VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1010209
Sex: F
Age: 41
State: CA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Racing heart, nervousness, severe fatigue, chills, body aches, fever of 101.6, headache, loss of appetite,

Other Meds: None

Current Illness: None

ID: 1010210
Sex: F
Age: 41
State: NY

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/a

Symptom List:

Symptoms: I felt very dizzy and started walking back to my room. Before I could get to my room I fell to the ground. I never lost consciousness but I couldn?t get up for about two minutes. I intentionally slept for the rest of the day and did not have any further severe adverse effects but that one really shook me!

Other Meds: Claritin-D Multivitamin

Current Illness: N/a

ID: 1010211
Sex: F
Age: 55
State: IL

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: COVID arm. Hard bump for a week then really itchy and about a 8 inch red circle around shot sight for an additional week. Itching only lasted a couple of days

Other Meds: Synthroid

Current Illness: None

ID: 1010212
Sex: F
Age: 34
State: WA

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Bactrim

Symptom List:

Symptoms: 15 hours after receiving second dose I experienced severe aches in my body which was in my joints and bones. Hot and cold chills. 101 degree temp 2 days after the second dose I developed a large bullseye rash about 2 inches under the injection site. That same arm feels asleep

Other Meds: Ibuprofen Vyvanse Birth Control

Current Illness: None

ID: 1010213
Sex: F
Age: 38
State: AZ

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Amoxicillin

Symptom List:

Symptoms: Feverish, chills, headaches, nausea, dry mouth, and sleepiness the day after the Vaccine was taken. Started out slowly late morning around 9am and got worse by the afternoon. Took Motrin to relieve symptoms and slept. The next day felt better but in the evening on 2/5/21 felt itchy starting from arms and neck. Then after about 10 min of itchiness in that area and started itchiness down to my stomach and legs. I took allergy medication prescribed by my physician: Cetirizine HCL 10mg tablet (1 tablet). No issues after that. Had some issue with the itchiness from the first dose around the 3rd-5th day after the first vaccine was given. Didn't take any allergy medications and had a tiny bit of dark circular spots on limps and torso but wasn't severe. Thought that was from something I ate, or clothes detergent, etc. so shrugged it off.

Other Meds: Multivitamins

Current Illness: None

ID: 1010214
Sex: F
Age: 37
State: OR

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Lymph node under arm pit swollen and painful for over 24 hours. Same arm as injection site.

Other Meds:

Current Illness:

ID: 1010215
Sex: F
Age: 24
State: OK

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Raw egg whites (it's th eprotein)

Symptom List:

Symptoms: My eyes have been occasionally twitching (lasts about 3 seconds) and this doesn't really happen. It occurs randomly throughout the day. I got the 2nd dose on the 4th but it's still happening as I'm typing this report.

Other Meds: None

Current Illness: None

ID: 1010216
Sex: M
Age: 33
State: TX

Vax Date: 02/01/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None known

Symptom List:

Symptoms: Red rashy areas on right upper arm, chest and back that began to appear on 2/4/2021. Raised pustules, almost like shingles in appearance.

Other Meds: Enbrel 50mg

Current Illness: N/A

ID: 1010217
Sex: M
Age: 30
State:

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Pine nuts

Symptom List:

Symptoms: Chills starting around 10:30 PM, joined shortly after by an increasingly painful headache. Alternating between chills and being overheated on and off all night, while headache became worse. Had to take ibuprofen at 7:30 AM after not being able to sleep, and was able to sleep. Woke up at 1 PM and had to take another ibuprofen for the headache. Chills were gone, but was overheated and sweating for an hour or two. Had to take another ibuprofen at night, but headache wasn't too much worse. Headaches were gone upon waking up at 9 AM on Sunday. Experienced lymph node swelling in armpit of arm that got the vaccination. Tried to do pushups, but became too painful. I had also experienced the lymph node swelling after my first vaccination 28 days before my second one. About a week after, and they always felt minorly swollen up until the time of my second vaccination. I didn't know they were caused by the vaccine until after the second vaccination. Currently 1:20 AM on Monday, and I have been experiencing redness and itching in a large patch around the vaccination site all day.

Other Meds: Omeprazole, propecia

Current Illness:

ID: 1010218
Sex: M
Age: 25
State: IN

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Body aches, head ache, chills for about 7 hours from 03:00 am until 11:00 am

Other Meds: None

Current Illness: None

ID: 1010219
Sex: F
Age: 44
State: CA

Vax Date: 01/29/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Itchy red welts that were painful to touch on my left arm in injection site.

Other Meds: Relpax 20 mg as needed, wellbutrin 300 mg daily, sumatriptan 50 mg as needed

Current Illness: None

ID: 1010220
Sex: F
Age: 43
State: CO

Vax Date: 01/20/2021
Onset Date: 01/27/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: nka

Symptom List:

Symptoms: About one week after my second shot, my hair began falling out in significant amounts. This has been continuing for several weeks now.

Other Meds: Synthroid, ortho tri cyclen lo

Current Illness: n/a

ID: 1010221
Sex: F
Age: 37
State: AZ

Vax Date: 02/05/2019
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Shrimp and similar Pineapple Ambient

Symptom List:

Symptoms: Very drowsy on first, second and third day A little bothersome in the shoulder second day A little sore throat for 3 days

Other Meds: No

Current Illness: No

ID: 1010222
Sex: F
Age: 55
State: AZ

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Allergic to eggs. Reaction to morphine, Vicodin, fentanyl (given during hospitalization, effects include: pronounced shortness of Breath, weighted feeling, immobility, etc)

Symptom List:

Symptoms: I felt numbness going up my neck while I waited in line after receiving the vaccine. I thought it was nerves. No one asked how I felt after the vaccine and was passed along ( I told my daughter - who drove me - about my neck while at the vaccine site.) I noticed that my face was also going numb a few minutes later. As soon as we arrived at our meeting place, I told my daughter that my face(vaccine side) was also numb: "like when you get an injection for dental work." It is now ten hours after I received the vaccine, and the numbness has not seized. It is still there and with a strong tingle sensation. I also feel generally unwell with body aches and weakness.

Other Meds:

Current Illness: None

ID: 1010223
Sex: F
Age: 84
State: NY

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: 48 hours after vaccination 2/4/21, diarrhea, followed by extreme, dizziness/lightheadedness, all day., starting 9:30am,2/6/21 Lightheadedness ongoing( day of reporting)2/7/21

Other Meds: Multi Vitamin, D3, Omega3,B12

Current Illness: None

ID: 1010224
Sex: F
Age: 39
State: CT

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Immediately after my second injection my left arm below the injection site become painful, hard and extremely swollen. After two days the swollen area became itchy and I have a 4x4 red rash. This did not happen after the first vaccination. I would like to know how long I should expect to have this swelling and rash for and if I should be concerned.

Other Meds: None

Current Illness: None

ID: 1010225
Sex: F
Age: 80
State: HI

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none known

Symptom List:

Symptoms: area of injection on upper left arm (ovoid rash about 6 inches by 3 inches) red and sore and warm (began a few hours after injection and continues now) Headache, body aches, chills and discomfort began a few hours after injection and lasted about one and a half days (totally gone now)

Other Meds: multivitamin

Current Illness: none

ID: 1010226
Sex: F
Age: 69
State: MD

Vax Date: 01/29/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Large red area around vaccination site, dark spot in center. Started itching with a rash, burning sensation when I scratched it. Treated with ice pack then an anti-itch cream several times a day. Symptoms lasted approximately 36 hours.

Other Meds: Rosuvastatin 10 mg 1Xaday Vitafusion Women's multi vitamin Nature Made D3 5000IU Caltrate 600mg

Current Illness: None

ID: 1010227
Sex: F
Age: 86
State: NJ

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: amoxicillin; duricef; penicillin; Percocet

Symptom List:

Symptoms: Headache and "Not feel well" 2/3/21 4:20AM Nausea, weak, tired, diarrhea 2/3/21 9:56AM Vomited and "almost" diarrhea 2/3/21 2:04PM Loose BM and nausea 7:10PM 2/3/21 7:10PM

Other Meds: Cura Med 375mg- Give 1 softgel (375mg) by oral route once daily for Supplement Digest Gold with ATPro Capsule- Give one capsule by oral route with meals as needed for GERD Ginger Tablet- GIve one tablet by oral route daily with meals (6 da

Current Illness:

ID: 1010228
Sex: F
Age: 66
State: AK

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: I had been freezing all evening after the shot. Went to bed as usual for the night. Woke up about 1 am which is normal for me. I was still freezing. Got up to go to the bathroom as I normally do. While sitting on the toilet, I started shaking violently - not just regular shivers. This was scary. Violent jerking from the waist up - head, arms, torso. I could not control it. Eventually it stopped. I put on warmer clothes and climbed back into bed. Eventually I warmed up and went to sleep. Other minor side effects were same as the first vaccine - sore and tender around the injection sight and slight headache.

Other Meds: Quetiapine Fumarate 50 mg

Current Illness: None

ID: 1010229
Sex: F
Age: 50
State:

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Hives Started on R side of body and has spread to entire body. All hives are itching, raised and warm.

Other Meds:

Current Illness:

ID: 1010230
Sex: F
Age: 68
State: CA

Vax Date: 02/03/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Gabapentin, amoxicillin, atropine sulfate, clotrimazole, meloxicam, methotrexate, NSAIDs, penicillins, sulfa class, and zomepirac sodium

Symptom List:

Symptoms: Patient was found unresponsive on 2/5/2021. Brought immediately to Emergency department due to respiratory depression/distress. At this time it is unclear etiology of presentation. However patient is slowly becoming more alert/awake.

Other Meds:

Current Illness: chronic pain syndrome , pancreatic mass, type 2 diabetes, hypertension, obesity

ID: 1010231
Sex: F
Age: 43
State: CA

Vax Date: 01/14/2021
Onset Date: 01/20/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: About 5 days after the 1st Moderna dosage shot, I noticed a rash and it was hot to the touch and itchy. I scratched it and it caused the rash to spread. It was a raised rash and eventually grew to over 4 inches in diameter. At that point, it was no longer itchy but became very painful. It was so painful that my arm started to feel numb and I could hardly move it. The rash was also very hard. I went to urgent care on the evening of January 21 to see Dr. He determined it was cellulitis and prescribed Keflex and Bactrim each for 7 days. After about 2-3 days of antibiotics I started to see the rash decrease in size, pain and hardness.

Other Meds: daily fish oil supplement

Current Illness: none

ID: 1010232
Sex: F
Age: 53
State: OK

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa meds, mushrooms, augmentin, Demerol,

Symptom List:

Symptoms: Fever 105.4 then 104.6 and 104.0 got the night of shot until 4 days after with chills, headache really bad and weakness fatigue, body and joints aches, no appetite, nauseous essential, saw spots

Other Meds: Snythroid, allopurinol, jardiance,Lantus solo star, novolin, lomotil, Metformin, Lasix, spirolactone, D3,

Current Illness: Thyroid, crohns, cirrhosis of liver Nash,, spleen, hiatal hernia, gerd, ulcer colitis, arthritis

ID: 1010233
Sex: F
Age: 37
State: OR

Vax Date: 01/26/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Unknown, occasional facial hives but without known cause

Symptom List:

Symptoms: Slight arm tenderness first 24 hours, then no adverse effects. However, after 9-10 days, I noticed my arm became extremely itchy at the injection site. Itchiness still persists and there is a red rash that did not form until approx. 10 days after injection. Hesitant to get the second shot as this showed up so long after the shot day that I am wary of a second shot and when this reaction will subside.

Other Meds: OTC multi-vitamin and vitamin E, anti histamine for nasal congestion

Current Illness: None

ID: 1010234
Sex: F
Age: 86
State: CA

Vax Date: 01/25/2021
Onset Date: 02/07/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: None stated.

Other Meds: Three high blood pressure meds., one osteo med.,

Current Illness: none One week after vaccine I had four hours of fatigue, diarrhea, nausea, severe mailaise

Date Died: 02/15/2021

ID: 1010235
Sex: F
Age: 87
State: FL

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/08/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Stroke. Massive brain bleed right side

Other Meds:

Current Illness:

ID: 1010390
Sex: F
Age: 38
State:

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Pertussis, Naldecon, Amoxycillan

Symptom List:

Symptoms: Patient received Covid Vaccine Dose 1 (Moderna) on 1/14/2021. 1/15/21 I experienced arm soreness, lethargy, body aches, achy joints, and felt like crap. 1/16/21 I developed two red swollen spots on my left arm (injection arm). The red areas were swollen, hot to touch, and each were a hard lump a little larger than a marble. These two spots were about 3 inches below the injection site and an inch closer to the body midline. These red spots worsened and joined together. 1/28/21 I was still experiencing the red raised area that had grown in size, still hot to the touch and now red and rashy around the outer edge. Redness diminished over the weekend and resolved by 2/3/21. Arm and shoulder still are achy and sore.

Other Meds: None

Current Illness: None

ID: 1010394
Sex: M
Age: 38
State:

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: 12 hours after shot, red swollen eyes, fatigue, body ache, tenderness and swelling of left arm. Shortly after chills, fever, swelling of lymph nodes, migraine, rapid heart rate, dizzy, nausea. Lasted about 36 hours. migraine, fatigue, body aches, selling of lymph nodes still present after 48 hours. 72 hours later bruised lymph nodes through out the body (left leg, right upper arm, and right rib cage.) Also noticeable joint and muscle pain. prominently lower back, and right rib cage.

Other Meds: none

Current Illness: none

ID: 1010397
Sex: F
Age: 27
State: WA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Allergies: latex, kiwi, lemongrass, grass, bleach, pine, bee venom

Symptom List:

Symptoms: Moderna COVID-19 Vaccine EUA In addition to arm soreness and headache (which I also experienced following my first dose of the Moderna Covid-19 vaccine), I have a raised, firm, very warm, and red area around the injection site (4inches in diameter). Though the red area is not exactly a circle, the diameter of the red area has steadily increased over the past few days. The area is not itchy. My arm is most painful when I move it (attempting to abduct at the shoulder feels impossible) and I cannot apply pressure (leaning or laying on that arm is also tremendously painful, as is the weight of a blanket touching the arm). My arm soreness after the first dose I received resolved after 5-6 days. My arm was firm and warm around the injection site for that dose, but did not have this red area surrounding the injection site.

Other Meds: Lamotrigine, 75mg per day (for epilepsy)

Current Illness: None

ID: 1010401
Sex: F
Age: 72
State: CA

Vax Date: 01/30/2021
Onset Date: 02/06/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa, Penicillin, Prawns, Pollen

Symptom List:

Symptoms: Sore arm for several days after the first injection; Mild redness, swelling, and itching at injection site 7 days after first injection

Other Meds: Raloxifene, Chlorhexidine gluconate, Eye Promise Restore Vitamins, Multi-vitamins, Calcium, Vitamin C, Magnesium, Ubiquinol CQ-10, Vitamin B6, Vitamin B-12

Current Illness: Runny nose from allergies

ID: 1010404
Sex: F
Age: 43
State:

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: no

Symptom List:

Symptoms: Fever of 101.6, body aches and headache

Other Meds: Terbinafine Zyrtec Omeprazole Valtrex B12/D3/Iron

Current Illness: Yes, uterine issues

ID: 1010485
Sex: M
Age:
State: NY

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 02/08/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: acute optic neuritis; A spontaneous report was received from a male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced acute optic neuritis. The patient's medical history was not provided. No relevant concomitant medications were provided. On 07 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot: 011L20A) in the left arm intramuscularly for prophylaxis of COVID-19. On 08 Jan 2021, the day after administration, the patient stated he started to develop an adverse reaction that eventually culminated in acute optic neuritis. He mentioned that he was unsure if the vaccine caused it. He had a CT scan, MRI scan and lumbar puncture with results pending. He also stated that every diagnosis that could cause optic neuritis came back negative. The only change was receiving the vaccine before his symptoms started. On 22 Jan 2021, the patient reported his eye was getting better, but his vision was still not fully repaired. Treatment for the event included prednisone. Action taken with mRNA-1273 in response to the event was not reported. The outcome for the event, acute optic neuritis, was unknown. Follow-up received on 22 Jan 2021 included: update the reporter address, lot number, treatment and status of event.; Reporter's Comments: This case concerns a male patient who received their first of two planned doses of mRNA-1273 (Lot 011L20A), and who experienced the serious unlisted event of acute optic neuritis. Based on the current available information and temporal association between the use of the product and the onset of event on the day after vaccination, a causal relationship cannot be excluded and the events are considered possibly related to the vaccine.

Other Meds:

Current Illness:

ID: 1010486
Sex: F
Age:
State: IL

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Rec V Date: 02/08/2021
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Symptoms: The vaccine was administered to the patient with a subq needle; A spontaneous report was received from a pharmacist concerning 65-year old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) administered with a 5/8-inch (subcutaneous) needle. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot#026L20A) for prophylaxis of COVID-19 infection. On an unknown date, the patient was administered a vaccine using a 5/8-inch (subcutaneous) needle. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine administered with a 5/8-inch (subcutaneous) needle, was considered recovered/resolved.; Reporter's Comments: This report refers to a case of needle issue for mRNA-1273, lot # 026L20A. There were no reported AEs associated with this case of needle issue.

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Current Illness:

ID: 1010487
Sex: M
Age:
State: IL

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Rec V Date: 02/08/2021
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Symptoms: The vaccine was administered to the patient with a subq needle; A spontaneous report was received from a pharmacist concerning 66-year old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) which was administered with a 5/8-inch (subcutaneous) needle. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received his first of two planned doses of mRNA-1273 (Lot number 026L20A) for prophylaxis of COVID-19 infection. On an unknown date, the patient was administered a vaccine using a 5/8-inch (subcutaneous) needle. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine administered with a 5/8-inch (subcutaneous) needle, was considered recovered/resolved.; Reporter's Comments: This case concerns 66 year old male patient who received his first of two planned doses of mRNA-1273 (Lot number 026L20A) for prophylaxis of COVID-19 infection while using a 5/8-inch (subcutaneous) needle. There were no reported adverse events after the vaccine was administered in this case of need issue.

Other Meds:

Current Illness:

ID: 1010488
Sex: F
Age:
State: TX

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 02/08/2021
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Symptoms: Night chills/sweating; HR of 130/HR was 120; soreness and bumps to anus; soreness and bumps to anus; Bodyaches; fever; chills/Night chills; nausea; headache/mild headache; muscle weakness; This is a spontaneous report from a contactable nurse (patient). A 55-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), lot number: EL3249, via an unspecified route of administration in the left arm on 07Jan2021 at a SINGLE DOSE for COVID-19 immunization. Medical history included palpitations. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient hasn't been tested for COVID-19. Patient was not pregnant at the time of vaccination. Historical vaccine included first dose of BNT162B2 on 18Dec2020 at 17:00 via intramuscular route of administration in the left arm for COVID-19 immunization. Concomitant medication included atenolol, vitamin b complex, colecalciferol (VITAMIN D), vitamins (MV), esomeprazole magnesium (NEXIUM), omeprazole (PROTON) and fish oil. The patient previously took morphine and experienced allergies. On 08Jan2021, 1 day post-vaccination after the second dose of vaccine, the patient experienced body aches, fever, chills, nausea, headache and muscle weakness. Then on 18Jan2021, she had night chills and sweating, HR (heart rate) of 130, and mild headache. She also noticed soreness and bumps to anus on 18Jan2021. On 19Jan2021, patient still had chills, HR was 120 and continue to feel muscle weakness Took 100mg atenolol to decrease HR. Usually prn 25 mg atenolol. The soreness and bump increase and was growing. Patient will consult with cardiologist regarding HR. The outcome of events body aches, fever, nausea, headache and was recovered on 13Jan2021. The outcome of event chills, muscle weakness, soreness and bumps to anus was not recovered. The outcome of the other events was unknown. Patient did not receive any treatment for the events body aches, fever, nausea, headache and muscle weakness. Whereas therapeutic measure was taken as a result of "HR of 130/HR was 120". No follow-up attempts are possible. No further information is expected. Information on the lot/batch number has been obtained.

Other Meds: ATENOLOL; VITAMIN B; VITAMIN D [COLECALCIFEROL]; MV; NEXIUM [ESOMEPRAZOLE MAGNESIUM]; PROTON [OMEPRAZOLE]; FISH OIL

Current Illness:

ID: 1010489
Sex: F
Age:
State: NM

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 02/08/2021
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Symptoms: itchy sensation to arms; redness to chest; This is a spontaneous report from a contactable pharmacist. A 56-years-old female patient started to receive BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), lot number EL1284, intramuscular in left arm, on 21Dec2020 at12:30 ( at the age of 56 years old) as a single dose for COVID-19 immunization. Medical history included asthma, hyperlipidemia, PTSD, and seasonal allergies. Concomitant medications were not reported. The patient previously took acetylsalicylic acid (ASPIRIN) (rash), ciprofloxacin, codeine (vomiting, rash), escitalopram (dizziness, rapid heart rate). Prior to the vaccination the patient was not diagnosed with COVID-19. The COVID-19 vaccine was administered at a hospital. There were no other vaccines within four weeks prior to the vaccination. On 21Dec2020 at 12:30, the patient experienced itchy sensation to arms, redness to chest. Rapid response was called, patient monitored. No additional intervention, no treatment provided. The outcome of the events was recovered. The patient was not tested for COVID-19 post vaccination.

Other Meds:

Current Illness:

ID: 1010490
Sex: F
Age:
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 02/08/2021
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Symptoms: fever (mentioned 99.4); chills; This is a spontaneous report from a contactable nurse. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration, in Jan2021 as the second dose, for COVID-19 immunization. Medical history included rotator cuff surgery 5 weeks ago inDec2020. There were no concomitant medications. The patient reported a rotator cuff surgery 5 weeks ago and received a second dose of the COVID vaccine in Jan2021 and experienced a fever (mentioned 99.4) and chills. The outcome of the events of fever and chills was not reported. Information on the lot/batch number has been requested.

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Current Illness:

ID: 1010491
Sex: F
Age:
State: GA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 02/08/2021
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Symptoms: nausea; extreme fatigue/tiredness; left arm very sore and achy, it became very stiff; left arm very sore and achy, it became very stiff; body aches increased; body aches increased; headaches on and off; chills; night sweats really bad for two nights; light fever; nose running; light cough; This is a spontaneous report from a contactable consumer who reported for herself. A 58 (units unknown) non-pregnant adult female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; solution for injection; Lot #: E10140) via an unspecified route of administration on 14Jan2021 as a single dose in the left arm for COVID-19 immunization. Medical history included high blood pressure (High blood pressure-take medication, heart medicine also) from an unspecified date and unspecified if ongoing. Prior to the vaccination, the patient was diagnosed with COVID-19 on an unspecified date and unspecified if ongoing. It was reported that the patient had no known allergies. Concomitant medications were not reported. It was reported that the patient had not taken other medications in two weeks. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 15Jan2021 at 17:30 (reported as "on Friday after the first dose") the patient experienced nausea, extreme fatigue, left arm very sore and achy, it became very stiff, body aches increased, headaches on and off, chills and night sweats really bad for two nights, tiredness, light fever, nose running and light cough. The clinical outcome of the events nausea, extreme fatigue, left arm very sore and achy, it became very stiff, body aches increased, headaches on and off, chills and night sweats really bad for two nights, tiredness, light fever, nose running and light cough were all recovering/resolving. It was reported that no treatment was received for the adverse events. It was also reported that since the vaccination, the patient had not been tested for COVID-19.

Other Meds:

Current Illness:

ID: 1010492
Sex: M
Age:
State: DC

Vax Date: 12/19/2020
Onset Date: 01/02/2021
Rec V Date: 02/08/2021
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Symptoms: blister; fever; chills; body aches; herpes in his mouth; This is a spontaneous report from a contactable consumer (patient himself). A 35-year-old male patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EJ1685, expiry date not reported), via an unspecified route of administration at the left arm on 19Dec2020 10:00 at single dose for COVID-19 immunisation. Medical history included ongoing Hemophilia A. There were no concomitant medications. The patient was vaccinated at a hospital. The vaccine was not administered at a military facility. The patient stated that he got his first COVID vaccine, but stated that he has hemophilia A and was worried about getting the second dose. The patient reported that two weeks later after getting the vaccine, on 02Jan2021, he had fever, chills, and body aches. He went to the dentist on 02Jan2021 who told him that he had a herpes in his mouth. The patient stated that it was just a blister. All of these effects have gone away completely now and he has recovered completely. The patient stated that he was able to get the fever under control by 06Jan2021. He was not scheduled to get the second dose yet but stated because he worked at the hospital he can go anytime and get it; he just had not gotten it yet because he wanted to ask about the hemophilia A. Clinical outcome of fever was recovered on 06Jan2021, for chills and body aches was recovered on 04Jan2021, for herpes in mouth was recovered on 15Jan2021, while for the blister was unknown.

Other Meds:

Current Illness: Hemophilia A

ID: 1010493
Sex: M
Age:
State: MI

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 02/08/2021
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Symptoms: Blood pressure sky high; Severe vertigo; Nausea; Vomiting; Cold sweats; This is a spontaneous report from a contactable consumer (patient). A 56-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: ELO3249; Expiration date was not reported) on 20Jan2021 (12:00) at a single dose on the left arm, with route of administration unspecified, for COVID-19 immunization at the workplace clinic. Medical history included watermelon allergy. Concomitant medications included celecoxib (CELEBREX), metoprolol tartrate, simvastatin and lisinopril. The patient had previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: ELO140; Expiration date was not reported) on the right arm on 30Dec2020 (when the patient was 56 years old) for COVID-19 immunization. On 21Jan2021 (03:45), in the morning, the patient's blood pressure was sky high; had severe vertigo; nausea; vomiting; and cold sweats. The patient had resulted in the emergency room/department or urgent case for the reported events. The patient had received unspecified medications as treatment for the nausea and vertigo. The outcome of the events, 'blood pressure was sky high', 'severe vertigo', 'nausea', 'vomiting' and 'cold sweats', was recovering. The patient was not diagnosed with COVID-19 prior to vaccination, and had been tested for COVID-19 (nasal swab) post-vaccination which was negative on 21Jan2021.

Other Meds: CELEBREX; METOPROLOL TARTRATE; SIMVASTATIN; LISINOPRIL

Current Illness:

ID: 1010494
Sex: F
Age:
State:

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 02/08/2021
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Symptoms: "feels like I got run over by a Mac truck"; headache; tingling to left hand; face warm; flushed; This is a spontaneous report from a non-contactable Physician. An adult female patient of unspecified age received dose 1 of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 18Jan2021 Intramuscular into left arm as single dose for COVID-19 immunisation. Medical history and concomitant medication were not reported. The patient was not pregnant at the time of vaccination. Patient did not have Covid prior vaccination. The patient did not have Covid tested post vaccination. It is not known if patient received other vaccine in last four weeks. Immediately after injection (18Jan2021), small amount of tingling to left hand, face warm, flushed was experienced and resolved within 30 minutes without intervention. The patient experienced "feels like I got run over by a Mac truck" on 19Jan2021 and headache on 19Jan2021. It was unknown if treatment was received. Outcome of event "feels like I got run over by a Mac truck" was recovered, 'headache' was recovered, 'small amount of tingling to left hand' was recovered, 'face warm' was recovered and 'flushed' was recovered. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.

Other Meds:

Current Illness:

ID: 1010495
Sex: F
Age:
State: FL

Vax Date: 01/09/2021
Onset Date:
Rec V Date: 02/08/2021
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Symptoms: arm pain; itching; It's become difficult to move her arm and has worsened since the injection/ I had a hard time lift my arm in changing clothes; It's become difficult to move her arm and has worsened since the injection/ I had a hard time lift my arm in changing clothes; I feel in my arm, around that shot you know I had the injection, start itchy start feel itchy; my arm feel pink, it's swell up and it's scratch; my arm feel pink, it's swell up and it's scratch; This is a spontaneous report from a contactable consumer (patient herself). A 77-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL3246, expiry date not reported), via an unspecified route of administration on 09Jan2021 at single dose for COVID-19 immunisation. Medical history included bone disorder (reported as bad bone problem). Concomitant medication included denosumab (PROLIA) for bone disorder. The patient received her first injection on 09Jan2021 and had been experiencing arm pain which was mild to moderate but about a week later she developed itching in the same arm. It's become difficult to move her arm and had worsened since the injection. She wanted to know if this type of experience had been reported and if she should receive the second vaccination scheduled for the 30th. The patient stated that she had a hard time lift my arm in changing clothes and she can't her shoulder. After one week later about almost 1 week later she felt in her arm, around that shot she had the injection, started itchy started to feel itchy and she was afraid maybe infection, dead skin, maybe infection or something. She showed it to her friend, saying "Look my arm feel pink, it's swell up and it's scratch, it's itchy." Clinical outcome of event "difficulty to move her arm and had worsened since the injection" was not recovered while for the other events was unknown.

Other Meds: PROLIA

Current Illness:

ID: 1010496
Sex: M
Age:
State: MD

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/08/2021
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Symptoms: vertigo starting the evening of vaccination; This is a spontaneous report from a contactable consumer (patient). A 35-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EL1283, expiry date not reported), via an unspecified route of administration on 15Jan2021 13:00 at single dose for COVID-19 immunization. Medical history included vertigo from an unknown date and unknown if ongoing. There were no concomitant medications. The patient experienced vertigo starting the evening of vaccination on 15Jan2021 and continues to persist 6 days later with decreasing intensity. The patient further reported they had vertigo that seems to resolve a couple hours after taking the vaccine and has persisted with positional changes. It was further reported that it was diminishing for the past couple of days but they were pretty intense about vertigo in particular. When they were in a laying down position like the whole room is spinning. It was horrible. The day after vaccine like they were spinning for hours at night and with positional changes from laying down to getting out of bed. When they initially lay down they got like a vertigo. The patient was recovering from the event.

Other Meds:

Current Illness:

ID: 1010497
Sex: F
Age:
State: WA

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 02/08/2021
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Symptoms: bleeding out of her left ear; The injection site feels like bruising; This is a spontaneous report from a contactable consumer (reporting for mother in law). A 90-years-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: EL1284, expiry date unknown), via an unspecified route of administration on an unspecified date in Jan2021 at a single dose for COVID-19 immunization. Medical history included patient was diabetic. The patient's concomitant medications included that patient was on blood thinner (unspecified). Reporter's mother-law (patient) received the Pfizer Covid vaccine yesterday (also reported as today), Jan2021. About 5 hours after receipt of the vaccine, patient was bleeding out of her left ear. It's been an ooze, like a capillary bleed. It's intermittent but it has not stopped. This was her first dose. She can hear OK and the ear was not painful. Her respiratory system seemed to doing fine. The injection site felt like bruising (Jan2021). The site looked fine, no bruising around the band aid and no swelling. She has never bled from her ear. There have not been any medication changes and no known damage to the ear. Patient asked if bleeding in the left ear been associated with the Covid vaccine. No treatment was received for the event bleeding out of her left ear. The outcome of the events bleeding out of her left ear and injection site felt like bruising was unknown.

Other Meds:

Current Illness:

ID: 1010498
Sex: F
Age:
State: MI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/08/2021
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Symptoms: Very sore upper arm and shoulder; Very sore upper arm and shoulder/pain through shoulder and neck throughout the night; pain through shoulder and neck throughout the night; difficulty sleeping; This is a spontaneous report from a contactable consumer. A 37-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in the left arm, on 15Jan2021 14:00 at SINGLE DOSE for COVID-19 immunization. The patient's medical history was not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient hasn't been tested for COVID-19. Concomitant medication included birth control (not specified). On 15Jan2021 16:00, the patient experienced a very sore upper arm and shoulder, pain through shoulder and neck throughout the night, caused difficulty sleeping; ibuprofen helped, lasted 1 day. Therapeutic measures were taken as a result of events. Outcome of events was reported as recovered. Follow-up attempts are completed. The following information on the batch number has been requested.

Other Meds:

Current Illness:

ID: 1010499
Sex: M
Age:
State: OR

Vax Date: 01/20/2021
Onset Date: 01/01/2021
Rec V Date: 02/08/2021
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Symptoms: Fever of about 100-101/fever of 101.3/He still has the fever and he just took it and it's now 100.9; slight headache; chills during the night but not now; a stuff neck; This is a spontaneous report from the Medical Team. A contactable consumer (patient) reported that a 73-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), lot number: EL1283, intramuscular ("in the muscle") in the right arm, on 20Jan2021 14:30 at a SINGLE DOSE for covid-19 immunization. The patient's relevant medical history was not reported. There were no concomitant medications. Patient received first dose of BNT162B2 (lot number: EJ1685) on 30Dec2020 for covid-19 immunization. The patient experienced 'Fever of about 100-101, chills during the night but not now and a stuff neck'. The patient later reported that he got some chills that evening when he got the second dose of vaccine (20Jan2021). Woke up this morning (21Jan2021) with a fever of 101.3 and slight headache. Patient wanted to know if he could take Tylenol, Ibuprofen, or Aspirin, if it's okay. He wanted to clarify that chills started later that evening (second dose vaccination) but it was not bothering him now. He still has the fever and he just took it and it's now 100.9. Patient was recovering from the events "a stuff neck" and "chills during the night but not now". Whereas he had not recovered from " Fever of about 100-101/fever of 101.3/He still has the fever and he just took it and it's now 100.9" and headache. No follow-up attempts are possible. No further information is expected. Information on the lot/batch number has been obtained.

Other Meds:

Current Illness:

ID: 1010500
Sex: F
Age:
State: IN

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 02/08/2021
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Symptoms: swollen left arm pit which is also slightly tender to touch; swollen left arm pit which is also slightly tender to touch; sore arm; low grade temperature (37.8 C); fatigue; chills; Second dose administered on 10Jan2021; first dose was administered on 29Dec2020; This is a spontaneous report from a contactable nurse (patient). A 33-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL9Z61), intramuscular (left arm) on 10Jan2021 15:00 at single dose for Covid-19 immunization. The patient received the first dose of BNT162B2 (lot number: EL1284) intramuscular (left arm) on 29Dec2020 (02:00 PM) for Covid-19 immunization. The patient's medical history included Covid-19; no known allergies. Concomitant medication included citalopram hydrobromide (CELEXA) taken PO (oral) daily before, during and after vaccination period. The patient is not pregnant. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient had no issues on day zero; on day 1 (11Jan2021) she had sore arm, low grade temperature (37.8 C), fatigue, and chills. All have resolved by 6am on day 2 (12Jan2021). On day 3 (13Jan2021), she noticed swollen left arm pit which is also slightly tender to touch but not bothersome. No other lymph areas are noticeably swollen or tender at this time. There was no treatment received for the adverse event. The outcome of events sore arm, low grade temperature, fatigue, and chills was recovered on 12Jan2021; the outcome of events swollen left arm pit which is also slightly tender to touch was recovering. The patient has not been tested for COVID-19 since the vaccination.

Other Meds: CELEXA [CITALOPRAM HYDROBROMIDE]

Current Illness:

ID: 1010501
Sex: F
Age:
State: FL

Vax Date: 01/09/2021
Onset Date: 01/01/2021
Rec V Date: 02/08/2021
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Symptoms: felt a little tender where the shot was; This is a spontaneous report from a contactable consumer (patient). This consumer reported for two patients (herself and her husband). This is the first of two reports. An 88-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: unknown), via an unspecified route of administration on 09Jan2021 at single dose for Covid-19 immunization. Medical history included ongoing cancer cell on eyelid. The patient's concomitant medications were not reported. The patient reported that she received the first dose of Pfizer vaccine on 09Jan2021. The patient reported that she has not had any reaction at all, maybe felt a little tender where the shot was, also reported as felt nothing except maybe a little soreness on the arm in Jan2021. She added that she is due to get her next shot on 30Jan2021 and is also due to have a surgery; she added eye surgery as she have a cancer cell eyelid and she was supposed to have cancer surgery on the 1st, and wanted to know if there would be a complication if she had the vaccine two days before that surgery. She also wanted to know if they will be getting the vaccination on 30Jan2021 and what to do if the facility run out of the vaccine when they are due for the second shot. The outcome of event is unknown. Information about lot/batch has been requested.; Sender's Comments: Linked Report(s) : same reporter, suspect product, and event, different patient

Other Meds:

Current Illness: Malignant neoplasm of eyelid (due to have a surgery)

ID: 1010502
Sex: F
Age:
State: WA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 02/08/2021
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Allergies:

Symptom List:

Symptoms: After second dose pain at injection site; chills; diarrhea; GI upset; unwell feeling; This is a spontaneous report from a contactable Other Health Professional reported for herself. A 27-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number unknown), via an unspecified route of administration left arm, on 20Jan2021 at SINGLE DOSE for covid-19 immunisation. Medical history reported as none. No reported allergies to medications, food or other products. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Facility where the most recent COVID-19 vaccine was administered as at the hospital. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient is not pregnant at vaccination time. The patient's concomitant medications were not reported. The patient previously took the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 30Dec2020 on the left arm. The patient experienced after second dose, pain at injection site, chills, diarrhea, GI upset, and unwell feeling on 20Jan2021 21:00. No treatment was given for the events. Outcome of the events was unknown. The reporter assessed the events as non-serious. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm