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: 1030376
Sex: F
Age: 46
State: NY

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: Dairy

Symptoms: Fever Freezing cold and shaking Extreme Entire Body aches - every part of body hurt especially in Hip/ pelvic area and neck. Skin hurt to touch Headache Arm pain ( injection arm)

Other Meds: Ajovy Vitamin D Biotin Elderberry Multi- vitamin Montelukast Allegra

Current Illness:

ID: 1030377
Sex: M
Age: 44
State: OH

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Headache, fever, muscle aches 12 hours after dose. Symptoms gone 12 hours later. 2 days later I woke up with numbness to my abdomen and upper quads. Day 3 the numbness was noticed throughout my body but worst in midsection, followed by legs. Muscle weakness started with spasms on occasion.

Other Meds: Vitamin D3, B-12, Zinc, Losartan, Hydrochlorothiazide, Humatrope, Ibuprofen, Testosterone

Current Illness: None

ID: 1030378
Sex: F
Age: 36
State: SC

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Initial On Call Documentation 2/5/21 at 20:36: Patient called after-hours line with complaint of swollen tongue 5 hours after her second Covid vaccine. She reported initial lip swelling with the first vaccine. She took Benadryl when she had lip tingling initially this afternoon. However, now she is noting indentations on her tongue. Heart rate around 125. Patient with no previous history of allergy and anaphylaxis. No epi-pen in home. Patient is tearful over the phone requesting advice. Discussed with patient that the safest option would be for her to report to urgent care versus ED for further evaluation and potential management for impending anaphylaxis, especially given lack of EpiPen in the home. Patient voiced understanding and is getting a ride to an urgent care. Follow Up Message from Patient 2/8/21 at 11:23: Update: I developed sudden swelling of my tongue on Friday night approx. 4 hours after receiving my second dose of the Moderna vaccine. I spoke to on call Dr. She advised me to go to urgent care if still open or ER. Throat started to tingle on the way their urgent care. I was given a dose of EpiPen, Pepcid, Benadryl, and Solu-Medrol. They wrote prescriptions and recommended following up with you this week. I've been taking prednisone, Benadryl, and Pepcid. Tongue is still a bit swollen, but it has not worsened. I now have two EpiPen's to use if needed. Follow Up PCP Appt 2/11/21 at 15:46: S/O: Patient had the second COVID 19 vaccine on Friday 2/5 and she premedicated with 10mg of Pepcid 10mg and post medicated with Benadryl 25mg. Later that evening she was resting when she felt some swelling of her tongue. She called the Dr who was on call and she was advised to go to the urgent care. She felt some tingling of her throat on the way there. She had no rash, difficulty breathing, or difficulty swallowing. She was given Solu-Medrol, Benadryl and Pepcid IV and was given a dose of an Epi-pen. She took Benadryl for 3 days. She finished a round of 60mg daily prednisone (for 5 days) yesterday. She felt jittery on the prednisone and this has persisted but is improving. She continues to have a feeling of chest pressure. First dose Moderna 025J20A 1/8/21; second dose Moderna 031L20A 2/5/21. She continues to note some mild swelling of her tongue but is otherwise improved. She does continue to have some pressure type pain in her chest which is also somewhat improved and more diffuse in nature. A/P: She is okay to taper off of her Benadryl. She has an EpiPen should she need it, though I do not anticipate this being necessary. She should note continued improvement in her symptoms to include the mild swelling that is persistent in her tongue.

Other Meds: Fluticasone nasal spray PRN

Current Illness: Chest pain and lip tingling after 1st dose of Moderna COVID vaccine on 1/8/21.

ID: 1030379
Sex: F
Age: 23
State:

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: amoxicillin

Symptoms: approx. 12 hrs. post vax, side effects experienced were chills, aches, extreme fatigue and night sweats. Throughout the next day, lightheadedness, aches, and extreme fatigue continued.

Other Meds:

Current Illness:

ID: 1030380
Sex: F
Age: 65
State: FL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: No

Symptoms: Had a fever of 101.2 was nausea and itching at site and all over my body I took Tylenol for the fever and and allergy medicine for the itching.

Other Meds: Vitamins D Vitamins E Letrozole 2.5 my amlodipine 5mg Buspirone 15mg Gabapentin 100mg

Current Illness: Cancer diagnosis June 2021

ID: 1030381
Sex: F
Age: 27
State: VT

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 20 minutes after receiving Covid 19 Vaccine /Pfizer, employee complaints of shortness of breath, chest tightness, pulse = 100. Medical team was called and Employee was taken to the ER.

Other Meds:

Current Illness:

ID: 1030382
Sex: F
Age: 58
State: OH

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: none known

Symptoms: Red rash on arm, minor swelling and tenderness about 3 by 7 inches in size

Other Meds: escitalopram

Current Illness: none

ID: 1030383
Sex: F
Age: 66
State: FL

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None thus far.

Allergies: Doxycycline

Symptoms: Fatigue, chills and pain all over my body. Not sure about fever as I didn't have a thermometer. The symptoms got better yesterday but deteriorated again Sunday night. It is now Monday morning, 9;48 pm est. and I am still feeling bad and having the symptoms stated above. I have been drinking orange juice and water and taking Tylenol and nyquil. I am concerned about how long the symptoms are continuing and if I should be doing something different.

Other Meds: Hydrochlorothiazide, 25 mg tab

Current Illness: Sudden pain on my left side between my lower back and hip. It happened the morning of and prior to the vaccine.

ID: 1030384
Sex: F
Age: 57
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: none

Allergies: NKMA

Symptoms: Dose # 2 Moderna COVID 19 Vaccine. Fever 100.7, chills, nausea, body aches lasting 36 hours

Other Meds: Losartan 50mg

Current Illness: none

ID: 1030385
Sex: F
Age: 80
State: FL

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: talked to patient , swelling got a bit worse , went to doctor , doctor suspects pink eye, doctor prescribes medication.

Allergies:

Symptoms: swelling of left side of face under left eye socket

Other Meds: thyroid medication htcz estidile levothyroxide

Current Illness:

ID: 1030386
Sex: M
Age: 72
State: PA

Vax Date: 01/28/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Moderate left jaw pain

Other Meds: Multivitamin, Lipitor, Toprol XL, Omeprazole, aspirin, OFEV, Anti diarrhea

Current Illness:

ID: 1030387
Sex: F
Age: 66
State: MI

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

Lab Data:

Allergies: Iodine, Benadril, Shell Fish Spinal Narcotic before surgery, Versed ,Astromorph, or Morpine

Symptoms: I was immobiled around 7:30. For 3 days I was unable to cope with side effects. I had a headache, body aches, neaseua, Dry heaves, chills sore arm, Droopy eyes. A feeling of all over fatique , after 5 days I broke out on my chest with a itchy rash, still had headache and neausea. Went to walk in heatlh clinc 2/11/21 Diagnosis was Viral syndrome post covid vaccination.

Other Meds: Vitamin D 3, Vitamin C , B12, B complex, Multi Vitamin, Turmeric ,Probiatic , Metamucil, Alfalfa, Calcium, Pepcid

Current Illness: none

ID: 1030388
Sex: F
Age: 32
State: OH

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: 1/17/21; Bloodwork done- Magnesium was dropped below normal, Chest Xray,

Allergies: none

Symptoms: 1/16/21 Once i left the site i started out with a headache that was on and off all day. 9pm at night i had extreme chills and felt like heart was racing. 1/17/21 @12am I had a headache, Heart Racing 130's to 150's checked with pulse OX at home, Chest Pain, SOB, Wheezing, Weak on Left side of the body felt like a flimsy fish, 102.0 Fever, Body Aches, Chills. Felt like i was Dieing.

Other Meds: Venlafaxine, trazodone, Vitamin D, spironolactone

Current Illness: COVID-19 1/3/2021

ID: 1030389
Sex: M
Age: 24
State: MA

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

Lab Data: None

Allergies: penecillin

Symptoms: About 8-10 minutes after injection, he was talking with a colleague in the observation area and became dizzy and sat down. Then got "really hot", then everything went black". Next thing he remembers is 2 colleagues assisting him to ambulate to ambulance. States his vitals were fine in the ambulance and at the hospital. IVF were given en route to hospital. Reports he "never eats breakfast". He was observed for ~ 2 hours at the hospital and released.

Other Meds: none

Current Illness: none

ID: 1030390
Sex: F
Age: 58
State: NJ

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

Lab Data:

Allergies: none

Symptoms: Sore arm about 7 hours after injection. Achy, chills, fever 101.8 about 12-14 hours after injection. Fever went down every couple of hours throughout the night 100.3, 99.3, 98.3 then normal for me 97.6. Next day had a headache and was weak (couldn't stand up for more than 10 minutes at a time) for the whole day. Took ibuprofen for headache. Woke up next day (48 hours after shot) feeling 85-90% normal. Was back to normal later that day.

Other Meds: none

Current Illness: none

ID: 1030391
Sex: F
Age: 27
State:

Vax Date: 01/06/2021
Onset Date: 01/13/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: ?Covid arm?. Large red, hot, swollen, itchy area appeared a week after injection. Grew in size to approximately 4 inches by 6 inches. Went away about 3 days later

Other Meds:

Current Illness:

ID: 1030392
Sex: M
Age: 63
State: MD

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: none known

Symptoms: 1. Lip rash began 7 hours after injection, fully erupted by the next morning. No treatment, cleared after 10 days; 2. Tiredness began 30 hours after injection, no treatment, lasted 10 days; 3. Skin rash on back and chest began 12 hours after injection, no treatment, lasted 10 days; 4. Loss of appetite began 42 hours after injection, no treatment, lasted 10 days; 5. Diarrhea began 48 hours after injection, no treatment, lasted two weeks; 6. Skin sensitivity, including inability to brush teeth without gagging, began 36 hours after injection, no treatment, lasted 10 days; 7. Night sweats began 78 hours after injection, no treatment, lasted 10 days; 8. Chills with no fever began 4 days after injection, no treatment, lasted one week.

Other Meds: Lipitor, Loratidine, low-dose aspirin, otc multi-vitamin

Current Illness: Chills two days prior to vaccination

ID: 1030393
Sex: F
Age: 23
State: VT

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 25 minutes after receiving Covid Vaccine/Pfizer, employee complains of hoarseness, increased cough, tickle in throat. Medical team was called and Employee taken to ER.

Other Meds:

Current Illness:

ID: 1030394
Sex: F
Age: 55
State: CA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: N/A

Allergies: Ampicillin, Amoxicillin, Sulfa drugs

Symptoms: Severe chills on 2/12/21; overnight on 2/12/21 restless sleep; 2/13/21 - headache, stomachache, diarrhea, vomiting, chills, temperature of 95.6

Other Meds: Tramadol, levothyroxine, Trelegy, prednisone, multi-vitamin, calcium, Nexium

Current Illness: None

ID: 1030396
Sex: M
Age: 30
State: FL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None.

Allergies: None known. Only perineal environmental allergies (e.g. dust, pollens, pet dander)

Symptoms: Symptoms included localized pain in upper arm around injection site, headache/migraine, muscle/joint pain and aching (particularly in the back, legs, and knees), chills/hot flashes, general lethargy, general discomfort/restlessness. Symptoms were experienced roughly in order listed above, beginning approx. 16 hours after receiving the vaccine. Symptoms lasted through Friday night and predominantly subsided Saturday morning. No symptoms by Sunday 02/14/2021.

Other Meds: Vitamin D3, cetirizine 10mg, fluticasone propionate

Current Illness: None.

ID: 1030397
Sex: M
Age: 83
State: NY

Vax Date: 02/10/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I did not have this reaction with the first dose. On Saturday the 13th, when I walk the groin on both sides (left and right) hurts. When I am sitting it doesn't hurt. It is still happening as of today.

Other Meds: Multivitamin one a day Drugstore version,

Current Illness:

ID: 1030398
Sex: F
Age: 57
State: PA

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

Lab Data: N/A

Allergies: No Known Allergies.

Symptoms: Delayed adverse effects occurred about 8 hours after 2nd dose administered. Injection site tenderness and bruising. Headache, chills, fatigue, achy joints, runny nose but no fever. Symptoms continued for 2 days after vaccine although not as severe by the 2nd day. Experienced nausea, dizziness or fogginess for 3-4 days after.

Other Meds: Calicium, Vitamin D3 and Omega3 Fish Oil supplements.

Current Illness: Breast Cancer surgery on 12/7/2020. Started radiation treatment on 1/25/2021. Day of vaccine 2nd dose was radiation treatment Day #9.

ID: 1030399
Sex: M
Age: 65
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Slept as usual the night of injection. The next morning, I felt like when I had COVID back in October ... a little fatigue, headache, difficult breathing. I went to work, but came home to rest for an hour before going back. I took Tylenol and felt better. Over the weekend, I took Tylenol 2 or 3 times more. Today, Monday, I feel fine.

Other Meds:

Current Illness:

ID: 1030400
Sex: M
Age:
State: IN

Vax Date: 02/08/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: N/a

Allergies: No

Symptoms: I have a big red rash on the front side of my neck. It?s really itchy and dry. When I put on lotion, anti-itch cream, or soap when I shower it stings really bad. I though the allergy could have been other stuff but I can?t think of anything else. So, it has to be the vaccine.

Other Meds: No

Current Illness: No

ID: 1030401
Sex: F
Age: 51
State: NY

Vax Date: 02/06/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: N/a

Allergies: N/a

Symptoms: ?Covid arm? itchy red oval on skin at injection site on left arm. 2-3 ? in diameter.

Other Meds: N/a

Current Illness: None

ID: 1030402
Sex: F
Age: 76
State: FL

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Penicillin, sulfa, Flagyl, NSAIDS, Cipro, eggs, dairy, soy, corn, apples, grapes.

Symptoms: Washed out, just relaxed slight fever, and chills, muscle aches, joint pains, 1 Tylenol and went to bed

Other Meds: Pravistatin, Vedic are, Singular, Advair, multivitamin, B-complex, Move free, probiotic, Colace

Current Illness: None

ID: 1030403
Sex: F
Age: 67
State: IN

Vax Date: 02/06/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Egg

Symptoms: Redness at sight of injection, (left arm), in a large circle and very itchy. This began after about 5 days after receiving the vaccine.

Other Meds: B12 vitamin D3 vitamin Prevacid Align

Current Illness: None

ID: 1030404
Sex: F
Age: 70
State: GA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: none

Allergies: peanuts, shrimp, iodine

Symptoms: Shot initially hurt at injection time, unlike 1st injection. By 2pm, could not lift arm without severe pain. Around 6pm, developed serious chill and could not get warm. So cold did not take off clothes and put two heavy robes over clothes and covered with heated blanket. Remained cold until around 5 am and was burning up at that time. Temp was 101.3. Had headache from hell and my body felt as if it had been beaten with worse pain in shoulders, upper and mid back and left knee. Interesting because shoulders have been previously injured and are in poor shape and recently had injured left knee. Don't know if relevant or if existing pain was amplified by effects of virus. With tylenol and aspirin, got temperature to 100 to 1. Felt bad all day Saturday and only got up to go to bathroom and eat bowl of soup. Pushed fluids. By Sunday morning, temp running 99.8 to 100.5 with meds. Pain and h/a continued with slight improvent in h/a. Today, Monday, I feel about 50% better. Temp 98.8 to 99.5. Headache at about 50% of previous level with body aches only slightly improved. Hopefully, I am coming to the end of this reaction

Other Meds: Metoprolol, HCTZ, Montekulast, Gabapentin, Aspirin, Spiriva, Symbicort, Ventolin, Vit C, D, multi.. zinc, allegra

Current Illness: N/A

ID: 1030405
Sex: M
Age: 71
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: No

Allergies: Keflax bioaxin

Symptoms: Low grade fever 100.8 and some achiness.

Other Meds: losartin (blood pressure) 50 mg daily vitamin d3 alive mens plus 50 multivitamin citracel flaxseed oil

Current Illness: No

ID: 1030406
Sex: M
Age: 66
State: VA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: patient went to urgent care on 2/7/21 and then was seen by primary care doctor on 2/8/21, and then referred to general surgery for abscess. Patient had I&D on abscess completed on 2/9/21.

Allergies: NKA

Symptoms: PATIENT DEVELOPED CELLULITIS AND ABCESS OF BACK AND HERPES ZOSTER OF NECK AND BACK STARTING THE NEXT DAY AFTER RECEIVING COVID 19 VACCINE.

Other Meds: TYLENOL 1000MG BY MOUTH EVERY 6 HOURS AS NEEDED ALLOPURINOL 300 MG BY MOUTH TWICE A DAY ATORVASTATIN 10MG BY MOUTH DAILY LISINOPRIL/HCTZ 20-12.5MG TAKE TWO TABLETS BY MOUTH DAILY METFORMIN XR 500MG TAKE 1 TABLET BY MOUTH DAILY WITH BREAKFAS

Current Illness: NONE

ID: 1030407
Sex: M
Age: 77
State: VA

Vax Date: 02/12/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: crab and lobster

Symptoms: I arose at 7, took a shower and felt fine. Then while making the bed with my wife I suddenly felt vey week, needed to sit on the side of the bed. My wife said my face was white. I had some mild intestinal cramping so went to the toilet. I was doubled over sitting on the toilet and in a cold sweat with diarrhea. There was no nausea. I felt weak afterwards and napped most of the morning with one more episode of diarrhea, very mild this time, at 10:45. I did not seek medical help, was able to eat lunch and dinner with no problem, but was very low on energy for the remainder of the day. I went to bed early with 2 Acetaminophen and slept 11 hours. Felt better the next day.

Other Meds: Terazosin , finasteride, Eye supplement; Antiacid

Current Illness: none

ID: 1030408
Sex: F
Age: 67
State: FL

Vax Date: 02/03/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Seasonal

Symptoms: None stated.

Other Meds: levothyroxine 115 mcg tablet venlafaxine 150 mg tablet amlodipine 2.5 mg tablet metoprolol 75 mg tablet hydrochlorothiazide 12.5 mg tablet Colestipol 2 gram tablet

Current Illness:

ID: 1030409
Sex: F
Age: 56
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Bee sting

Symptoms: Patient felt lightheaded, diaphoretic. BP 79/47; brought to ED- Glucose 92; given 1 L NS and discharged.

Other Meds: Prilosec

Current Illness:

ID: 1030410
Sex: F
Age: 82
State: GA

Vax Date: 02/01/2021
Onset Date: 02/07/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: none

Allergies: amlopidine

Symptoms: Itching, a bit of swelling and redness and heat at site of injection.

Other Meds: atorvastatin, cetirizine, cholecalciferol ,clopidgrei, asprin, losartan, montelukast, metoprolol succinate ER, nitroglycerin (as needed), zaditor, B complex, Levetiracetam.

Current Illness: no

ID: 1030411
Sex: F
Age: 74
State: MD

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: Sulfa

Symptoms: Body aches , chills and low fever, the next day. Was somewhat better second. Today 3rd day think better, just arm still sore from injection.

Other Meds: Metoprolol. Irbesartan. Levi thyroxine and simvastatin

Current Illness: None

ID: 1030412
Sex: F
Age: 29
State: NY

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Sulfur

Symptoms: My arm has been in dire pain for 10 days. I do not have range of motion and cannot lift arm or hold heavy objects. No OTC pain medication helps. I cannot sleep because of the pain.

Other Meds: None

Current Illness: None

ID: 1030413
Sex: M
Age: 41
State: WI

Vax Date: 02/06/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Slight rash, itchiness of arm at injection site. Showed up 8 days after vaccination.

Other Meds: Atorvastatin, lisinopril, omeprazole

Current Illness: none

ID: 1030414
Sex: F
Age: 59
State: NJ

Vax Date: 02/03/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies: Codeine

Symptoms: Around the vaccination site there is a red circle, it is firm and raised and itchy and tender to the touch. I noticed it a few days ago

Other Meds: None

Current Illness: none

ID: 1030415
Sex: M
Age: 48
State: WI

Vax Date: 02/06/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: 6 days after the vaccine there developed a local erythematous rash around the infection site. within 24 hours, there developed diffuse total body hives that lasted for >48 hours and confluent erythema of the dorsal surfaces of both hands and feet with severe joint pain of the hands and feet

Other Meds: atorvastatin (not new med)

Current Illness: none

ID: 1030416
Sex: F
Age: 71
State: NC

Vax Date: 01/31/2021
Onset Date: 02/08/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: N/A

Allergies: Penicillin

Symptoms: Moderna COVID-19 vaccine Approximately one week after the injection, the injection site on left arm became, red, swollen, bumpy, and feverish to touch. It was two plus inches wide and one and one-half inches long in a roundish/oval shape. It began to fade on 2/12 until I thought it was completely gone. On 2/14, it was redder with a bolder outline. It is now over 2 weeks since the injection and it is still red with a brighter outline but it is not as bright as it was a week ago. It does not hurt and never did.

Other Meds: Pravastatin 20mg, Alendronate Sodium 70mg, Ketorolac 0.5% Ophth Solution, Prednisolone Ac 1% Ophth Solution, Ofloxacin 0.3% Ophth Solution, Aspirin 81, Calcium 600mg with Vit D

Current Illness: Cataract procedure on 2/2/2021

ID: 1030417
Sex: F
Age: 52
State: GA

Vax Date: 02/03/2021
Onset Date: 02/09/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data: None

Allergies: None.

Symptoms: First 2 days - Pain at injection site and arm. Around Day 6-7 - New pain and itching around injection site. Days 8-10 - increased redness - about a 2-inch patch going down arm. Day 11-increased redness. Some itching and a longer streak of redness. About 3 inches down arm. Day 12 - Woke up with larger, more defined area of redness and some itching. About 4 1/2 inches long and 2 inches wide. Called Occupational Health Clinic at CDC mid morning. Recommended start Benadryl, Tylenol (500mg every 6 hrs) , and icing of the area. OHC clinician will check back in the evening.

Other Meds: None.

Current Illness: None.

ID: 1030421
Sex: U
Age:
State: AZ

Vax Date: 10/02/2020
Onset Date: 10/02/2020
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE reported; Consumer received PROQUAD and VARIVAX both in the same day on 10/2/2020; This spontaneous report was received from a physician referring to a patient of unknown age and gender. The patient's concomitant medication, pertinent medical history and drug reactions and allergies were not reported. On 02-OCT-2020, the patient was vaccinated with measles, mumps, rubella and varicella (oka-merck) virus vaccine live (PROQUAD) (strength, route, lot# and expiration date were not provided) 0.5 ml and varicella virus vaccine live (oka/merck) (VARIVAX) (strength, route, lot# and expiration date were not provided) 0.5 ml for prophylaxis in the same day (inappropriate schedule of product administration). No additional adverse event (AE) reported.

Other Meds:

Current Illness: Prophylaxis

ID: 1030422
Sex: U
Age:
State: FL

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: no further AE; pt received an expired dose of Varivax; This spontaneous report was received from a medical assistant to a patient of unknown gender and age. The patient's concurrent conditions, medical history and concomitant therapies were not provided. On 09-FEB-2021, the patient was vaccinated with an expired dose of varicella virus vaccine live (oka/merck)(VARIVAX) 1 injection, lot # S002396, expiration date 23-JAN-2021 (dose and route of administration were not provided) for prophylaxis.No adverse events were reported.

Other Meds:

Current Illness:

ID: 1030423
Sex: U
Age:
State: NV

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

Lab Data:

Allergies:

Symptoms: PNEUMOVAX23 was given to the incorrect patient. Patient was 17 years old and caller wants to know if there are any side effects; PNEUMOVAX23 was given to the incorrect patient. Patient was 17 years old and caller wants to know if there are any side effects; This spontaneous report was received from a medical assistant regarding a 17-year-old patient of unknown gender. The patient's concurrent conditions, pertinent medical history, drugs reactions, allergies, and concomitant therapies were not provided. On 10-FEB-2021, Pneumococcal Vaccine, Polyvalent (23-valent) (PNEUMOVAX23) 0.5 milliliter (route of administration, anatomical site, vaccination scheme, lot number and expiration date were not provided) for prophylaxis was administered to the incorrect patient (Wrong patient received product). The patient was 17 years-old and caller wants to know if there were any side effects (Product administered to patient of inappropriate age).

Other Meds:

Current Illness:

ID: 1030424
Sex: F
Age:
State: WA

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

Lab Data:

Allergies:

Symptoms: Treated for cancer after the first shot / diagnosed with cancer after / 1st / vaccine; This case was reported by a consumer via call center representative and described the occurrence of cancer in a 60-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix. On an unknown date, less than 2 years after receiving Shingrix, the patient experienced cancer (serious criteria GSK medically significant). On an unknown date, the outcome of the cancer was unknown. It was unknown if the reporter considered the cancer to be related to Shingrix. Additional details were provided as follows: The patient had reported the case for herself. The age at vaccination was not reported. The patient received first shot two years ago from the reporting date. The patient was diagnosed with cancer after receiving 1st dose. The patient asked, if get treated for cancer after the first shot, should you start over after 2 years, as she just received one more shot. The patient was advised to not get second shot during treatment. The consent to follow-up was requested.

Other Meds:

Current Illness:

ID: 1030425
Sex: F
Age:
State: SC

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

Lab Data:

Allergies:

Symptoms: passed out a few minutes after receiving the dose; This case was reported by a nurse via call center representative and described the occurrence of passed out in a adult female patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. Previously administered products included methotrexate and Immunoglobulin therapy. Concurrent medical conditions included multiple sclerosis, hypertension, allergy to chemicals (to detergent), bee sting, perfume sensitivity and wasp sting. Concomitant products included prednisone, baclofen, gabapentin, benadryl (nos) (Benadryl) and paracetamol (Tylenol). On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season (intramuscular). On an unknown date, several minutes after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced passed out (serious criteria GSK medically significant). The patient was treated with sodium chloride. On an unknown date, the outcome of the passed out was recovered/resolved. It was unknown if the reporter considered the passed out to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were provided as follows: The age at vaccination was not reported. The concomitant medication included antihypertensive. The patient also mentioned that she received a dose of a flu vaccine (unknown manufacturer) in the past and passed out a few minutes after receiving the dose. Patient states that she received normal saline after she passed out, however, she was not hospitalized. The patient was at work (at a hospital) when this event occurred. The reporter did not consent to follow-up. This case was linked with the case US2021AMR034326 reported for same patient.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR034326:same reporter, pharma case

Other Meds: PREDNISONE; BACLOFEN; GABAPENTIN; BENADRYL; TYLENOL

Current Illness: Allergy to chemicals (to detergent); Bee sting; Hypertension; Multiple sclerosis; Perfume sensitivity; Wasp sting

ID: 1030426
Sex: F
Age: 76
State: WV

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Hemorrhage on right eye; A spontaneous report was received from a consumer concerning a 76-year-old, female patient who received Moderna's COVID-19 vaccine and experienced hemorrhage on the right eye. The patient's medical history was not provided. No relevant concomitant medications were reported. On 28 Jan 2021 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 007M20A) intramuscularly for prophylaxis of COVID-19 infection. On 29 Jan 2021, the day following her injection, the patient experienced a right eye hemorrhage. The patient also informed that she had a substance of unknown origin injected into her eye, when she visited the eye doctor. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The second dose is scheduled for 24 Feb 2021. The outcome for the event hemorrhage on the right eye was not reported.; Reporter's Comments: This case concerns a 76-year-old, female, who experienced serious events of Eye haemorrhage after receiving first dose of mRNA-1273. Noting her recent visit (unknown date) to an eye doctor involved an injection into her eye may remain as confounder. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Follow-up information is expected.

Other Meds:

Current Illness:

ID: 1030427
Sex: U
Age:
State: OH

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: given the less than the prescribed dose of the vaccine; A spontaneous report was received from a pharmacist concerning 13 patients who received less than the prescribed dose of Moderna's COVID-19 Vaccine (mRNA-1273). There were no medical history or concomitant medications reported. On 03 Feb 2021, the patients received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. The pharmacist reported patients were given less than the prescribed dose of the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, given the less than the prescribed dose of the vaccine, was considered resolved on 03 Feb 2021.; Reporter's Comments: This case concerns 13 patients with no patient identifiers who received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. There were no reported adverse events after the study drug was administered in this case of given the less than the prescribed dose of the vaccine.

Other Meds:

Current Illness:

ID: 1030428
Sex: F
Age:
State: FL

Vax Date: 12/29/2020
Onset Date:
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Did not receive second dose; A spontaneous report was received from a consumer concerning a 74-year old female who received Moderna's COVID-19 vaccine (mRNA-1273), but did not receive second dose. The patient's medical history was not provided. No relevant concomitant medications were reported. On 29 Dec 2020, the patient received their first of two planned doses of mRNA-1273 (Batch number: 039K20A) in right arm for prophylaxis of COVID-19 infection. On 08 Feb 2021, the patient reported they did not receive the second dose and 42 days have passed. No adverse event was reported by the patient after being given the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event did not receive second dose was considered resolved.; Reporter's Comments: This report refers to a case of product administration error for mRNA-1273. This case of inappropriate schedule of vaccination has no associated AEs.

Other Meds:

Current Illness:

ID: 1030429
Sex: M
Age:
State: IL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/15/2021
Hospital:

Lab Data:

Allergies:

Symptoms: received a dose of Pentacel in error instead of prescribed Adacel, no adverse event; 66 years received a dose of Pentacel in error, no adverse event; Initial information regarding an unsolicited valid non-serious case was received from an other health professional via Medical Information (Reference number- 00448734) and transmitted to Sanofi on 27-Jan-2021. This case involves a 66-year-old male patient who received a 0.5ml standard dose of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] [lot UJ267AA, expiry date: 04-Jun-2021] once via an intramuscular route at left deltoid for prophylactic vaccination in error on 27-Jan-2021 instead of prescribed DIPHTHERIA-2/TETANUS/5 AC PERTUSSIS VACCINE [ADACEL] (wrong product administered, product administered to patient of inappropriate age). The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. No other vaccine was given concomitantly. This was an actual medication error case due to wrong vaccine administered, inappropriate age at vaccine administration (latency same day). The reporter wanted to know if the dose would be valid At the time of reporting, no adverse event was reported. 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 the guidelines. 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:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm