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: 1020095
Sex: F
Age: 61
State: OH

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: fever (up to 101) for three days after receiving vaccine. Diarrhea several days following vaccination Muscle aches and generalized body aches continue as of this reporting date. Seeing PCP today.

Other Meds:

Current Illness:

ID: 1020096
Sex: F
Age: 69
State: CA

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: None

Allergies: almond milk latez

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Fast Heartbeat - initially after injection but I thought it was a panic attack. But it subsided and I drove home. About 1.5 hours after the injection I realized my heart was pounding. I felt the pounding/racing heartbeat for about another hour. My BP was normal, pulse was 90 but it has often been 90 on other occasions.

Other Meds: Diltiazem Synthroid Flexeril Aspirin Citracal Metamucil Cinnamon Fish Oil

Current Illness:

ID: 1020097
Sex: M
Age: 50
State: OR

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: None

Allergies: iodine, shellfish

Symptoms: Patient had moderna covid vaccine last week. Initially he had normal post vaccine effects - soreness in the upper arm, fatigue. Over the weekend those symptoms were practically gone. Then he developed severe pain in the arm at the site of the injection followed by nausea and sweats. He is soaking thru his clothes. Not eating much. No fever, cough, sob. Just feels bad.

Other Meds: gabapentin 300 mg TID Percocet 5-325mg Q6h PRN

Current Illness: None

ID: 1020099
Sex: F
Age: 55
State: CA

Vax Date: 08/14/2019
Onset Date: 11/08/2019
Rec V Date: 02/10/2021
Hospital:

Lab Data: EYE EXAMS

Allergies: NONE

Symptoms: EYE IRRITATION/BLURRED VISION

Other Meds: NONE

Current Illness: NONE

ID: 1020101
Sex: F
Age:
State: IN

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

Lab Data:

Allergies: None

Symptoms: Body aches and fatigue for 24 hours

Other Meds: Tryfeminnor Sertraline HCL

Current Illness: None

ID: 1020102
Sex: F
Age: 70
State: GA

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

Lab Data:

Allergies: Penicillin

Symptoms: Due to me having a previous reaction 48 years to Penicillin they asked me to wait 30 minutes after vaccination instead of 15 minutes. I left and about 10 minutes after I left, all of sudden I started feeling, I started feeling hives on the roof of my mouth. I could feel with my tongue blister things on the roof in my mouth. Within in a few minutes they began to burst and liquid came out. I did call my doctor and they had someone call me and to make an appointment with an allergist. I do not remember the Allergist's name but I am scheduled to see her tomorrow 2/11/2021 at 8:30 AM. I spoke with my doctor and 2 people. As of today my mouth is still a little sore, my tongue feels funny and swollen.

Other Meds: Gabapentin 300 MG twice a day, Fluoxetine cap 10 MG once daily, Rosuvastatin tab 400 MG once a day, Lorsartan 6.25 MG daily, OTC sleep aide, OTC acid reflux (Acid Pep) 20 MG daily,

Current Illness:

ID: 1020103
Sex: M
Age: 63
State: TX

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Minor fatigue and fever.

Other Meds:

Current Illness:

ID: 1020104
Sex: F
Age: 24
State: IN

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: n/a

Allergies: biaxin, pertussis vaccine, flu shot, eggs, fish/sea food/shell fish

Symptoms: minor pain at injection site for 48 hours following injection 12 hours following injection had minor pain in shoulders headache and general malaise 15 hours following injection approximately 20 hours following injection major body aches & chills & head ache, woke up with a fever of 102 F 24 hours following injection and fever subsided by 29 hours following injection Mild headache continued until 31 hours following injection and symptoms were gone by 36 hours following injection

Other Meds: may have taken 1 dose of 10mg of Cetirizine either 12 or 36 hours before vaccination

Current Illness: n/a

ID: 1020105
Sex: F
Age: 71
State: CA

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: NA

Allergies: KNA

Symptoms: pt c/o lightheadedness, dizzy, nausea. pt was seated, vitals taken, vitals wnl, after 15 minutes, s/s subsided, pt d/c home. vtals: BP 150/70, P 68, O2 97%, RR 20, T 98.4.

Other Meds: multivitamin, b-complex, vit c & d, supra lysiene,

Current Illness: non stated

ID: 1020106
Sex: F
Age: 39
State:

Vax Date: 12/24/2020
Onset Date: 12/26/2020
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I had a migraine headache for 2 days that I had never experienced before. It started in the base of my neck and wrapped around both sides of my head and into my forehead. Nothing made it better. Ice, heat, over the counter pain relievers. I had to wait it out.

Other Meds:

Current Illness:

ID: 1020107
Sex: F
Age: 71
State: IN

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

Lab Data:

Allergies: sulfa, amoxicillin

Symptoms: chills, fever, body aches, painful arm

Other Meds: calcium, probiotics, D3, B12, rosuvastatin

Current Illness: none

ID: 1020108
Sex: F
Age: 55
State: NY

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

Lab Data: not going to ER

Allergies: sulpha

Symptoms: Fatigue extreme, bone pain, cannot stand up, Head ache, Chills, symptoms like Covid

Other Meds: None

Current Illness: none

ID: 1020109
Sex: M
Age: 49
State: AZ

Vax Date: 02/05/2021
Onset Date: 02/07/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies: Penicillan

Symptoms: My right wrist has broken out with a red rash and burnt like skin.

Other Meds: Flonase, Escitalpragm-10 mg

Current Illness:

ID: 1020110
Sex: F
Age: 52
State: TX

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: headache, body aches and fever 101.4

Other Meds:

Current Illness:

ID: 1020111
Sex: F
Age: 67
State: CA

Vax Date: 01/27/2021
Onset Date: 02/04/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: None

Allergies: N/a

Symptoms: Reaction after one and half weeks at vaccine site. Red, swollen, itchy, painful. This is after initial pain in arm went away.

Other Meds: Arimidex, Lipitor, benacar

Current Illness: None

ID: 1020112
Sex: M
Age: 28
State: CA

Vax Date: 02/06/2021
Onset Date: 02/08/2021
Rec V Date: 02/10/2021
Hospital: Y

Lab Data: ECG showed T wave inversion in V1 TTE normal troponin normal d-dimer normal chest xray normal lower extermeity venous doppler normal CBC, CMP, ESR normal.

Allergies:

Symptoms: Chest pain and shortness of breath. working diagnosis: pleuritis has history of mild COVID infection: diagnosed with COVID via PCR on 12/12/2020 and recovered. Hospitalized at Medical Center from 02/8/2021 to 02/09/2021.

Other Meds:

Current Illness:

ID: 1020113
Sex: F
Age: 36
State: PA

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: none

Allergies: penicillin, rofecoxib, bactrim

Symptoms: 4pm injection, 4:03pm reaction tickle in throat, tingle in throat, then up to roof of mouth and tongue. No swelling. 30 min later changed to a sensation of scalding in her mouth. Lasted 3.5 hrs. 1 hr after symptoms took famotidine and cetirizine (5pm) symptoms resolved at 7pm

Other Meds: famotidine 40mg daily albuterol inhaler PRN budesonide 160/formoterol 4.5mcg 2 puffs BID montelukast 10mg daily tiotropium 60mg inhaler daily metformin 1000mg BID omeprazole 20mg daily cetirizine 10mg BID

Current Illness:

ID: 1020114
Sex: F
Age: 63
State: OK

Vax Date: 02/01/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: None

Allergies: None that I I know of.

Symptoms: Low grade fever, headache, muscle spasms, fatigue, aches and stiff muscles

Other Meds: Lisinopril, cymbalta, hydrochlorthyzide, gabapentin,

Current Illness: Osteoarthritis, neuropathy, bulging disc 4&5 HBP

ID: 1020115
Sex: F
Age: 36
State: MA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: EKG and Chest X-Ray on 2/6/2021

Allergies: Fentanyl, Adhesive, Flu Vaccine, Naproxen, Penicillin, Zofran

Symptoms: She states that after 10 minutes of getting her vaccine she started to have SOB, she was asked to sit for observation and then her BP rose to 150/110. She was then rushed to the ER at Mount Auborn Hospital. Pt informs that an EKG and chest xray was taken an they were Neg, she was also given an IV of Benadryl, Pepcid, 2 bags of saline and prednisone.

Other Meds: Prednisone 10mg and Albuterol 90mcg

Current Illness: None

ID: 1020116
Sex: F
Age: 36
State: NM

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: Point of care blood glucose: 132

Allergies: Cephalexin

Symptoms: 36 yo female received Pfizer Covid-19 vaccine #1 at Mass Vaccination Clinic , and shortly after in monitoring area, complained of wheezing (was diagnosed with bronchitis and wheezing the day before), itchiness of throat, subjective discomfort of throat (swelling) with swallowing within few minutes of vaccine. Exam: VS: HR 73, RR 20, BP 132/84, O2 sat 93%. BG 132 RUL wheezing, no lip/tongue/oropharyngeal swelling Albuterol MDI 2 puffs was taken. Benadryl 50mg po was given. Monitored for 50 minutes after vaccine. RUL wheezing improved, throat itching/discomfort resolved. Repeat VS: HR 70, RR 20, BP 116/72, O2 sat 93% (on RA). Pt discharged to home.

Other Meds: Albuterol MDI

Current Illness: Bronchitis

ID: 1020117
Sex: F
Age: 33
State: IL

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

Lab Data: None

Allergies: Ceclor - hives

Symptoms: My Eczema is very mild, I haven't had a big flare up in over 10 years. I had a big flare up about 3-4 hours after getting the vaccine. My Eczema flared up in places where I didn't know that I had Eczema. It was not painful, it's just itchy, dry, and uncomfortable in spots that are covered with clothes.

Other Meds: None

Current Illness: None

ID: 1020118
Sex: F
Age: 44
State: TX

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

Lab Data: 1/7/21 1st Moderna Vaccine administered

Allergies: Allergy to latex

Symptoms: Swollen eyelids, rhinitis, itchy, crusty eyes and eye discharge, mild body aches, headache

Other Meds: Zyrtec (generic Allertek), a multivitamin, acetaminophen, Olive Leaf Extract (450 mg), Ubiquinol (200-300 mg), NAC (N-Acetyl Cysteine - 1,200 mg), Quercetin (1,000 mg), Melatonin (3-9 mg).

Current Illness: None

Date Died: 02/03/2021

ID: 1020119
Sex: F
Age: 70
State: MI

Vax Date: 01/18/2021
Onset Date: 02/03/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: None.

Allergies: None

Symptoms: My mother died suddenly on February 3rd. She went into shock/cardiac arrest and appeared to have internal bleeding. No autopsy has been performed. Unsure if it was related to the COVID vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1020120
Sex: F
Age: 49
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: body aches and fever

Other Meds:

Current Illness:

ID: 1020121
Sex: F
Age: 33
State: MD

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

Lab Data: N/a

Allergies: Penicillin Wheat, gluten, barley and rye (Celiac disease)

Symptoms: Flu like symptoms, heart palpitations, fast heart rate, fever, chills, sweats

Other Meds: Botox injections for migraines Depo for birth control B2 400mg 1 a day MagOx 400mg 1 a day

Current Illness: N/a

ID: 1020122
Sex: F
Age: 44
State: MD

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: NONE

Allergies: Penicillin

Symptoms: ON DAY 8 POST VACCINATION, I DEVELOPED 24 HOURS OF IRREGULAR (MID-CYCLE) VAGINAL BLEEDING

Other Meds: Zyrtec 10mg

Current Illness: none

ID: 1020124
Sex: F
Age: 45
State: MN

Vax Date: 01/29/2021
Onset Date: 02/05/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: No official lab tests

Allergies: None

Symptoms: One week after receiving the Moderna vaccine I noticed that my right arm started to become painful near the injection site. It was hot to the touch, hard beneath the surface near the injection site, and was red (a coworker circle the redness to see if it would spread) Throughout the day the heat increased at the site, the redness grew and started spreading throughout my upper arm. I could feel swelling, pain, heat, and bleeding at the injection site after taking a shower. I also had a terrible headache. The next day (Saturday, February 6th) I chose to go to urgent care via directions from my sister who is a nurse. I was seen right away, and the doctor was confused about my reaction. He stated that these types of symptoms typically show up 24-48 hours after the vaccination, but he hadn?t seen reactions of this nature 7 days out. He stated that he thought I had a bacterial infection (cellulitis ) and prescribed me the antibiotic Cephalexin for a duration of five days. I still have a rash today, but not nearly what it was 3 days ago.

Other Meds: Daily vitamin

Current Illness: None

ID: 1020125
Sex: M
Age: 36
State: PA

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

Lab Data:

Allergies:

Symptoms: fever of 100.6-102.5 for 2 days, chills/shivering, weak, body aches, headache. Tylenol and stayed hydrated

Other Meds: linsinopril, zoloft, ambien, omeprezole

Current Illness: I tested positive on 12-29-20

ID: 1020126
Sex: M
Age: 32
State: IN

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

Lab Data:

Allergies: None

Symptoms: After my second immunization I experienced extreme fatigue lasting approximately 24-36 hours after the vaccination, a headache that lasted the same amount of time, and a mild-grade fever (100-101 degrees F) during the same timeframe.

Other Meds: I take 1 multi-vitamin, 2 super B-complex, 2 vitamin D, and 2 fish oil supplements daily. No other prescriptions or supplements.

Current Illness: None

ID: 1020142
Sex: F
Age: 43
State: PA

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 02/10/2021
Hospital:

Lab Data: None

Allergies:

Symptoms: Lip tingling, throat tight, cough, flushing, jittery sensation

Other Meds:

Current Illness:

ID: 1020148
Sex: F
Age:
State: CA

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

Lab Data:

Allergies:

Symptoms: She missed her 3rd dose of Gardasil; Description: Customer reports she missed her 3rd dose of GARDASIL 9 that was scheduled to be given 03/2020.; No additional AE. No PQC. No additional information provided.; This spontaneous report has been received from a consumer, a female patient of unknown age, who referred about herself. Information about her pertinent medical history, concurrent conditions, concomitant medications and previous drug reactions and allergies was not provided. On unknown dates, the patient received the first and second dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9), 1 dosage form (reported also as "1 dose"), for prophylaxis (formulation, strength, frequency, route of administration, anatomical location were not provided; lot number and expiration were unknown by the reporter). The patient reported that she missed her third dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) that was scheduled to be given on an unknown day in March 2020 (inappropriate schedule of product administration) (circumstance or information capable of leading to medication error). No additional information was provided (no adverse event).

Other Meds:

Current Illness:

ID: 1020149
Sex: F
Age:
State: NY

Vax Date: 12/12/2020
Onset Date: 12/01/2020
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: mom is positive for varicella; had been breastfeeding until the infant developed the rash; This spontaneous report was received from a physician and refers to a 41-old female patient. The patient's concurrect conditions, medical history, concomitant medications, drugs reactions or allergies were not provided. On 12-DEC-2020, the patient was vaccinated post partum with varicella virus vaccine live (oka/merck)(VARIVAX)in left upper right arm ( lot # 279202867, dose and expiration date were not reported) since it was determined, that she was seronegative for varicella virus vaccine (VZV) (for prophylaxis). The physician reported that the patient was not sure if she had chicken pox in the past and there were no available medical records for her. The physician also stated that there was no known recent exposure to VZV and confirmed that the patient did not develop an injection site reaction or rash post-vaccination. An immnunological work-up was not performed for the patient. It was reported that on 12-JAN-2021, the patient's child developed diffuse distribution of vesicles. The physician reported that the baby's rash specimen was collected on 14-JAN-2021, which was approximately 8 hours after acyclovir treatment began. The polymerase chain reaction (PCR) sample was tested on 15-JAN-2021 and revealed the vaccine strain (it was also reported that the infant developed chickenpox 30 days post maternal vaccination). The physician reported that patient was breastfeeding until the infant developed the rash (maternal exposure during breast feeding ). The infant had more that 20 diffuse lesions on her trunk, legs, arms, face It was reported that the baby was treated with acyclovir for a total of seven days and reported that the baby was currently "doing well." The physician also stated that an immunological work-up for the baby was performed and the results were pending. The outcome of varicella virus test positive was not reported. The causal relationship between varicella virus test positive and varicella virus vaccine live (oka/merck)(VARIVAX ) was not provided. This is one of the two linked reports of mother and child (the child case # 2101USA008744).; Sender's Comments: US-009507513-2101USA008744:

Other Meds:

Current Illness:

ID: 1020150
Sex: F
Age:
State: NY

Vax Date: 12/01/2020
Onset Date: 12/01/2020
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: chickenpox; Vaccine exposure via breast milk; Secondary transmission to the Non-vaccinated person who develops the disease; This spontaneous report was received from a physician and refers to a 5-week-old female patient. The concurrent conditions included meningomyelocele and hydrocephalus. The patient's concomitant medications conditions included vancomycin and acyclovir. On 12-DEC-2020, the patient's mother was vaccinated post partum with varicella virus vaccine live (oka/merck)(VARIVAX)in left upper right arm ( lot # 279202867, dose and expiration date were not reported) since it was determined, that she was seronegative for varicella virus vaccine (for prophylaxis). The physician reported that the mother was not sure if she had chicken pox in the past and there were no available medical records for the mother. The physician also stated that there was no known recent exposure to VZV and confirmed that the mother did not develop an injection site reaction or rash post-vaccination. An immnunological work-up was not performed for the mother. It was reported that on 12-JAN-2021, the patient developed diffuse distribution of vesicles. The physician reported that the baby's rash specimen was collected on 14-JAN-2021, which was approximately 8 hours after acyclovir treatment began. The polymerase chain reaction (PCR) sample was tested on 15-JAN-2021 and revealed the vaccine strain (it was also reported that the infant developed chickenpox 30 days post maternal vaccination). The physician reported that the baby had been breastfeeding until the infant developed the rash(Vaccine exposure via breast milk). The infant had more that 20 diffuse lesions on her trunk, legs, arms, face She reported that the baby was treated with acyclovir for a total of seven days and reported that the baby was currently "doing well." The physician also stated that an immunological work-up for the baby was performed and the results were pending. The outcome of varicella and secondary transmission was not reported. The causal relationship between varicella, secondary transmission and varicella virus vaccine live (oka/merck)(VARIVAX ) was not provided. This is one of the two linked reports of mother and child (the mother's case # 2101USA008318).; Sender's Comments: US-009507513-2101USA008318:

Other Meds: vancomycin; acyclovir

Current Illness: Hydrocephalus; Meningomyelocele

ID: 1020151
Sex: U
Age:
State: IA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE information. No other AEs.; Patient was administered a VARlVAX post expiry; This spontaneous report was received from a physician (discrepancy: also reported with qualification of "other" on the source document) and refers to a patient of unknown age. The patient's pertinent medical history, concomitant medications and drug reactions or allergies were unknown. On 13-JAN-2021, the patient was vaccinated with expired varicella virus vaccine live (oka/merck) (VARIVAX) lot # S000132, expiration date 02-JAN-2021, dose of 0.5 ml (formulation, strength, route of administration and anatomical location were not reported) for prophylaxis. No additional adverse events were reported. Outcome was unknown.

Other Meds:

Current Illness:

ID: 1020152
Sex: F
Age:
State: FL

Vax Date: 10/11/2016
Onset Date:
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: uncontrolled diabetes; Bell's palsy; hypertension; chest pain; raised area the size of a softball in her upper left arm that turned black and blue and hot to the touch.; raised area the size of a softball in her upper left arm that turned black and blue and hot to the touch.; This initial spontaneous report was received on from a lawyer regarding a case in litigation and refers to a female patient of unknown age. The patient's concurrent conditions, medical history and concomitant medication were not provided. On or about 11-OCT-2016, the patient was vaccinated with a dose zoster vaccine live (ZOSTAVAX) (dosage regimen was not reported) for the prevention of shingles (herpes Zoster). On an unspecified date, shortly after to the patient vaccination, the patient presented a raised area of the size of a softball in her upper left arm that turned black-blue and hot to the touch, facial droop, uncontrolled diabetes and hypertension. On an unspecified date, the patient was diagnosed with acute bell's palsy, hypertension, chest pain and diabetes with hyperglycemia. Additionally, the symptoms had been resulted in physical limitation not presented prior vaccination. The patient sustained severe and permanent injuries; the patient also experienced mental and emotional distress due to resulting physical limitations and seriousness of patient's conditions. As a direct and proximate result, the patient suffered serious, progressive, permanent and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. The reporter considered all the events to be related to zoster vaccine live (ZOSTAVAX). Upon internal review, the events of uncontrolled diabetes and bell's palsy was considered as medically significant.

Other Meds:

Current Illness:

ID: 1020153
Sex: U
Age:
State: NY

Vax Date: 06/01/2015
Onset Date:
Rec V Date: 02/10/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: shingles; ill-defined disorder; This initial spontaneous report was received on from a lawyer regarding a case in litigation and refers to a patient of unknown age and gender. The patient's concurrent conditions, medical history and concomitant medication were not provided. On or about 01-JUN-2015, the patient was vaccinated with a dose zoster vaccine live (ZOSTAVAX) (dosage regimen was not reported) for the long-term prevention of shingles and zoster-related conditions and was administered by a pharmacist. On an unspecified date, subsequent to the patient vaccination, the patient presented shingles (herpes zoster) and other zoster-related conditions (ill-defined disorder). As a direct and proximate result, the patient had been treated by a health care provider. Additionally, the patient had and would be continued suffer ongoing injuries, including but not limited to mental and physical pain and suffering; medical care and treatment for these injuries; significant and related expenses as result of these injuries, including but not limited to medical losses and costs included care for hospitalization, physician care, monitoring, treatment medication and supplies. As a direct and proximate result, the patient suffered severe and permanent physical injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions. The reporter considered the event shingles (herpes zoster) and ill-defined disorder to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1020154
Sex: M
Age: 1
State: NY

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: PRODUCT STORAGE ERROR; This spontaneous report was received from a licensed practical nurse regarding a 1 year old male patient. No information was provided regarding medical history, concurrent conditions, or concomitant medications. On 15-JAN-2021, the patient received improperly stored doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live(M-M-R II) lot # S037501, expiration date of 12-NOV-2021, subcutaneous in the right thigh , varicella virus vaccine live (oka/merck)(VARIVAX) lot # T017686 with expiration date of 21-MAY-2022, subcutaneous in the left thigh, hepatitis a virus vaccine inactivated(HAVRIX) lot # ZJ3G3 with expiration date of 12-JUN-2022, intramuscular in the right vastus lateralis and pneumococcal 13v conj vaccine (crm197)(PREVNAR 13) lot # D57723 with expiration date of 30-SEP-2022 intramuscular in the left vastus lateralis, all for prophylaxis The vaccines experienced temperature excursions with a total of 29.5h. This is one of several reports from the same reporter(US-009507513-2101USA011364).

Other Meds:

Current Illness: Prophylaxis

ID: 1020155
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: A patient got PROQUAD the patient is 32 years.; patient got PROQUAD who was suppose to get V ARlV AX; This spontaneous report as received from a nurse practitioner and refers to a 32 year old patient of unknown gender. The patient's concurrent conditions, medical history and concomitant therapies were not provided. On an unknown date, the patient was vaccinated with measles, mumps, rubella and varicella (oka-merck) virus vaccine live(PROQUAD) orally (dose, frequency, lot# and expiration date were not reported), for prophylaxis who was suppose to be vaccinated with varicella virus vaccine live (oka/merck)(VARIVAX).

Other Meds:

Current Illness:

ID: 1020156
Sex: M
Age:
State:

Vax Date: 07/02/2020
Onset Date:
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: first dose of Gardasil 9 was administered on 02-JUL-2020, the second dose on 29-JAN-2021 and the third one was schedule for to months after the second (March 2021), This conflicts with the normal 0, 2, and 6 month dose schedule; No additional side effects to report.; This spontaneous report was received from a consumer (mother's patient) referring to a currently 19-year-old male patient. The patient's pertinent concurrent conditions, medical history, concomitant medications and previous drug reactions or allergies were not provided. On 02-JUL-2020 and 29-JAN-2021, the patient was vaccinated with first and second dose respectively of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) by intramuscular route as routine vaccination (prophylaxis) (concentration, dosages, lot numbers and expiration dates were not reported), also the patient had the third dose scheduled for 2 months after the second (approximately on March 2021) (inappropriate schedule of product administration). No additional side effects to report.

Other Meds:

Current Illness:

ID: 1020157
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: She had hives all the way up and down her arms, that were painful and very hot.; She had hives all the way up and down her arms, that were painful and very hot.; She had hives all the way up and down her arms, that were painful and very hot.; This spontaneous report has been received from an approximately 64 year old female patient with high blood pressure, high cholesterol, severe depression and anxiety. The patient's drug reactions included hyperaction to an unspecified medication. Concomitant therapies included "Affixer", rosuvastatin calcium(CRESTOR) and lisinopril(manufacturer unknown). On an unspecified day in 2008, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23) injection (route, lot number and anatomical location were not reported) for prophylaxis (indication reported as "Doctor wanted her to get the vaccine"). On an unspecified day in 2008, she had a serious reaction to the vaccine for about 3-4 weeks. She had hives all the way up and down her arms, that were painful and very hot. The patient seek for medical attention; however, no treatment was given. On an unknown date, 4 weeks after getting the vaccine, the patient recovered from the events. The patient considered the events to be related to Pneumococcal Vaccine, Polyvalent (23-valent)(PNEUMOVAX23).

Other Meds: CRESTOR; PRINIVIL

Current Illness: Anxiety; Blood pressure high; Cholesterol high; Depression; Drug hypersensitivity

ID: 1020158
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Her allergies include a delayed reaction to the Pneumovax 23 vaccine that made her entire arm swell to her wrist; This spontaneous report was received from a female consumer of unknown age referring to herself. The patient's pertinent concurrent conditions included sjogren's syndrome. The patient medical history and concomitant medications were not provided. On an unknown date, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23) as prophylaxis (concentration, vaccination scheme frequency, dosage, route of administration and anatomical location, lot number and expiration date were not reported). On an unknown date, the patient stated that ,she had a delayed reaction to pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23), that made her entire arm swell to her wrist (peripheral swelling). At the time of this report, the outcome of peripheral swelling was not reported. As the patient reported having an adverse reaction to pneumococcal vaccine, polyvalent (23-valent)(PNEUMOVAX23), , therefore the causality is being considered as related.

Other Meds:

Current Illness: Sjogren's syndrome

ID: 1020159
Sex: F
Age: 59
State: IN

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: ringing in both ears/ rinigng in one ear; arm was sore; given intramuscular instead of subcutaneous; special senses- ear nerve deafness; otitis media; This spontaneous report was received from a 59-year-old female patient who was referring to herself. The patient's concurrent conditions included hypertension and sleep apnea. The patient had no drug reactions or allergies. The patient mentioned prior to vaccination, she was tired, but at the reporting time she was not. The concomitant medication included lisinopril (manufacturer unknown). On approximately 22-JAN-2021 (reported as about 2 weeks ago), the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) intramuscularly (lot #, expiration date, strength and site of administration was not provided) for prophylaxis (reported as vaccination). The patient received the vaccine intramuscularly instead of subcutaneously. On the day the patient received the vaccine, the her arm was sore but it went away the next day. On approximately 25-JAN-2021 (reported as about 3 days after the vaccination), the patient experienced ringing in one ear and then the ringing moved to both ears. The ringing in both ears was ongoing. On an unspecified date, in 2021, the events of nerve deafness and otitis media as a side effect of the vaccine were reported. The outcome of nerve deafness and otitis media was unknown. The outcome of pain in arm was recovered. The outcome of ringing in the ears was reported as not recovered. The nerve deafness and otitis media was reported as related to the vaccine. The relationship between the pain in arm and ringing in the ears and the vaccine was not provided. Upon internal review the event of nerve deafness was considered to be medically significant.

Other Meds: PRINIVIL

Current Illness: Hypertension; Sleep apnoea

ID: 1020160
Sex: U
Age:
State: OK

Vax Date: 02/01/2015
Onset Date:
Rec V Date: 02/10/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: other zoster-related conditions; shingles; This spontaneous report was received from a lawyer regarding a case in litigation and refers to a patient (pt) of unspecified age and gender. No information was provided regarding the pt's medical history, concurrent conditions, previous drug reactions, allergies and concomitant medications. On or about 01-FEB-2015, the pt was inoculated with zoster vaccine live (ZOSTAVAX) (strength, dose, route of administration, anatomical location, lot # and expiration date were not provided) for the long-term prevention of shingles and zoster-related conditions. On an unspecified date after receiving zoster vaccine live (ZOSTAVAX) (reported as "subsequent"), the pt was treated by an unspecified healthcare provider at a emergency room for shingles and other zoster-related conditions (Ill-defined disorder). As a direct and proximate result of zoster vaccine live (ZOSTAVAX) vaccine, the pt would continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and would continue to suffer such losses, and damages in the future. The outcome of the events was considered not recovered and causality was related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1020161
Sex: F
Age: 75
State: ND

Vax Date: 01/14/2021
Onset Date: 01/21/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Cellulitis; A spontaneous report was received from a 75-year-old female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and developed cellulitis. The patient's medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included levothyroxine, clopidogrel, rosuvastatin, vitamin D, and zinc. On 14 Jan 2021, approximately one week prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 21 Jan 2021, the patient developed cellulitis. On 24 Jan 2021, the patient was seen in urgent care and given antibiotics for the cellulitis infection. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, cellulitis, was unknown.; Reporter's Comments: This spontaneous report concerns a 75-year-old female patient on blood thinners who experienced a serious event of cellulitis approximately 1 week after the administration of the first dose of the mRNA-1273 vaccine (Lot #: 041L20A, expiration date-Unknown). Treatment given include an unspecified antibiotic, and outcome is unknown. Based on the information provided, which includes a temporal association between the reported event and the administration of mRNA-1273 vaccine, a causal association cannot be excluded. Causality is confounded by the patient's advanced age.

Other Meds: LEVOTHYROXINE; CLOPIDOGREL; CRESTOR; VITAMIN D [VITAMIN D NOS]; ZINC

Current Illness:

ID: 1020162
Sex: F
Age:
State: CA

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

Lab Data: Test Date: 202101; Test Name: IgE; Result Unstructured Data: Normal; Test Date: 202101; Test Name: Complement level; Test Date: 20210115; Test Name: COVID antibody test; Test Result: Negative ; Test Date: 202101; Test Name: Intradermal test; Result Unstructured Data: Test done 3 times for Polysorbate. Result: Negative; Test Date: 202101; Test Name: Skin prick test; Result Unstructured Data: Test for PEG allergy. Result: Reaction; Test Date: 202101; Test Name: Tryptase; Result Unstructured Data: Elevated; Test Date: 202101; Test Name: WBC; Result Unstructured Data: Elevated. without left shift; Test Date: 202101; Test Name: WBC

Allergies:

Symptoms: Anaphylactic reaction; Massive bloody diarrhea; One large vomitus; A spontaneous report was received from a physician who was also a female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced massive bloody diarrhea, anaphylactic reaction and one large vomitus. The patient's medical history included hives. No relevant concomitant medications were reported. On 11 Jan 2021 at 1 p.m., prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot Number: 027L20A) intramuscularly or subcutaneously in the left deltoid for prophylaxis of COVID-19 infection. On 11 Jan 2021, the event began 9 hours later with massive bloody diarrhea from 11 p.m. to 3 p.m. and one large vomitus. On 12 Jan 2021, the patient experienced hives at 3 a.m. She woke up again because of the hives at 6:30 a.m. Within 15 minutes, hives were all over the place and spread very quickly everywhere but her face. Hives were the worst in the palm of her hands. Treatment included diphenhydramine. Thirty minutes later, she woke up with a beefy red and fat tongue that felt huge and wouldn't fit in roof of her mouth. The patient found it hard to talk and swallow, and her speech was funny. The patient went to the emergency room (ER). At the ER, treatment included intravenous (IV) solumedrol, IV diphenhydramine, IV famotidine, and IV fluids. She reported that it took approximately 2-3 hours for her tongue to feel the right size, and she stayed in the ER for approximately 4 hours. At home, after seeing her primary care physician, she began taking diphenhydramine, famotidine, oral methylprednisolone, and fexofenadine. On an undisclosed date, the patient saw an allergist/ immunologist who did bloodwork and an intradermal test for polysorbate; all three times tested was negative. The allergist also did a skin prick test for polyethylene glycol (PEG) allergy, and there was a reaction at full concentration. On an undisclosed date, the patient's complement level was normal, and her tryptase was elevated which indicated acute inflammatory. Immunoglobulin E level was normal. White blood cell count was 19,000 with no left shift; 48 hours later white blood cell count was 16,000; her physician thought it was due to steroids and stress of a reaction. On 15 Jan 2021, a COVID antibody test was negative. Complement level was normal, and tryptase was elevated, which indicated acute inflammatory. White blood cell count was 19,000 with no left shift. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the event, anaphylactic reaction, was not provided. The outcome for the event, massive bloody diarrhea, was considered resolved on 12 Jan 2021. The outcome for the event, one large vomitus, was considered resolved on 11 Jan 2021.; Reporter's Comments: This spontaneous report concerns a female patient with medical history of hives, who experienced serious events of massive bloody diarrhea and anaphylactic reaction and non-serious event of one large vomitus. The events occurred on the same day after the first dose of mRNA-1273 vaccine (Lot Number: 027L20A, expiration date: unknown). Skin prick test for polyethylene glycol (PEG) showed reaction at full concentration. Treatment included solumedrol, diphenhydramine, famotidine, methylprednisolone and fexofenadine and outcome is resolved. Based on the information provided which include tempral association and evidence of reaction to a constituent of the mRNA-1273 vaccine, Ac causal association between the events and the vaccine administration cannot be excluded.

Other Meds:

Current Illness:

ID: 1020163
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: patient can't take the flu shot. They made patient had the flu; patient had 3 of them and patient got sick every time; Initial information received on 02-Feb-2021 regarding an unsolicited valid non-serious case received from a consumer (patient). This case involved a patient of unknown age who can't take the flu shot. they made patient had the flu (influenza) and had 3 of them and patient got sick every time (illness), while patient received vaccines INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, patient who can't take the flu shot. they made patient had the flu (influenza) and had 3 of them and patient got sick every time (illness), (latency: unknown) following the administration of suspect vaccine. It was not reported if the patient received a corrective treatment. Outcome of the event was unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 1020164
Sex: F
Age: 4
State: TX

Vax Date: 12/12/2020
Onset Date: 12/12/2020
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies:

Symptoms: a patient received a dose of FLUZONE which was stored at 0.7 Celsius for 25 hours and 24 minutes/ No AE; Initial information received on 25-Jan-2021 regarding an unsolicited valid non-serious case received from the other health care professional (medical assistant) via Medical Information (Reference number: 00444786). This case involves a 4 years old female patient who received a 0.5 ml dose of INFLUENZA QUADRIVAL A-B MULTIDOSE VACCINE PRESERVED [FLUZONE] that was stored at 0.7 Celsius for 25 hours and 24 minutes lot UJ452AB, Expiry date: 30-Jun-2021 via intramuscular route in unknown administration site on 12-Dec-2020 for prophylactic vaccination. The patient's medical history, medical treatments, vaccinations, concomitant medications and family history were not provided. It was an actual medication error due to incorrect product storage (latency: same day). Description: Call received from medical assistant (MA) reporting a temperature excursion of unknown cause. Caller reporting PENTACEL, IPOL, FLUZONE QUADRIVALENT Multi Dose Vials (MDVs) AND PREFILLED SYRINGES, MENACTRA, ADACEL and DAPTACEL at 0.7 Celsius for 25 hours and 24 minutes. Caller reported opened IPOL MDVs and opened Fluzone Quadrivalent MDVs. Caller reporting excursion occurring in December 2020. Caller reporting 11 doses of Fluzone Quadrivalent MDVs were administered post excursion. Caller with question on viability of administered vaccines. At the time of reporting, patient had no adverse event. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holders compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1020165
Sex: F
Age: 35
State: CT

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data:

Allergies: N/a

Symptoms: 1 week post my 1st Moderna covid vaccine I developed a rash on the immunized arm. The rash was tender, and itchy. It has hives, and developed a ring around it that is best describes as a hive shaped as a large circle that outlined a large, indurated area. It started small and then got larger. The rash subsided in about 5 -6 days.

Other Meds: N/a

Current Illness: N/a

ID: 1020166
Sex: F
Age: 25
State: MN

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

Lab Data: N/A

Allergies: codeine and dairy products

Symptoms: Re-swelling of injection site and muscle pain.

Other Meds: fluoxetine, birth control, seasonal allergy medication, vitamin D, and iron

Current Illness: N/A

ID: 1020167
Sex: F
Age: 44
State: MD

Vax Date: 02/03/2021
Onset Date: 02/09/2021
Rec V Date: 02/10/2021
Hospital:

Lab Data: NONE.

Allergies: PENICILLIN

Symptoms: ON DAY 6 POST VACCINATION, I DEVELOPED 12 HOURS OF IRREGULAR (MID-CYCLE) VAGINAL BLEEDING.

Other Meds: ZYRTEC 10 MG

Current Illness: NONE

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm