name: Chest x-ray; Test Date: 20210109; Test Name: EKG

Allergies:

Symptoms: Arrhythmia; Heart palpitations; A spontaneous report was received from a 42 year-old, male, patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced heart palpitations and arrhythmia. The patient's medical history was not provided. No relevant concomitant medications were reported. On 07 Jan 2021 at 14:30, approximately 2 days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 09 Jan 2021, the patient went to the emergency room (ER) because he had heart palpitations and an arrhythmia for about 5 hours. Blood tests, electrocardiogram (EKG) and a chest x-ray were normal. On 10 Jan 2021, the patient's heart palpitations came back again. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome for the events, heart palpitations and arrhythmia, was not reported.; Reporter's Comments: This case concerns a 42-year old male patient. The medical history is not provided. The patient experienced a medically significant and unexpected event of Arrhythmia and an unexpected non-serious event of Heart palpitations approximately two days after receiving their first of two planned doses of mRNA-1273 (Lot unknown). Based on the current available information and temporal association between the use of the product and the onset of the events, a causal relationship cannot be excluded and the events are considered possibly related to the vaccine.

Other Meds:

Current Illness:

ID: 0985630
Sex: F
Age: 33
State: TX

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

Lab Data:

Allergies: Yes, tramadol

Symptoms: Today 01/29/2021 I noticed swelling and redness around injection site. Warm to touch. baseball size

Other Meds: None

Current Illness: None

ID: 0985631
Sex: M
Age: 59
State: TX

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

Lab Data:

Allergies:

Symptoms: Received a 0.25ml dose; A spontaneous report was received from a consumer who was also a 59-years old, male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced received a 0.25 milliliter (mL) dose. The patient's medical history, as provided by the reporter, included diabetes. Concomitant medications reported included unspecified diabetes medication. On 22 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 22 Jan 2021, the patient noticed that he received a 0.25 mL dose rather than the full 0.5 mL dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, received a 0.25ml dose, was considered resolved on 22 Jan 2021.; Reporter's Comments: This case concerns a 59-year-old male patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product administered to patient of inappropriate age.

Other Meds: Diabetes medication

Current Illness: Diabetes mellitus NOS

ID: 0985632
Sex: M
Age: 87
State: NJ

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

Lab Data: at ~10pm (2 hrs after vaccination): home BP ~150/80 home HR ~65 home O2 sat ~96%

Allergies: unknown

Symptoms: ventral tongue and lip tingling, beginning 20 min after vaccination, improving over hours beginning prior to and continuing after Diphenhydramine, 50-75% resolved after 2 hrs and fully resolved on awakening this am, no SOB, no lip swelling, no rash, no nausea, no throat fullness, no fever

Other Meds: unknown

Current Illness: none

ID: 0985633
Sex: F
Age: 65
State: AZ

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Induced a bout of vertigo which lasted 11 days, although a vertigo sufferer no prevous bout has gone more than about 3 days. the dizziness was severe enough it prevented patient from working for at l9 days

Other Meds: Levothyrixine; Tribenzor

Current Illness: None

ID: 0985634
Sex: F
Age: 74
State: TX

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

Lab Data: COVID-19 test 1/3/2021-Negative

Allergies: Penicillin, Erythromycin, Keflex

Symptoms: 1/15/21 sore arm 3 days later, 24 hours after pressure on head, 30 mins of being lightheaded, later on muscle aches, 1/21 pt started to experience low grade fever, 1/22 called PCP; PCP recommended COVID test. 1/23 COVID test, 1/24 injection site and below rash, low grade fever continued, 1/27 rash/fever gone

Other Meds: Betimol 0.5% one drop both eyes twice a day, Pilotarpine 1% one drop twice daily , Vyzulta 0.024% one drop daily, Levothyroxine 25 mcg once daily, Multivitamins-Calcium, Vitamin D3, Vitamin E, Vitamin D

Current Illness: None

ID: 0985635
Sex: F
Age:
State: TX

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

Lab Data:

Allergies:

Symptoms: awful burning in the chest/pain in her chest; horrible pressure and pain in her chest; nausea; felt woozy; This is a spontaneous report from a contactable consumer (patient). A 72-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number EL3246), via an unspecified route of administration in the right arm on 13Jan2021 at 17:39 at a single dose in the hospital for covid-19 immunisation. Medical history included anxiety, seizures, and high cholesterol. She passed out last summer and they put her in the hospital from 31Aug2020 and ran all kinds of tests. In the end, they said she only had a few PVCs (premature ventricular contractions) and she doesn't need to see the doctor for a year. Mentioned she also has chronic bronchitis and this is related to having low platelet count and low immunity. All of these events predate treatment with Pfizer COVID 19 vaccine. Concomitant medication included amlodipine, atorvastatin for high cholesterol, clonazepam for seizures, escitalopram for anxiety, levothyroxine sodium for thyroid, and mirtazapine for sleep; all were ongoing. Stated that she had something weird happen after her injection about four hours after the shot. She received the first dose of the Pfizer COVID 19 vaccine on 13Jan2021 at 17:39 in the right arm. About three or four hours later on 13Jan2021, she was getting ready for bed and when she sat down and leaned over she had a god awful burning in her chest and nausea. She was going to take baking soda but when she sat up she had horrible pressure and pain in her chest and felt woozy so she sat on the floor and then the pain started to radiate through her arm and into her neck. The horrible pain and pressure in her chest felt like something was sitting on her chest and the bad pain in her chest was going into her arm and a little into her neck. She laid real still on the floor, and did a lot of praying, and then 20 minutes later it totally stopped. She got up slowly and finished getting ready for bed and was fine. She was just hoping they will still let her get the second shot. The whole event only lasted 20 minutes and when it was over it was completely gone. She did tell her husband when he came home. She was alone when this happened. The patient wanted to know if she can receive second dose of vaccine. She stated it almost felt like a heart attack. She was planning to get the second dose on 03Feb2021. Wanted to know if her effect will preclude her from getting the second dose of the vaccine. Outcome of the events was recovered on 13Jan2021.

Other Meds: AMLODIPINE; ATORVASTATIN; CLONAZEPAM; ESCITALOPRAM; LEVOTHYROXINE [LEVOTHYROXINE SODIUM]; MIRTAZAPINE

Current Illness:

ID: 0985636
Sex: M
Age:
State: NC

Vax Date: 01/06/2021
Onset Date: 01/12/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: low grade headache; minor disorientation that continues to persist; This is a spontaneous report from a contactable consumer. A 69-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) lot number: EK9231, via an unspecified route of administration on 06Jan2021 14:00 at a single dose on the left arm for COVID-19 immunization. Medical history included heart rhythm (heart rate abnormal). Concomitant medication included metoprolol for heart rhythm and an unspecified statin. The patient received the first dose on 06Jan2021, and on 12Jan2021 he experienced low grade headache and minor disorientation that continues to persist. They started on the same day in the morning, unable to provide exact time. The low grade headache was lasting all day. He is scheduled to get the second dose on 27Jan2021 and was afraid of taking it due to these side effects. The outcome of the events was not recovered.

Other Meds: METOPROLOL

Current Illness:

ID: 0985637
Sex: F
Age: 61
State:

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

Lab Data:

Allergies: N/A

Symptoms: Within 2 hours of shot extreme soreness in arm, around 6pm shooting pain across forehead, nausea, chills, low grade fever, body aches.

Other Meds: Thyroid Meds

Current Illness: N/A

ID: 0985638
Sex: F
Age:
State: NC

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: This is a spontaneous report from a contactable nurse (patient herself). A 53-years-old female patient received second dose of BNT162B2 ( COVID-19 VACCINE, Solution for injection, lot number EL3248, expiry date not reported), intramuscular in the right arm on 13Jan2021 11:15 at a single dose for COVID-19 immunization. The patient's medical history was not reported. The patient had no known allergies. The patient had no covid prior to vaccination. The patient was not pregnant at the time of the vaccination. Concomitant medications included first dose of varicella zoster vaccine rge (cho) (SHINGRIX) on 07Dec2020 at a single dose in the left arm for immunization; bupropion hydrochloride (WELLBUTRIN); and unspecified hormone replacement. The first dose of BNT162B2 for COVID-19 immunization (lot EK5730; brand Pfizer,) was on 22Dec2020 07:15 AM via intramuscular route in the left arm. The patient was having sharp stabbing pains every 5-10 seconds in the left parietal occipital area; started about 13 hours after second vaccine (14Jan2021 03:00 AM). No treatment received in relation to the reported event. The patient was not tested for covid post vaccination. The outcome of the event sharp stabbing pains every 5-10 seconds in the left parietal occipital area was not recovered.

Other Meds: WELLBUTRIN

Current Illness:

ID: 0985639
Sex: F
Age:
State: CA

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

Lab Data: Test Name: BP; Result Unstructured Data: Test Result:123/59; Test Name: Heart Rate; Result Unstructured Data: Test Result:70; Test Name: O2 Saturation; Test Result: 100 %

Allergies:

Symptoms: dizzy; headache; nausea; puffy throat; This is a spontaneous report from a contactable pharmacist. A 56-year-old female patient received first dose BNT162B2 (Pfizer BioNTech Covid 19 vaccine, lot number EL3249), intramuscular at Arm Left on 12Jan2021 at the 56 years old at single dose for COVID-19 immunization. The medical history included bronchitis and palpitations. The concomitant medications were not reported. The patient experienced dizzy, headache, nausea, "puffy throat" all on 12Jan2021. There was treatment received for events dizzy, headache, nausea, "puffy throat". The patient underwent lab tests and procedures, which included Blood pressure (BP) 123/59, O2 Saturation 100%, Heart Rate70 all on an unknown date. The outcome of all the events was recovered in Jan2021. No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 0985640
Sex: F
Age: 46
State: MO

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Employee reports not being able to sleep at all night of injection, injection site pain.

Other Meds:

Current Illness:

ID: 0985641
Sex: F
Age:
State: NJ

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

Lab Data:

Allergies:

Symptoms: Intermittent fever; chills; body aches; tiredness; pain and swelling in a axilla area of left arm; pain and swelling in a axilla area of left arm; This is a spontaneous report from a contactable nurse (patient). A 63-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number: EK9231), via an unspecified route of administration in left arm on 12Jan2021 at 07:00 at single dose for COVID-19 immunization. Medical history included hypertension and ventricular septal defect. The patient was not pregnant. Patient has no COVID-19 prior to vaccination. Concomitant medications included aspirin (ASPIRIN [ACETYLSALICYLIC ACID]), docusate sodium (COLACE), losartan, omeprazole and montelukast sodium (SINGULAIR). The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number: EJ1685), via an unspecified route of administration in left arm on 22Dec2020 at 2PM for COVID-19 immunization. On 12Jan2021 at 11:30 PM, the patient experienced intermittent fever and chills, body aches, tiredness, and pain and swelling in the axilla area of left arm. Patient has not tested for COVID-19 post vaccination. The outcome of the events was recovering.

Other Meds: ASPIRIN [ACETYLSALICYLIC ACID]; COLACE; LOSARTAN; OMEPRAZOLE; SINGULAIR

Current Illness:

ID: 0985642
Sex: F
Age: 50
State: NC

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

Lab Data: None.

Allergies: None

Symptoms: COVID-19 Vaccine EUA; fever, chills, joint intense pain in hip joints and neck, headache, exhaustion, loss of appetite, nausea, heart fluttered for a few seconds at various times throughout the day, swelling and pain at injection site. Symptoms started around 9PM on the 26th, started to feel better at 8AM morning of the 28th. Could not work or focus at all for the 27th. Took tylenol, motrin, and aleve for pain, which eased some pain, but not full relief, constantly felt pain. By 8AM on the 28th, pain, headache, exhaustion, appetite loss, nausea, and heart flutters stopped. Pain at arm shot site diminished to only when touched, discomfort shifted to right side of rib cage under the armpit, and is still present at 12:15pm on Jan 29th. Called primary physician to verify all was OK, and as predicted it passed within 24-48hrs. No allergic reactions ever.

Other Meds: Neocell collagen powder , 1 scoop a day

Current Illness: Cold/flu - no fever, non-covid related, was covid tested twice to confirm. Jan 10-14

ID: 0985643
Sex: F
Age:
State: OK

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Swelling and redness of the arm, the size of an orange; Swelling and redness of the arm, the size of an orange; Headaches; Tiredness; Feeling unwell; This is a spontaneous report from a contactable other health professional. A 59-year-old female patient (pregnant: No) received second dose of bnt162b2 (lot number: EL1283), intramuscularly in left arm on 12Jan2021 16:00 at single dose for COVID-19 immunization. The patient's medical history was not reported. Concomitant medication included sertraline hydrochloride (ZOLOFT), ibuprofen. The patient previous received first dose of bnt162b2 (lot number: EK5730) intramuscularly in left arm on 21Dec2020 11:30 AM for COVID-19 immunization. The patient experienced swelling and redness of the arm, the size of an orange, headaches, tiredness, feeling unwell on 13Jan2021 06:00. No treatment received. The outcome of events was resolving. The event was not resulted in a visit to doctor or other healthcare professional office/clinic or Emergency room/department or urgent care. No covid prior vaccination. No covid tested post vaccination. Not known allergies. Facility type vaccine was hospital. No other vaccine in four weeks.

Other Meds: ZOLOFT; IBUPROFEN

Current Illness:

ID: 0985644
Sex: M
Age:
State:

Vax Date: 01/13/2021
Onset Date: 01/15/2021
Rec V Date: 01/29/2021
Hospital:

Lab Data:

Allergies:

Symptoms: He woke up and his eye felt like it was hurting; He has a swollen eye and it is still like this today; This is a spontaneous report from a contactable consumer (patient). A 41-year-old male patient received the first dose of BNT162B2 (Pfizer-BIONTECH Covid-19 Vaccine), via an unspecified route of administration on 13Jan2021 as a single dose for COVID-19 immunisation. The patient's medical and concomitant medications were not reported. The patient stated that he received the first dose of the vaccine on Wednesday, the 13th of Jan2021 at 2:00. The symptoms began on Friday (15Jan2021) after he had taken a nap. He woke up and his eye felt like it was hurting. He has a swollen eye and it was still like this today. He stated there was a delay in the reaction and he has never experienced anything like this before. He was trying to determine if this was from something he ate or something else, but the only thing different was that he got the vaccine. He asked if this has been reported by other people. Outcome of the events was not recovered. The events were reported as non-serious. Information about the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0985645
Sex: F
Age: 23
State:

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

Lab Data:

Allergies:

Symptoms: "Staff member was receiving her first dose today. Staff member reported to fell sweaty, lightheaded, tongue felt tingling. Vaccine Staff took staff member back to vestibule, to have staff member to lay down. Vital signs: 1535 HR 94 B/P 108/72 SpO2 100 1540 HR 92 B/P 109/72 SpO2 100 1550 HR 77 B/P 97/63 SpO2 100 Staff member reported feeling better after sitting for 5 min. Monitored staff member for about 20 min. "

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm