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: 0993951
Sex: U
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A needle went into the arm of a patient and needle fell off the syringe; A spontaneous report was received from a nurse, concerning a patient of an unspecified age and gender who received Moderna's COVID-19 vaccine (mRNA-1273) and the needle went into the arm of a patient and the needle fell off the syringe There were no medical history and concomitant medications provided. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: not provided) for prophylaxis of COVID-19 infection. The reporter stated that a needle went into the patient's arm and the needle fell off the syringe. Both the needle and syringe were discarded, and the patient was vaccinated with a new needle a syringe. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event, a needle went into the arm of a patient and needle fell off the syringe was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot number: not provided) for prophylaxis of COVID-19 infection and a needle went into the arm of a patient and the needle fell off the syringe. There we no reported adverse events after the vaccine was administered in this case of syringe issue.; Sender's Comments:

Other Meds:

Current Illness:

ID: 0993952
Sex: F
Age: 52
State: FL

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Got the vaccine subcutaneous/intradermaly; A spontaneous report was received from a 52-year old, female nurse who received Moderna's COVID-19 vaccine (mRNA-1273) subcutaneously/intradermally. The patient's medical history was not provided. No relevant concomitant medications were reported. On 20 Jan 2021, the patient received their first dose of two planned doses of MRNA-1273 (Lot Number: 039K20A) subcutaneously/intradermally in the right deltoid zone for prophylaxis of COVID-19 infection. On 20 Jan 2021, the nurse received the mRNA-1273 vaccine subcutaneously/intradermally. No treatment for the event was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, she got the vaccine subcutaneously/intradermally was considered resolved on 20 Jan 2021.; Reporter's Comments: This case concerns a 52 year old female nurse who received her first dose of two planned doses of MRNA-1273 (Lot Number: 039K20A) subcutaneously/intradermally in the right deltoid zone for prophylaxis of COVID-19 infection. There were no reported adverse events associated with the event of incorrect route of product administration.

Other Meds:

Current Illness:

ID: 0993953
Sex: F
Age:
State: AZ

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient was receiving the 1st dose and the needle broke away from the syringe; Vaccine leaked on the floor, not sure if patient received any vaccine; A report was received from a pharmacist concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and the needle breaking away from the syringe and vaccine leaking on the floor. The patient's medical history was not provided. No relevant concomitant medications were reported. On 25 Jan 2021, the patient received the first of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. The reporter that they vaccinated a patient with the first dose and the needle broke away from the syringe, the vaccine leaked on the floor, and they were not sure if the patient received any vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event was considered resolved.; Reporter's Comments: This case a concerns a patient who received the first of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly for prophylaxis of COVID-19 infection and experienced the needle broke away from the syringe, the vaccine leaked on the floor, and they were not sure if the patient received any vaccine. There we no reported adverse events after vaccine was administered.

Other Meds:

Current Illness:

ID: 0993954
Sex: U
Age:
State: OR

Vax Date:
Onset Date:
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Vial was punctured for over two weeks; A spontaneous report was received from a healthcare professional concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) after the vial was punctured for over two weeks. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received the second of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly for prophylaxis of COVID-19 infection. On the unknown date, the vaccine administration facility had administered the second dose of the Moderna COVID-19 vaccine to the patient. After they administered the dose, the facility realized that the same COVID-19 vaccine vial had not been properly stored or disposed of after it was previously punctured. The vial had been expired for about 2 weeks. 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 was not applicable. The event, vial was punctured for over two weeks, was considered resolved.; Reporter's Comments: This case concerns a patient who received the second of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly for prophylaxis of COVID-19 infection and vial was punctured for over two weeks. There were no reported adverse events after the vaccine was administered associated with the event of out of specification product use.

Other Meds:

Current Illness:

ID: 0993955
Sex: M
Age:
State: FL

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: nose bleed; This is a spontaneous report from a contactable consumer (patient's daughter). An elderly 79 years old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot/batch number and expiry date were not provided) solution for injection, via an unspecified route of administration on 17Jan2021 at a single dose for Covid-19 immunization. The patient's medical history was not reported. Concomitant medications includes Aspirin. The reporter informed that her father (patient) received the first dose of the COVID-19 vaccine yesterday (17Jan2021) and today (18Jan2021), he experienced nose bleed. The patient had a nose bleed which lasted for a pretty long time. The patient just tried to stop it in a regular way. Just pinching the nose and stuff like that. The reporter did not know if there is any other medication that he takes only the Aspirin. The reporter just wanted to know if this was normal side effect. Outcome of the event was unknown. Information on the lot/batch number has been requested. Follow-up (18Jan2021): New information received from a contactable consumer (patient's daughter) included: concomitant drug, event details. Information on the lot/batch number has been requested.

Other Meds: ASPIRIN [ACETYLSALICYLIC ACID]

Current Illness:

ID: 0993956
Sex: F
Age:
State: FL

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: felt extremely thirsty; facial flushing; Mild hives on face neck and upper chest; Mild cognitive and speech slowing; Mild cognitive and speech slowing; Felt strange sensation on top of head; This is a spontaneous report from a contactable Other Health Professional (patient). A 58-year-old female (not pregnant) received first dose of bnt162b2 (Pfizer-BioNTech COVID-19 mRNA vaccine, Lot Number and Expiration Date unknown) via an unspecified route of administration on 14Jan2021 04:00 PM (vaccine location: right arm) at single dose for COVID-19 immunisation.The patient's medical history included hashimotos, fibromyalgia, known allergies to sulfa drugs and extreme shellfish. There is no other vaccine in four weeks. The concomitant drug included levothyroxine sodium (SYNTHROID), Amitriptyline, Valsartan, Vitamin D. After about 12 mins from shot on 14Jan2021 04:15 PM, patient felt extremely thirsty. Then spouse noted facial flushing and called an advanced registered nurse practitioner (ARNP) on site to eval. Mild hives on face neck and upper chest developed then. Then increase flushing on face. Mild cognitive and speech slowing. Felt strange sensation on top of head. Self medicated with 50 mg Benadryl capsule. Emergency medical technician (EMT) and ARNP insisted should go to emergency room (ER), in ambulance not with spouse. Other treatment included OTC ongoing Benadryl and Pepcid. The outcome of events was recovered in Jan2021. Information on the batch number has been requested.

Other Meds: AMITRIPTYLINE; SYNTHROID; VALSARTAN; VITAMIN D [VITAMIN D NOS]

Current Illness:

ID: 0993957
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/02/2021
Hospital:

Lab Data: Test Date: 20210114; Test Name: Covid test; Result Unstructured Data: Test Result:positive

Allergies:

Symptoms: A patient has received the first dose of the vaccine and his second dose is due tomorrow. 4 days ago the patient tested positive and is nonsymptomatic; A patient has received the first dose of the vaccine and his second dose is due tomorrow. 4 days ago the patient tested positive and is nonsymptomatic; This is a spontaneous report from a contactable nurse. A patient of unspecified age and gender received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) lot number and expiration date unknown, via an unspecified route of administration on an unspecified date at a single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient has received the first dose of the vaccine and his second dose was due tomorrow (19Jan2021). 4 days ago (14Jan2021), the patient tested positive for Covid test and was not symptomatic. The doctor asked to call the company to see if it was alright to give the second dose. The outcome of the event was unknown. Information on the Batch/Lot number has been requested.; Sender's Comments: A causal association between BNT162B2 and the reported events cannot be excluded based on a compatible temporal relation. However, full immunity is only expected 2 weeks after the second dose.

Other Meds:

Current Illness:

ID: 0993958
Sex: F
Age:
State:

Vax Date: 12/29/2020
Onset Date: 01/08/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: Test Date: 20210108; Test Name: Tested; Result Unstructured Data: Test Result:positive for the virus

Allergies:

Symptoms: tested positive for the virus; tested positive for the virus; This is a spontaneous report from a non-contactable Nurse (patient). A female patient of an unspecified age (58 unit unspecified) received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiry date unknown) via unspecified route of administration on 29Dec2020 at single dose for Covid-19 immunization. The patient's medical history and concomitant medications were not reported. The patient received the first dose of the Pfizer vaccine, and on the 8th (Jan2021) tested positive for the virus. The facility she was tested at stated that the patient cannot get the shot for 14 days for the quarantine time. The patient wanted to know if she has to wait 10 or 14 days to get the vaccine and tomorrow was day 12. The patient informed that she was due to get her 2nd dose tomorrow (19Jan2021). The outcome of the events tested positive for the virus was unknown. No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Sender's Comments: A causal association between BNT162B2 and the reported events cannot be excluded based on a compatible temporal relation. However, full immunity is only expected 2 weeks after the second dose.

Other Meds:

Current Illness:

ID: 0993959
Sex: M
Age:
State: MI

Vax Date: 01/15/2021
Onset Date: 01/17/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: hit was head and it was bleeding; hit was head and it was bleeding; dizzy; fell; Nauseous; This is a spontaneous report from a contactable consumer (Husband). An 81-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 15Jan2021 18:00 on Arm left at single dose (Lot # EL3249) for covid-19 immunisation. Medical history and concomitant medications were none. He did fine right after, his arm wasn't sore, he felt fine. The next day he had nothing, no soreness, nothing, he felt great the next day. Dizziness started in the morning 17Jan2021 when he got up he said good morning and then said he would bring her back a cup coffee then he became very dizzy and leaned against the wall for support and then he fell, he was okay but he fell. He did go the emergency room because he fell and hit was head and it was bleeding. They told him it was not related to the vaccine but it is one of the things that are on the form that could happen. She says it was okay if it caused it she is just looking for a reason. Now today (18Jan2021) he feels fine she wants to know what causes that side effect. She says she is supposed to be getting her vaccine too. He had one bad dizzy spell and then it went away, and she thinks he got kind of nauseous with it. It says this can happen, it said it could happen right after but in his case it did not, it happened within probably 34 hours or something. Outcome of the event dizziness has recovered completely at this point. Outcome of other events was unknown.

Other Meds:

Current Illness:

ID: 0993960
Sex: F
Age:
State: NC

Vax Date: 01/14/2021
Onset Date: 01/01/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: Test Date: 202101; Test Name: BP; Result Unstructured Data: Test Result:157/85; Test Date: 202101; Test Name: BP; Result Unstructured Data: Test Result:152/85; Comments: that was high; Test Date: 202101; Test Name: BP; Result Unstructured Data: Test Result:146/77; Comments: down she took some Tylenol then; Test Date: 202101; Test Name: pulse rate; Result Unstructured Data: Test Result:77

Allergies:

Symptoms: she got it Thursday and that night she noticed a little itching/itching a little again in the palm of her hands; some face soreness; her BP was 152/85 that was high; she has to got the rash on her behind where she has been scratching; having an allergic reaction; a little puffiness on her lip; the cellulitis part of her skin; This is a spontaneous report from a contactable consumer (patient). A 72-year-old female patient received first dose BNT162B2 (Pfizer BioNTech Covid 19 vaccine, lot number EL3247), via an unspecified route of administration on 14-JAN-2021 at the 72 years old at single dose for COVID-19 immunization. The medical history included COPD so sometimes she would cough, kidney stent, rheumatoid ("two" Tylenol and 20 mg prednisone for "her rheumatoid"). The concomitant medication was clarithromycin (MACROBID) from an unspecified date to 12Jan2021. The patient got it on the 14Jan2021. She says she had been doing fine she didn't know now. She was a retired paramedic so she usually felt things out, she got it Thursday and that night she noticed a little itching on 14Jan2021 but she did not think anything of it. Friday evening she had a good time eating some walnuts and she woke up about 2:30 itching that was Saturday morning before day, she took Benadryl and went back to sleep later then later on she was itching a little again in the palm of her hands and she just took a Benadryl and it went away. Then Sunday night, last night, she was okay so she decided to go to the pharmacy to get some Benadryl, they had no Benadryl and she only had old Benadry. Then about 12:30 she started itching on her bottom, itching on her arms and she was scratching. She noticed she was having some face soreness in Jan2021 but she was using some expired facial cream so she thought that was why her face was sore so she put some hydrocortisone cream on it. Since she was itching she decided to take a little of her nieces Benadryl, it is pediatric Benadryl. She was itching so she called her doctor and she heard him in the ER say they had too many people in there to tell her to go to the ER so she said okay. She hung up and called the pharmacy and they said it sounds like having an allergic reaction in Jan2021 and she told him she had the COVID vaccine but she doesn't think she was short of breath and she gave them her vitals her BP was 152/85(BP 157/85) that was high for her in Jan2021, but it came down, she took some Tylenol then it was 146/77, her pulse rate was 77 and her respirations were good she did not have shortness of breath or cough well she has COPD so sometimes she would cough. Then she got up and said let me go one over and get some Benadryl so she went by there got some good Benadryl and she thought she would call and see what they think about all this. She took the Benadryl at 10:25 and she is doing okay right now but she had whelps, she has to got the rash on her behind where she has been scratching in Jan2021, it is on the left side of her hip, the cellulitis part of her skin that is mostly where she is itching in Jan2021. She remembers when she worked at the health department they would give Benadryl and Prednisone. She thought if the Benadryl does not help then she would call, then she decided she would go ahead and call to see what information they have. She says Pfizer is giving her alerts that she has been answering but she did not have the itching at that time. She retired from being a paramedic in 2009. She says she is 72 now but she woke up in 1985 and her lip was swollen like not totally swollen but her top lip was swollen more than the bottom in Jan2021. They gave her an Epinephrine shot and Benadryl and she is just wondering if this itching is related to the vaccine or if it is just an allergy that she may have come up on or something like to the walnuts or something. She says they went there and they gave the shot and they gave Benadryl but they are not sure. She said the doctor never figured our what it was that cause it and it never happened again until she did notice a little puffiness on her lip again this morning. She said the itching first started around 2:34 AM in the morning before light. It had improved since taking up to date Benadryl. She was supposed to get her second dose 04Feb2021. She didn't want COVID 19. She knew she just came off, she had a kidney stent and she had stopped taking 2 days before, she was taking Macrobid. She was not taking that right now. She took a lot of other medications but the Macrobid she was just on and it was stopped on Tuesday 12Jan2021, 2 days before the vaccine. She didn't know if the Macrobid would interfere with getting vaccine. The outcome of the event itching was recovering, the other events was unknown.

Other Meds: MACROBID [CLARITHROMYCIN]

Current Illness:

ID: 0993961
Sex: F
Age:
State: TX

Vax Date: 01/12/2021
Onset Date: 01/01/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: cannot hold anything down her stomach/ what she did eat came back up; bad headaches; bad aches; This is a spontaneous report from a contactable consumer (patient). A 29-years-old female patient started to receive the 1st dose BNT162B2 (PFIZER-BIONTECH COVID-19, lot number: EH9899), via an unspecified route of administration at right arm muscle on 12Jan2021 in the morning about 9:30AM or 10:00AM at single dose for COVID-19 immunization. Medical history was reported as none. The patient's concomitant medications were not reported. The patient had not had a vaccine before vaccination. The patient was experiencing bad aches in Jan2021, bad headaches started 15Jan2021 about 17:30, Friday evening when she got off work and cannot hold anything down her stomach when she got up about 8:00 on 16Jan2021. What could she take to settle her stomach. She didn't each much at all, but what she did eat came back up. She was scared to eat something at the moment. She was just lost. She went to the Emergency Room on 16Jan2021, but it was a long wait so she went home. The outcome of events bad headaches and cannot hold anything down stomach was not recovered, of the other event was unknown. She wanted to know what she should take for these side effects and if the 2nd dose was optional. She wanted to know if she would feel better after the 2nd dose of the vaccine. She also wants to know if it was possible for her kids to get the virus if she was having the side effects, how long does the Pfizer-BioNTech Covid-19 Vaccine remain in the system. It was not reported as serious.

Other Meds:

Current Illness:

ID: 0993962
Sex: M
Age:
State: PA

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Lymphangitis of left underarm, swollen out to size of softball; administration date=16Jan2021/ 31Dec2020; This is a spontaneous report from a contactable other HCP(patient). A 37-year-old male patient received second dose BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot: EK4176), via an unspecified route of administration at left arm on 16Jan2021 16:45 at single dose for COVID-19 immunization. Medical history included gastrooesophageal reflux disease(GERD), insomnia. There was no Known allergies. Concomitant medication included zolpidem tartrate (AMBIEN), pantoprazole sodium sesquihydrate (PROTONIX). There was no other vaccine in four weeks. Patient previously first dose BNT162B2(lot number=EK5730) on 31Dec2020, 19:00 at Left arm at single dose for COVID-19 immunization. The patient experienced Lymphangitis of left underarm, swollen out to size of softball on 18Jan2021 10:00, occupational health advised to get seen,went to Emergency room, urgent care recommended paracetamol (TYLENOL)for swelling and no anti-inflammatories that may hinder the immune process. Treatment paracetamol was received. Outcome of the event was recovering. There was no covid tested post vaccination.; Sender's Comments: The Company cannot completely exclude the possible causality between the reported "Lymphangitis of left underarm, swollen out to size of softball" and the administration of COVID 19 vaccine, BNT162B2, based on the reasonable temporal association and lacking alternative explanations. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RA, IEC, as appropriate.

Other Meds: AMBIEN; PROTONIX [PANTOPRAZOLE SODIUM SESQUIHYDRATE]

Current Illness:

ID: 0993963
Sex: M
Age: 69
State: WV

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Received a Moderna vaccine at another clinic 12/30/20. 1/27/2021 he received a Pfizer vaccine at clinic

Other Meds:

Current Illness:

ID: 0993964
Sex: M
Age: 64
State: FL

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Fever to 101.7 body weakness sweats dysentery feeling of malaise, duration ran 48 hours

Other Meds: Metform

Current Illness: Non

ID: 0993965
Sex: M
Age:
State: AZ

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

Lab Data:

Allergies:

Symptoms: None stated.

Other Meds: I didn't get my card back. First vaccine was 1/12/2021

Current Illness:

ID: 0993966
Sex: F
Age: 44
State:

Vax Date: 01/25/2021
Onset Date: 02/02/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: pt given Tylenol Zofran, tordial

Allergies:

Symptoms: Intermittent tingling/numbness to left arm after vaccine x 8 days after. Intermittent tingling/numbness to left leg after vaccine x 8 days after. Noticed small erythematic area 3 cm x 3 cm around injection site. ED MD noted, no cellulitis.

Other Meds:

Current Illness:

ID: 0993967
Sex: M
Age: 65
State: FL

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: None

Allergies: N/A

Symptoms: For informational purposes, I am a health care provider myself. I have been experiencing severe episodes of vertigo, starting approximately 1 week after receiving my first dose of the Pfizer vaccine, and only when lying in bed. They occur a few times per night, and have occurred essentially every night since they started. They are very intense, but also very short in duration, of about 3-5 seconds. When I called my primary care physician to see if she had any thoughts, or suggestions, or if she thought it could be due to the vaccine, she informed me that she also had the same reaction, severe vertigo, while lying in bed, at about the same time period, 1 week after her first injection, although she just had 2 isolated episodes of it, and she had the Moderna vaccine. Neither of us have seen any published information listing this as a side effect of the vaccine.

Other Meds: Losartan 100mg daily Zyrtec 10mg daily Methyl B!@ 1000mcg 2x/week Vitamin D3 5000iu 4x/week

Current Illness: N/A

ID: 0993968
Sex: F
Age: 49
State: PA

Vax Date: 12/29/2020
Onset Date: 12/31/2020
Rec V Date: 02/02/2021
Hospital:

Lab Data: NA

Allergies: diflucan, morphine, msg

Symptoms: bilateral hip joint pain

Other Meds: multivitamin, pramapaxole, sertraline, levothyroxine, proprano

Current Illness: sinus infection

ID: 0993969
Sex: F
Age: 27
State: CA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: ?Moderna COVID-19 Vaccine EAU? Fever and chills for 1 day and sore arms for 3-4 days Took tylenol for the fever and cold compress for the sore arms.

Other Meds: Tylenol

Current Illness:

ID: 0993970
Sex: F
Age: 40
State:

Vax Date: 01/25/2021
Onset Date: 02/02/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: No

Symptoms: 8 days after my 1st vaccination, I woke up to the injection site being swollen, hot, red & extremely itchy. The swelling is about 2-3 inches in diameter.

Other Meds: No

Current Illness: No

Date Died: 01/13/2021

ID: 0993998
Sex: F
Age:
State: CA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: Test Date: 202101; Test Name: oxygen level; Result Unstructured Data: Test Result:gone down; Test Name: Covid-19 test; Test Result: Negative

Allergies:

Symptoms: passed away; cough; This is a spontaneous report from a contactable consumer, the patient's daughter. A 92-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN), via an unspecified route of administration in the left arm on 13Jan2021 at 11:00 (at the age of 92-years-old) as a single dose for COVID-19 immunization. Ongoing medical history included nursing home resident, admitted to hospice on 13Jan2021 (prior to vaccination), and oxygen supplementation (due to low oxygen levels) from a few days prior to the vaccine (Jan2021). Other relevant medical history included congestive heart failure from Dec2020 and sulfa allergy. Prior to the vaccination, the patient was tested numerous times (as reported) for COVID-19 and was negative. There were no concomitant medications. The patient did not receive any other vaccines within four weeks prior to the vaccination. A few days before the vaccination, her oxygen level had gone down, and she had been placed on oxygen. Prior to receiving the vaccine, the patient was reported as being 'fine'. On 13Jan2021, the patient received the vaccine at 11:00. The patient coughed maybe 5 or 6 times and then dropped her head. Resuscitation was not performed as patient had a do not resuscitate (DNR) order. The patient passed away on 13Jan2021 at 13:05. The cause of death was not reported. An autopsy was not performed. The clinical outcome of the cough was unknown at the time of death. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away

Other Meds:

Current Illness: Hospice care (prior to vaccination); Living in nursing home; Oxygen supplementation (few days before vaccine was given oxygen level was low and started on oxygen)

ID: 0993999
Sex: F
Age:
State: NC

Vax Date: 12/01/2020
Onset Date: 01/14/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: Test Name: MRAs; Result Unstructured Data: Test Result:no bleeding; Test Name: MRIs; Result Unstructured Data: Test Result:no bleeding

Allergies:

Symptoms: Bleeding/felt blood on her arm /blood was coming from the top of the band aid; This is a spontaneous report from a contactable consumer reporting for self. This 81-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot# EL3248) via unspecified route of administration on 14Jan2021 02:00 PM at right arm at single dose for COVID-19 vaccination, clopidogrel (manufacturer: Aurobindo, lot# QR7520022-A, expiry date: Apr2022) oral from Dec2020 at 75 mg once a day for TIA (Transient ischaemic attack). Medical history included TIA from Aug2019. She had her first TIA Aug2019, and then had her second a couple months ago, it was not as severe, the buildings moved and she walked like she was drunk, but had only one other thing than walking funny and buildings moving, she can't remember what that was. Pain, blood cholesterol abnormal. Pain in both of her arms, she said her left arm hurt more than her right arm from time to time, and when the left started hurting she took all the pills, but she didn't take Hydrocodone though it is prescribed, she didn't take that unless she was in a lot more pain than usual. She said her doctors said different things about her arm pain, one said she had a torn rotator cuff, another said arthritis, someone else said it was something in her neck but it was a big word that she didn't know, she just knew she had pain. Concomitant medications included acetylsalicylic acid (BABY ASPIRIN, manufacturer: Bayer, UPC number: 349483 48150) from Aug2019 for TIA; carbamazepine from Jan2021 for pain in both of her arms; metoprolol succinate, had been taking it a couple years; zolpidem; hydrocodone for pain (she only takes if she is dying of pain, clarified to being in a lot of pain); atorvastatin for cholesterol. The patient reported that she had COVID-19 and experienced side effect. She said it happened after the 15 minutes observation when she left to drive home on 14Jan2021. She said 5 minutes into her drive she felt blood on her arm and put her hand in her shirt, and wiped it, saw blood. She said the bleeding was weird so she pulled over to look at her arm, and blood was coming from the top of the band aid where normally it would seep down from the bottom. She used five baby wipe, and wiped a lot of blood, until finally she thought it stopped bleeding. She was not light headed or in pain, it was a 45 minute drive and she got home and was still bleeding so she took her shirt off and put a towel around it to stop the bleeding and it finally stopped. She said she didn't think to report it until her doctor said to when she told him, he had said maybe the girl who gave her the shot hit a vein, but she should tell them. She said maybe she did hit a vein, because she had never had problems when getting a shot or more than a spot of blood in the past. She said one thing that may be important was that she had a couple of TIAs, many series (unable to clarify) her doctor friend assessed that with three MRIs and MRAs. She said she just refilled one of her medications, Clopidogrel, and was reading the instructions for it and it says it can cause excessive bleeding. She said that she was not bleeding so she didn't worry about it, that maybe that caused excessive bleeding. She had not had a second dose, but she didn't want to go through this again with the bleeding, though if it was just a vein or air that may not happen. She said she was very healthy, no underlying conditions at all, never had a problem before, her arm was not painful, she was not light headed. She said the baby wipe she had on her arm after the car ride was full of blood, and she still couldn't get the band aid off, so she wrapped her arm towel kept sopping up blood until finally it quit. She put another band aid over the bloody band aid, and it quit and she was fine. She had no injection site pain, no tiredness, no headache. Lab data included she had MRIs and MRAs, but there was no bleeding. The action taken for clopidogrel was unknown. The outcome of event was recovered.

Other Meds: BABY ASPIRIN; CARBAMAZEPINE; METOPROLOL SUCCINATE; ZOLPIDEM; HYDROCODONE; ATORVASTATIN; CLOPIDOGREL

Current Illness:

ID: 0994000
Sex: U
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: faint; dizzy; funny taste in mouth; urine issues; diarrhea; upset stomach; feeling abnormal; This is a spontaneous report from a contactable consumer. This consumer reported same events for two patients (one is patient self). This is the second of two reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date in Jan2021 at single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. In Jan2021, the patient experienced faint, dizzy, funny taste in mouth, urine issues, diarrhea, upset stomach, feeling abnormal. The outcome of event was unknown. Information on the lot/batch number has been requested.; Sender's Comments: Linked Report(s) : US-PFIZER INC-2021044692 Same reporter/ vaccine/ AEs, different patient

Other Meds:

Current Illness:

ID: 0994001
Sex: F
Age: 50
State: OH

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: CBC 1/28/2021 WBC 7.3 4.5 - 11.5 E9/L Final 01/28/2021 ?7:50 AM - Lab RBC 5.07 3.50 - 5.50 E12/L Final 01/28/2021 ?7:50 AM - Lab Hemoglobin 13.5 11.5 - 15.5 g/dL Final 01/28/2021 ?7:50 AM - Lab Hematocrit 42.5 34.0 - 48.0 % Final 01/28/2021 ?7:50 AM - Lab MCV 83.8 80.0 - 99.9 fL Final 01/28/2021 ?7:50 AM - Lab MCH 26.6 26.0 - 35.0 pg Final 01/28/2021 ?7:50 AM - Lab MCHC 31.8Low 32.0 - 34.5 % Final 01/28/2021 ?7:50 AM - Lab RDW 14.6 11.5 - 15.0 fL Final 01/28/2021 ?7:50 AM - Lab Platelets 270 130 - 450 E9/L Final 01/28/2021 ?7:50 AM - Lab MPV 10.8 7.0 - 12.0 fL Final 01/28/2021 ?7:50 AM - Lab Neutrophils % 40.3Low 43.0 - 80.0 % Final 01/28/2021 ?7:50 AM - Lab Immature Granulocytes % 0.1 0.0 - 5.0 % Final 01/28/2021 ?7:50 AM - Lab Lymphocytes % 51.3High

Allergies: NKA

Symptoms: Initially started swelling then the arm became red with a large blister few days later skin peeled

Other Meds: Metformin, Lisinopril, Vascepa, Viibryd

Current Illness: none

ID: 0994002
Sex: F
Age: 35
State:

Vax Date: 01/20/2021
Onset Date: 01/31/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: discomfort/soreness at injection site ten days following vaccination, after immediate injection site soreness/discomfort had subsided for over a week.

Other Meds:

Current Illness:

ID: 0994003
Sex: M
Age: 84
State: OK

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 02/02/2021
Hospital: Y

Lab Data: CTA head/neck negative for large vessel occlusion.

Allergies:

Symptoms: Stroke like symptoms consisting of facial asymmetry & slurred speech. Patient sent to stroke facility w/ Neurology services.

Other Meds:

Current Illness:

ID: 0994004
Sex: M
Age: 51
State: PA

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: N/A

Allergies: Possibly penicillin

Symptoms: Swelling in axillary region of the right arm, the arm the injection was administered

Other Meds: Vitamin B Complex

Current Illness: N/A

ID: 0994005
Sex: M
Age: 36
State: AZ

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

Lab Data: N/A

Allergies: N/A

Symptoms: At around 11pm I had the chills, I was shaking pretty bad, no fever and I had a major headache. I do not have any access to tylenol and I will wait to take some when I arrive home at 7am. Its about 530am and I still have a headache. I've been drinking lots of water and I feel nauseous now.

Other Meds: Just my one a day for men's, fish oil, and vitamin C pills. Taken at 4pm

Current Illness: N/A

ID: 0994006
Sex: M
Age: 74
State: OH

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: NONE

Allergies: NONE

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA COVID 19/Pfizer EL 9264 Nausea, tiredness, headache, muscle pain, flu Like symptoms, Ached all over for 14 hours......took Advil and symptoms subsided

Other Meds: Prilosec, Magnesium Oxide, Fiber Capsules, Multivitamin, Calcium with D3

Current Illness: NONE

ID: 0994007
Sex: F
Age: 34
State: PR

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

Lab Data: No

Allergies: No allergies

Symptoms: The first dose of vaccine gave me nasal bleeding on the ninth day and the second dose gave me nasal bleeding on the second day.

Other Meds: I?m not taking any medication.

Current Illness: No

ID: 0994008
Sex: F
Age: 60
State: VA

Vax Date: 01/13/2021
Onset Date: 01/30/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: NONE

Allergies: NKA

Symptoms: FEVER FOR ABOUT 24 HOURS, HEADACHE FOR ABOUT 24 HOURS AND LEFT ARM RED AND WARM TO TOUCH FOR 36 HOURS

Other Meds: STELARA, VITAMIN D, ZYRTEC,SYNTHROID, CALCIUM MAGNESIUM, MULT-VITAMIN, OMEGA XL, FOSAMAX

Current Illness: NONE

ID: 0994009
Sex: F
Age: 69
State: DC

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: None

Allergies: Erythromycin Oxycodone Tropical fruits

Symptoms: Some vaccine leaked out of suringe onto my arm as was being injected. I had also taken 400 mg of ibuprofen at 8 am to prermpt any side effects, not knowing that might impact anyobody development. I am concerned i wont have adequate antibodies from both events

Other Meds: Ibuprofen took 400 mg at 8 am Atorvastatin Hctz

Current Illness: None

ID: 0994010
Sex: F
Age: 29
State: MA

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: 1/29: sore Left arm 1/30: rash on Left arm 2/1: rash on Left arm improved, sore armpit 2/2: rash on left armpit with itchiness

Other Meds: Lexapro Omeprazole Birth control

Current Illness: N/A

ID: 0994011
Sex: F
Age: 29
State: NJ

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

Lab Data:

Allergies: None

Symptoms: ~18 hours after second moderna vaccine, I experienced High fever ~101F, sweating, chills. Lymph nodes around neck are swollen. Significant arm pain at site of injection, which is extremely painful and unable to lift or lay on arm. Mild headache and joing pains.

Other Meds: None

Current Illness: None

ID: 0994012
Sex: F
Age: 63
State: NH

Vax Date: 01/15/2021
Onset Date: 01/23/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: None.

Allergies: Allergic to acyclovir and clarithromycin medications. Shellfish allergy. MSG causes severe migraines.

Symptoms: Started to notice severe left-sided lumbar spine pain, severe left iliac crest pain radiating down left leg to above knee area, lymphatic edema. Treatment with acupuncture and massage therapy has helped alleviate the severity of the previous mentioned symptoms to where they are now tolerable. Slight chest heaviness and slight exacerbation of asthma symptoms which have been controlled with asthma inhalers.

Other Meds: Advair 500/50 inhaler, baclofen 10 mg, celebrex 100 mg, famotidine 20 mg, hydrochlorothiazide 25 mg, levothroxine 75 mcg, Nasacort, trazodone 50 mg, Tylenol 500 mg, Zoloft 50 mg, and Zyrtec.

Current Illness: None.

ID: 0994013
Sex: F
Age: 69
State: NY

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: CIPRO (tongue swelling, throat constricting) Erythromycin - mild

Symptoms: 2:AM on Feb 18 started chills while sleeping. Had hot tea and blankets and it subsided. fever of 100-101 throughout the day. Sleeping. Pain at injection site . Symptoms lasted about a day and a half. This was the first dose!

Other Meds: lisinpril 5mg, Simvastatin 10mg, L-Thyroxine 112mcg, low dose aspirin

Current Illness: none

ID: 0994014
Sex: F
Age: 52
State: MA

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: very sensitive to various products

Symptoms: Yesterday, Feb 1st around 5 p.m., I noticed a rash on my neck and my neck became very itchy. Today, Feb 2nd, upon waking my face is puffy, red & blotchy.

Other Meds: Synthoid .88 for Hashimoto's Vitamin D 5000 Probiotic

Current Illness: no illness Shingrix dose 1 vaccine = Tues, Jan 12 2021

ID: 0994015
Sex: M
Age: 77
State: AL

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 02/02/2021
Hospital: Y

Lab Data: ABG on arrival to ER 6.956/76.8/48.5/16.7 on 100% O2

Allergies: NKDA

Symptoms: Cardiac arrest of unknown etiology. Sudden collapse with PEA requiring CPR and intubation. Now has severe anoxic encephalopathy and expect death.

Other Meds: Pravastatin 20mg daily, omeprazole 40mg daily, lisinopril 10 mg daily, glimepiride 2 mg daily, donepezil 10 mg QHS, fish oil, niacin 100mg daily, Vit C 500mg daily, Vit E, multivitamin

Current Illness:

ID: 0994016
Sex: F
Age: 87
State: KY

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/02/2021
Hospital: Y

Lab Data:

Allergies: Cipro, Prolia, Sulfa antibiotoics

Symptoms: Found confused, vomited, admitted and dx with ICH.

Other Meds:

Current Illness: None reported

ID: 0994017
Sex: F
Age: 44
State: MD

Vax Date: 01/23/2021
Onset Date: 02/02/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Rash at injection site

Other Meds: None

Current Illness: None

ID: 0994018
Sex: M
Age: 72
State: MD

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: n/a

Allergies: stayins

Symptoms: Sore shoulder, bicep sore, pain with movements

Other Meds: Vitamin Losartan , 50mg 2x Metoprolol, 50mg2x Cialis, 5mg, 1x Fenofibrate, 145mg,1x

Current Illness: n/a

ID: 0994019
Sex: M
Age: 38
State: MI

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pain at the injection site the next day. it was not bad and was gone by the 3rd day

Other Meds:

Current Illness:

ID: 0994020
Sex: F
Age: 46
State: CA

Vax Date: 01/16/2021
Onset Date: 01/01/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: None known

Symptoms: Period very very late for jam and just dark brown spotting very end of jan beginning of feb. unusual

Other Meds: Effexor 5mg

Current Illness: None

ID: 0994021
Sex: M
Age: 24
State: WI

Vax Date: 01/21/2021
Onset Date: 01/30/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: N/A

Allergies: None at this time

Symptoms: Moderna COVID-19 Vaccine EUA Hives Rash on hands and feet, severe itching and irritation, along with pain. Currently lasting more than 3 days but seems to be winding down on the third day

Other Meds: 500mg Vitamin C taken nightly 100mg Vitamin D taken nightly 25mg Melationin taken nightly

Current Illness: N/A

ID: 0994022
Sex: F
Age: 25
State:

Vax Date: 01/25/2021
Onset Date: 01/31/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies: Sulfa

Symptoms: Day 6, developed large local reaction w/ erythema, swelling, tenderness. Splotchy, 10cm x 5cm

Other Meds: Birth control pill

Current Illness: UTI

ID: 0994023
Sex: F
Age: 59
State: WI

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

Lab Data:

Allergies: Saccharin, Nickel

Symptoms: Patient received immunization from vial containing diluent in the amount of 1.0 rather than 1.8 ml 0.9% sodium chloride, so dose was concentrated.

Other Meds:

Current Illness:

ID: 0994024
Sex: F
Age: 60
State: NY

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data: Shingles diagnosed clinically by MD.

Allergies: Morphine: Hives

Symptoms: 2nd dose received 8am 1/27. Fever, 102.1 and severe headache 1/28, 12 am. Developed Shingles 1/28, 10 pm. Shingles lesions continue to develop at the time of this report, despite starting Valtrex 1/29 am

Other Meds: Effexor 225 mg daily.

Current Illness: None

ID: 0994025
Sex: F
Age: 38
State:

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

Lab Data: None

Allergies: IV contrast - anaphylactic reaction

Symptoms: Flushing, hives, tachycardia, diaphoresis to 140s within 3 minutes of vaccine. At vaccination site, blood pressure 104/60, slightly lower than normal blood pressure. At vaccination site, patient was given 25 mg Benadryl IM. HR started going down about 15 minutes after Benadryl. HR went down to 90s upon arrival to the ED. HR is normally in the 60s. No further treatment in the ED. Patient did experience fever up to 101 and malaise for 3 days after vaccine. Along with pain at injection site.

Other Meds: Zyrtec, Flonase

Current Illness: No

ID: 0994079
Sex: F
Age: 69
State: KY

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/02/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Sacral Herpes Outbreak; Arm soreness; A spontaneous report was received from a healthcare professional, who was a 69-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced arm soreness and a sacral herpes outbreak. The patient's medical history was not provided. No concomitant product use was reported. On 13 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 013L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. On 13 Jan 2021, the day of vaccination, the patient experienced arm soreness. On 14 Jan 2021, the patient experienced a sacral herpes outbreak high on her right butt cheek. Treatment for the event, included valaciclovir. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, arm soreness and sacral herpes outbreak, was unknown.; Reporter's Comments: This case concerns a 69-years-old female patient, who experienced a serious unexpected event of herpes simplex and non-serious unexpected event of pain in extremity. The event of pain in extremity occurred 1 day (same day) after first dose of mRNA-1273, lot # 013L20A. The event of herpes simplex occurred 2 days after first dose of mRNA-1273, lot # 013L20A. Concomitant medication included Valacyclovir. Treatment details were not provided. Based on the current available information and temporal association between the use of the product and onset of the event a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 0994080
Sex: M
Age: 89
State: NY

Vax Date: 01/13/2021
Onset Date: 01/16/2021
Rec V Date: 02/02/2021
Hospital: Y

Lab Data: Test Date: 20210116; Test Name: chest x-ray; Test Result: Negative ; Test Date: 202101; Test Name: COVID-19 test; Test Result: Positive

Allergies:

Symptoms: Tested positive for COVID-19; Weakness; Sweating; Shortness of Breath; A spontaneous report was received from a healthcare professional concerning a 89-year-old, male, patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and tested positive for COVID-19, experienced weakness, sweating, and shortness of breath. The patient's medical history included diabetes mellitus, hypertension, hypercholesterolemia, and benign prostatic hyperplasia. Products known to have been used by the patient, within two weeks prior to the event, included metformin, glimepiride, atorvastatin, acetylsalicylic acid, norvastatin, irbesartan, triamterene, finasteride, mirabegron. On 13 Jan 2021, approximately three days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 16 Jan 2021, the patient experienced weakness, sweating, and shortness of breath. On an unknown date, the patient tested positive for COVID-19 and was admitted to the hospital for supervision. Chest x-ray results were negative. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event, tested positive for COVID-19, was considered not resolved. The outcome of the events, weakness, sweating, and shortness of breath, was unknown.; Reporter's Comments: This case concerns a 89 year-old, male patient with history of diabetes mellitus, hypertension, hypercholesterolemia, who experienced events of tested positive for COVID-19, weakness, sweating, and shortness of breath. The events occurred 3 days after the first and last dose of mRNA-1273 vaccine administration. Based on the current limited available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded and the events are assessed as possibly related. However, the patient was positive for COVID and may provide an explanation for the events. Further information have been requested.

Other Meds: METFORMIN; GLIMEPIRIDE; LIPITOR; BABY ASPIRIN; NORVASTATIN; AVAPRO; TRIAMTERENE; FINASTERIDE; MYRBETRIQ

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm