VAERS 2021 Database www.vaers.hhs.gov

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VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

Date Died: 12/29/2020

ID: 1035552
Sex: F
Age:
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: approxmately 1:30 Pm the resident passed away; This is a spontaneous report from a Pfizer sponsored program. A non-contactable consumer reported that a female patient of an unspecified age (reported as 85 without unit) received the 1st dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EL0140), intramuscular at left arm on 29Dec2020 11:29 at single dose for COVID-19 immunization. Medical history included dementia, aphasia, type 2 diabetes mellitus (DM), iron deficiency, asthenia, osteoporosis, polyneuropathy, anxiety, Major depressive disorder (MDD). Concomitant medication included gabapentin, memantine. The patient had allergies to codiene, phenobarbital, penicillin. The vaccine was administrated with no immediate adverse reaction at 11:29. Vaccine screening questions were completed and resident was not feeling sick and temperature was 98F. At approximately 13:30 on 29Dec2020, the resident passed away. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected. ; Reported Cause(s) of Death: approxmately 1:30 Pm the resident passed away

Other Meds: GABAPENTIN; MEMANTINE

Current Illness:

Date Died: 02/02/2021

ID: 1035553
Sex: F
Age:
State:

Vax Date: 01/19/2021
Onset Date: 01/25/2021
Rec V Date: 02/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Pt passed soon after; shortly after progressed with other covid symptoms and was admitted / acute resp failure, COVID pneumonia; acute resp failure, COVID pneumonia; Became hypotensive due to massive hamatoma 2' bleeding into abd rectus muscle.; Became hypotensive due to massive hamatoma 2' bleeding into abd rectus muscle.; Became hypotensive due to massive hamatoma 2' bleeding into abd rectus muscle.; This is a spontaneous report from a non-contactable Pharmacist. A 76-years-old non-pregnant female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE lot number EL3247), intramuscular on 19Jan2021 at single dose for COVID-19 immunisation. The patient medical history included COVID symptoms from 16Jan2021 and ongoing. Concomitant medications were not reported. The patient with acute resp failure, COVID pneumonia, that developed symptoms 9 days prior to admit and ultimately received first vaccine 6 days prior to a admit, then shortly after progressed with other covid symptoms and was admitted on 25Jan2021. She decompensated while intp and was transferred to ICU for rising O2 needs, ultimately had to be intubated. Became hypotensive due to massive hamatoma 2' bleeding into abd rectus muscle. Sx and IR consulted and did beside exploration of hematoma. Initially blood pressure responded but overnight continued with refractory hypotension. Maxed out vasopressin and levophed, hemodynamics deteriorated. The patient died on 02Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Sender's Comments: Based on temporal association, the causal relationship between bnt162b2 and the events death, COVID-19 pneumonia, acute respiratory failure, hypotension, abdominal wall haematoma and abdominal wall haemorrhage cannot be excluded. The information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pt passed soon after

Other Meds:

Current Illness: Suspected COVID-19

ID: 1035555
Sex: M
Age:
State: CA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: When he went to the bathroom it was like diarrhea, watery, and had blood; He also had pains in his stomach; he could hardly move; Last night he sweated, the sheets were all wet; Pain on the right side of his back/ night before he had it on his left side/ he moved it hurt so bad; He only slept for 4 hours; Fever and chills; Fever, temperature was only 100; his blood pressure went up; Stomach problems; This is a spontaneous report from a contactable consumer (patient). A 68-year-old male patient received first dose of bnt162b2 (Pfizer-Biontech COVID-19 Vaccine, Lot number: EL9265), via an unspecified route of administration at the left arm on 27Jan2021 at a single dose for covid-19 immunization. The vaccine was administered in a hospital. Medical history included ongoing high blood pressure and ongoing cholesterol. Ongoing concomitant medications included lisinopril for high blood pressure, amlodipine for high blood pressure and atorvastatin for cholesterol. The patient previously took montelukast and dries up his sinuses. On 27Jan2021 he received the first dose in the afternoon about 5 o'clock or a little after. It started with stomach problems on 27Jan2021. He kept feeling like he had to go to the bathroom all throughout the night on 27Jan2021. He slept through the night and was okay. He had a little something going on in his stomach. The next day (28Jan2021), that evening, around 7pm he had fever and chills and his blood pressure went up. His temperature was only 100. It never went over that. And he was having to go to the bathroom. In the morning, it was fine but at night he was having to go. Normally he has a bowel movement in the morning. When he went to the bathroom it was like diarrhea, watery, and had blood. It was not dried blood, but blood. It happened twice. He then had to go again. The same thing happened again and then it stopped. He also had pains in his stomach. He went to sleep and the next day he went to the bathroom the first thing in the morning and it was normal. The reported also mention that stomach problems were worse on 28Jan2021. He only slept for 4 hours on 28Jan2021. The next day, 29Jan2021 he was fine. He only had a little bit of a fever and a little bit of chills. Then the chills and fever went away that day. He did not feel ill or weak at all when this was happened which is why he did not go to the doctor. He did not feel that the symptoms were bad enough. He felt okay once they were over. He had to get it out. On 31Jan2021, he also had fever and pain on the right side of his back. It was a really sharp pain and he could hardly move. The night before he had it on his left side. He made himself get out of bed. When he moved it hurt so bad. On 31Jan2021, he sweated, the sheets were all wet. He slept 4 hours. He has been using ice packs and icing it down. The pain on the right side has gone away but the pain on the left side is still there. It has improved and there is only a little pain. He iced it down first thing this morning. He walks everyday. The outcome of the event diarrhea bloody was recovered on an unspecified date, stomach problems and his blood pressure went up recovered on 28Jan2021; pain back was recovering; outcome for all other events was unknown.

Other Meds: LISINOPRIL; AMLODIPINE; ATORVASTATIN

Current Illness: Blood cholesterol abnormal; Blood pressure high

ID: 1035556
Sex: F
Age:
State: TX

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: stayed up all night, slept all day; Hallucinations/ just saw people but never heard voices; stayed up all night, slept all day; This is a spontaneous report from a contactable consumer (patient's daughter). An 87-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) Solution for injection (lot number: EN5318, expiration date unknown) via an unspecified route of administration on the right arm on 01Feb2021 at a single dose as vaccine for COVID-19. The patient had no medical history and no concomitant medications. On 01Feb2021 23:00, the patient experienced hallucinations. It was reported that patient started hallucinating on 01Feb2021 23:00 and just saw people but never heard voices. The reporter stated that her mom never had hallucinations ever. The patient feared people were in the house and stayed up all night (from 01Feb2021 23:00), slept all day (on 02Feb2021). The reporter wanted to know if they have ever heard of this happening. She has made an appointment with the patient's doctor. The outcome of the events was unknown.

Other Meds:

Current Illness:

ID: 1035557
Sex: M
Age:
State: NY

Vax Date: 01/29/2021
Onset Date: 01/31/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Swollen lymph nodes; Developed Shingles on his face; This is a spontaneous report from a contactable other healthcare professional. This other healthcare professional reported for a 32-year-old male patient (her fiance). A 32-year-old male patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiration date were not reported), via an unspecified route of administration at the right arm on 29Jan2021 at single dose for COVID-19 immunization. The patient's medical history was not reported. There were no concomitant medications. The patient previously took the first dose of bnt162b2 on 08Jan2021 for COVID-19 immunization. The patient developed shingles on his face on 31Jan2021 and swollen lymph nodes on 01Feb2021. The events were reported as serious (medically significant) and worsened. There were no investigation assessment. The patient had not recovered from the events at the time of the report. Information on the batch number has been requested.; Sender's Comments: Based on the compatible temporal association and the drug's known safety profile, the Company considers the event swollen lymph nodes is possibly related to suspect vaccine BNT162B2. Other than a temporal association, there is no evidence or argument to suggest a causal relationship between BNT162B2 and the event shingles, which is likely an intercurrent condition. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds:

Current Illness:

ID: 1035558
Sex: F
Age:
State: MI

Vax Date: 01/19/2021
Onset Date: 01/01/2021
Rec V Date: 02/17/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Low platelets; Rash on her body; Bruising; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received bnt162b2 (Pfizer-BioNTech COVID-19 mRNA vaccine; lot number: EL3249), via an unspecified route of administration in the right arm on 19Jan2021 at a single dose for covid-19 immunization. Medical history included ongoing diabetes mellitus since 2011 (reported diagnosed 10 years from this report, ongoing congenital heart defect which patient was born with but did not find out until she was in her 50s; does not bother her too much; one of the major arteries has a 90 degree angle vs. an S curve, mild multiple sclerosis; no longer has this as she has not had another relapse; she was diagnosed almost 30 years ago; she has never had another attack since she had 2 of them and was on medication that did damage to her liver, breast cancer; patient is a breast cancer survivor and issues with magnesium levels. There were no concomitant medications. On 28Jan2021 the patient had blood work done for her kidney doctor. They withdrew blood from her arm. They had a hard time stopping the bleeding afterwards. They finally got it to stop and put regular cotton balls and a band aid on it. By the time she was walking out she was bleeding out of her arm she felt in her coat. They were able to stop the bleeding again. This was at about 10 AM. Patient went home and afterwards was called back and instructed to go to the ER for critical care. Her platelets were low at 10,000 at that time. They got to the ER and they checked her platelets and they were down to 8,000. They administered some steroids; Prednisone. They decided to admit her after giving the treatment in the ER. After that her platelets came back to 11,000. The next morning on 29Jan2021 her platelet count was 7,000. They started administering the same drug through an IV. He thinks it was still a steroid. They did it in smaller amounts and overnight the next day her platelets were up to 26,000 on 30Jan2021. They continued the treatment during the night again and on Sunday they were 36,000 and they released her that day late on Sunday. They went back and did blood work yesterday on 01Feb2021. The local doctor said her platelets are up to 61,000. The patient was getting blood work every Monday and Thursday for 3 weeks. Th patient had blood work and platelets checked before the vaccine and they were normal. The patient was hospitalized from 28Jan2021 to 31Jan2021 due to the event. The patient also noticed rash on her body and bruising maybe on 21Jan2021 or 22Jan2021. The bruising was really bad on her left hand by her wrist. It was really dark. She was also bruised everywhere they poked her with an IV and bruises where they put the heart monitor on her and pressed down to stick it to her. The bruising is still all over her body. It has stayed about the same. The one on her hand is still severe. The other from where she has been poked are starting to clear up. Overall it was about the same. The outcome of event bruising was not recovered, low platelets was unknown while rash on her body recovered on unspecified date.

Other Meds:

Current Illness: Congenital heart valve disorder; Diabetic

ID: 1035559
Sex: M
Age:
State: NC

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Stroke; like he had a film over his eye, it was cloudy, like a cloudy day; This is a spontaneous report from a contactable consumer (patient). A 81-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot/batch number: EL1283 and expiry date: 30Apr2021) solution for injection, intramuscular in left arm on 18Jan2021 13:10 at a single dose for Covid-19 immunization. Medical history included chicken pox, measles, and mumps (had chicken pox vaccine, measles, and mumps when he was younger, and he got the flu shot for flu). The patient's concomitant medications were not reported. The next day (19Jan2021) after receiving the injection, patient reported it was like he had a film over his eye, it was cloudy, like a cloudy day. This went on for a couple of days before it improved. There was still a little bit in his left eye, but he can read and it has improved. He can see now and his eyes were improving. He found out that he had a stroke on 28Jan2021. He did not go to the hospital. He does not think the stroke affected anything else. He was supposed to have an MRI sometime this week. He went to the eye doctor and the eye doctor was the one that discovered the stroke and his eye doctor sent the report over to his primary office. He had a vision field test which was how the stroke was diagnosed. He was taking a baby aspirin and he will be put on a blood thinner called Plavix. He has not started Plavix yet, he has to go pick it up. Outcome of the event stroke was unknown while the other events was recovering. No follow-up activities are needed. No further information is expected.

Other Meds:

Current Illness:

ID: 1035568
Sex: U
Age:
State: NJ

Vax Date: 12/12/2011
Onset Date:
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: autoimmune disorder; hypersensitivity; headaches; Information has been received from a lawyer regarding a case in litigation referring to a patient (pt) of unknown age and gender. Information about concurrent condition, medical history and concomitant medication was not reported. On or around 12-DEC-2011 (at approximately 67 years old), the pt was vaccinated with zoster vaccine live (ZOSTAVAX) (strength, dose, lot#, expiration date and route unknown) for the long-term prevention of shingles and zoster-related conditions. Subsequently, the pt was treated by a health care provider (reported as provider) for the following injuries resulting from zoster vaccine live (ZOSTAVAX) use: autoimmune disorder, hypersensitivity and headaches. The outcome of the events was unknown. Upon internal review, autoimmune disorder was determined to be medically significant.

Other Meds:

Current Illness:

ID: 1035578
Sex: M
Age: 70
State: PA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The syringe separated from the needle and leaked out on my skin, it appears as i wasn't clear if i got the full dose; The syringe separated from the needle and leaked out on my skin; The pharmacist who administered the vaccine tried twice in giving the dose and same thing happen both times; don't know how much I got; I had a little tenderness, no pain; A spontaneous report was received from a physician, a 70-year-old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced "PT had a little tenderness, no pain," "the syringe separated from the needle and leaked out on my skin," and "the pharmacist who administered the vaccine tried twice in giving the dose and same thing happen both times; don't know how much I got." The patient's medical history was not provided. No relevant concomitant medications were reported. On 01 Feb 2021, at 13:30, the patient received their first of two planned doses of mRNA-1273 (Lot number: 012MZ0A/012M20A) intramuscularly for prophylaxis of COVID-19 infection. On 01 Feb 2021, during vaccine administration, the syringe separated from the needle and leaked onto the patient's skin. It wasn't clear if the full dose was given. The pharmacist administering the vaccine then tried to give a second dose and the same thing happened both times. The patient was not sure how much he received. No treatment was provided. Action taken with mRNA-1273 in response to the events was not reported. The events of "the syringe separated from the needle and leaked out on my skin", and "the pharmacist who administered the vaccine tried twice in giving the dose and same thing happen both times; don't know how much I got", were considered resolved on 01 Feb 2021. The event outcome of "I had a little tenderness, no pain" was considered unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Very limited information regarding these event/s has been provided at this time

Other Meds:

Current Illness:

ID: 1035579
Sex: U
Age:
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Systemic symptoms; Bruising after vaccination; Limited range of motion in arm and struggles to lift arm; Tender arm; Vaccine inadvertently injected into the bursa; A spontaneous report was received from a nurse concerning a unknown patient of an unknown age, unknown race and ethnicity, who was administered Moderna's COVID-19 vaccine (mRNA-1273) and vaccine inadvertently injected into the bursa/incorrect route of product administration, experienced tender arm/tenderness, systemic smptoms/general symptom, bruising after vaccination/vaccination site bruising, and limited range of motion and struggles to lift arm/injected limb mobility decreased. The patient's medical history was not provided. No concomitant medications were reported. On 06 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (batch number: unknown), for prophylaxis of COVID-19 infection. On 06 Jan 2021, the patient reported that she received her first vaccine, and it was inadvertently injected into the bursa. The patient later reported that she experienced a tender arm, systemic symptoms, bruising after vaccination, limited range of motion and struggles to lift the injected arm. She stated she will seek medical attention. No treatment information was provided. Consent given for Safety to follow up. Action taken with second dose of mRNA-1273 in response to the events was not reported. The outcome of the event, vaccine inadvertently injected into the bursa, was recovered on 06 Jan 2021. The events, tender arm, systemic symptoms, bruising after vaccination, and limited range of motion and struggles to lift the injected arm, were not resolved at the time of this report.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded

Other Meds:

Current Illness:

ID: 1035580
Sex: M
Age: 63
State: NC

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Ampicillin, Glyburide, Niacin, eggs

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Injection site pain, fever, chills, slight diarrhea, fatigue

Other Meds: Metformin, Ozempic, Lisinopril, Lipitor, Mag-Oxide, Drisdol, Vitamin B12 injections, Lantus, Allopurinol

Current Illness: None

ID: 1035581
Sex: F
Age: 54
State: FL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: Latex

Symptom List: Rash, Urticaria

Symptoms: 02/03/2020 16:00pm Pain developed in the left deltoid and arm, site of vaccine. Swelling of site was mild. No rash. Difficulty lifting arm, very painful to touch, difficulty removing clothing and difficulty sleeping due to arm pain. 02/04/2020 02:30am Pain worsened in left arm. Developed mouth ulcers which were unexpected and painful. Rigorous chills. Temp normal, 97.7 F. 02/05/2020 05:00am Extreme fatigue, continued pain in left arm and continued painful mouth ulcers. 02/06/2020 02:30am Woke up and symptoms resolved with the exception of arm pain which remained until 02/08/2020. 02/15/2020 05:00am Mild left arm pain at site returned for duration of the day and then resolved by bedtime. 02/17/2020 04:00am 2 inch x 3 inch non-raised rash/redness appeared left deltoid at vaccine site with no pain. Warm to touch.

Other Meds: Synthroid, Zoloft, Amlodipine, Vitamin D3, CoQ10, Rosuvastatin

Current Illness: None

ID: 1035582
Sex: F
Age: 38
State: MI

Vax Date: 02/09/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Week after shot my arm all the sudden starting itching and super sore again and skin is red n swollen.

Other Meds:

Current Illness:

ID: 1035583
Sex: F
Age: 72
State: IN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Prednisone Sensitive to latex, cortisones

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Started with sinus drainage, which became constant and intermingled with blood. Arm was sore, joint and muscular aches. Then progressed to persistent productive cough. No fever during this time. These symptoms lasted until 2/15/2021.

Other Meds: Alendronate sodium, multivitamin, fiber tablets, Viactiv, potassium, magnesium, Vitamin D

Current Illness:

ID: 1035584
Sex: F
Age: 73
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Demerol, penicillin

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Dissiness for 5 days

Other Meds: Multi vitamin, 80mg aspirin, med for rls, B-complex, osteo-biflex

Current Illness: None

ID: 1035585
Sex: F
Age: 63
State: NJ

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Experienced syncopal episode following vaccine. Epinephrine 0.3mL administered by EMS at site.

Other Meds: rosuvastatin (CRESTOR) 5 mg tablet

Current Illness:

ID: 1035586
Sex: M
Age: 60
State: GA

Vax Date: 02/09/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Since 12 Feb to present I have had aching bones and joints alone constant fatigue and general weakness in my left arm.

Other Meds: Ultram EQ 500 mg Celebrex 200 mg Protein Shake supplement

Current Illness: none

ID: 1035587
Sex: M
Age: 61
State: PA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: NA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccination out of manufacturers specifications. Pt stated 2nd dose was within 4 day grace period when in fact after checking the patient was 7 days early. Discovery was after injection was given. Per CDC guidelines series not needed to restart.

Other Meds: NA

Current Illness: NA

ID: 1035588
Sex: F
Age: 71
State: NH

Vax Date: 02/04/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Sudafed

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: red, round rash at injection site. Itching and mild swelling, no pain

Other Meds: metformin, atorvastatin, famotadine, wellbutrin, locating, alendronate sodium, vitamin D, Omega-3

Current Illness: none

ID: 1035589
Sex: F
Age: 85
State: PA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/17/2021
Hospital: Y

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: none

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: severe nausea, chills diarehha, throwing up

Other Meds: calcium

Current Illness: none

ID: 1035590
Sex: F
Age: 48
State: PA

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Anaprox and crab

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: 101.7 fever, chills, headache, muscle aches, joint aches, pain at injection site with hardness and swelling at site. Started with injection site pain and muscle aches at about 12 hours (12am), chills by 2am, and progressed to full detailed symptoms by the time I woke up at 615am (fever,

Other Meds: Multi vitamin and fish oil -regular daily doses

Current Illness: None

ID: 1035591
Sex: F
Age: 28
State: TN

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Cephlasporins, Sulfa, PCN

Symptom List: Unevaluable event

Symptoms: Received 1st dose COVID-19 Vaccine at 1705. Ambulated to restroom and noted hives developed on torso and legs with heaviness in chest; denies difficulty breathing. Received MD evaluation in ED. Benadryl 50mg IV and Decadron 10mg IV. Discharged home in stable condition. Instructed NOT to receive 2nd COVID-19 Vaccine. Home with Prednisone and Epi-pen PRN.

Other Meds: None

Current Illness: None

ID: 1035592
Sex: F
Age: 66
State: MI

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Pain in arm that ultimately went from injection site down to wrist. Unable to raise arm for 5 days Upper arm still sore after 12 days. Pain on movement and unable to sleep on that side, as the arm pain awakens me. Also, the injection seemed to be placed extremely high on the arm, about an inch from top of shoulder and in the center/front or arm where it more bone/less muscle

Other Meds: Lisinopril

Current Illness:

ID: 1035593
Sex: F
Age: 78
State: FL

Vax Date: 02/01/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Not many. Relatively healthy.

Symptom List: Injection site pain, Pain

Symptoms: Wed Feb 17. Fatique feet seem discolored at times arm seems to feel like mild pins and needles

Other Meds: I am due for my six month Prolia shot. What to do? This survey should be extended. Adverse affects start later. The site is still hurting and a large hard area is there. It itching and hot. When touched sore.

Current Illness: None

ID: 1035594
Sex: F
Age: 50
State: NH

Vax Date: 01/21/2021
Onset Date: 01/25/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: thimersol

Symptom List: Injection site pain, Menorrhagia

Symptoms: Red rash and swelling at injection site. The red rash and swelling with pain to touch lasted until Feb 8. then the arm was still slightly swollen and currently black and blue

Other Meds: Tamoxifen Neurontin Synthroid Liothyronine Phentermine Zyrtec Singulair

Current Illness: none

ID: 1035595
Sex: F
Age: 72
State: FL

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Bee venom & venom wasp (prior anaphylaxis), Keflex, Penicillin

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: SEVERE muscle pain, burning sensation in chest cavity and espophagus, slight fever (1 degree), fatigue, headache. These were the most severe manifestations I have ever experienced. Since I have previously had anaphylaxis, I am more worried about the reactions. I was not able yo sleep at all due to the strong pain. I do feel better this morning, but nowhere near ok.

Other Meds: Atenolol 15 mg one half/day Atorvastatin 10 mg Latanaprost 0.005% in each eye Multivitamin Vit B12 1000 mg

Current Illness: none

ID: 1035596
Sex: F
Age: 57
State: OH

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: ADR occurred covid vaccination clinic on 1/27/21. Employee received covid 2nd vaccination (Moderna Lot 013L20A, Exp 07/08/21) on 1/27/21. Reaction reported 1/29/21 documented left arm red, swelling warmth at covid vaccine site. Patient was recommended to be seen by physician following Monday for medical evaluation if symptoms continued. Per documentation in Athena, 1/29/21 patient received a one time diphenhydramine 50mg injection, with instruction to start ice pack.

Other Meds:

Current Illness:

Date Died: 01/17/2021

ID: 1035597
Sex: M
Age: 42
State: GA

Vax Date: 12/30/2020
Onset Date: 01/17/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Death on 1/17/2021. Found at home deceased.

Other Meds:

Current Illness: unknown

ID: 1035598
Sex: M
Age: 60
State: VA

Vax Date: 02/06/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Terrible rash on hands and feet

Other Meds: Ginko biloba; fish oil; daily vitamin; zinc supplement; vitamin C; vitamin D

Current Illness: Not applicable

ID: 1035599
Sex: F
Age: 62
State: WI

Vax Date: 12/19/2020
Onset Date: 12/22/2020
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Dust, seasonal - although that has not been nearly as bad as when I was younger

Symptom List: Nausea

Symptoms: Woke up one morning w/pain/ache in left lower jaw/back teeth, especially w/opening my mouth. Chewing on back molars hurt. As time went on pain worsened and radiated into my cheek, left eye and left ear. ~ One week later, I saw a dentist; he couldn't say whether it was TMJ or tooth problem, so sent me home w/quick splint to separate my top & bottom teeth at night and some exercises. These didn't help, so ~ a week after that, he gave me antibiotic. No improvement in symptoms until ~ a week after that. I saw pcp, as it felt like something was crawling inside my left ear. Ears were fine; she agreed w/inconclusive answer of dentist - at this point, there was some improvement in my symptoms. She suggested prescription-strength Naproxen for 10 days, which I did. the pain/ache has been mostly gone since completing the Naproxen. For last few weeks, I've been back to normal - no ache/pain/strange sensations in ear at all.

Other Meds: Amlodipine, Lovastatin, Glucosamine, 55+ Centrum MVI for women, Naproxen (Tylenol PRN)

Current Illness: No illness.

ID: 1035600
Sex: F
Age: 21
State: TN

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain

Symptoms: After injection, she was instructed to stay for observation. Upon checking on her, patient stated her heart was racing and she felt weak. She was instructed to remain for 30 more minutes of observation. Checked patient post 30 mins. and attempted to have ambulate. She stated she still felt "woozy". Conversation was had with another RN. Pulse was checked and 104. Pupils were dilated and her speech was delayed. We felt she should go to ED to be checked and she agreed. Patient was taken by W/C to ED

Other Meds: Tylenol PRN

Current Illness: None

ID: 1035601
Sex: F
Age: 30
State: CT

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: ?Covid arm? , red rash, warm to touch, itchy, painful

Other Meds: None

Current Illness: None

ID: 1035602
Sex: M
Age: 27
State: NY

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Migraine-like headache started at around noon, got worse at 2pm, slept from 3-6, still had headache. began feeling nauseous, vomited at 8pm. Took Tylenol and slept at 11pm, feeling OK with sore arm now.

Other Meds: Cosentyx, Escitalopram

Current Illness:

ID: 1035603
Sex: F
Age: 37
State: MI

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: 37 YEAR OLD FEMALE STARTED EXPERIENCING GENERALIZED ANXIETY. ONSITE EMS WAS REQESTED. BP 124/80 HR 71 100%O2 ON ROOM AIR. SHE WAS EVALUATED BY EMS AND ONSITE PHYSICIAN AND TRANSPORTED TO A LOCAL HOSPITAL.

Other Meds: FLONASE NASAL SPRAY

Current Illness:

ID: 1035604
Sex: M
Age: 75
State: AZ

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NOTHING

Symptom List: Erythema, Pruritus

Symptoms: NOTHING

Other Meds: NOTHING

Current Illness: NOTHING

ID: 1035605
Sex: F
Age: 45
State: NH

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: gluten

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Severe headache and chills after vaccine up to 24 hours. Severe headache remained up to 55 hours. Stomach upset and vomiting (x1) started at 55 hours and continued through 68 hours (present time). Treated with ibuprofen alternating with tylenol for 50 hours. Meds were taken after eating.

Other Meds: ibuprofen, levoxyl, lorazepam, estradiol, Lexapro, progesterone

Current Illness: n/a

ID: 1035606
Sex: F
Age: 27
State: FL

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Dogs

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Rash in blotches around injection site, showed up 8 days later, slightly itchy, warm to the touch

Other Meds: Wellbutrin, straterra, lamictal

Current Illness: None

ID: 1035607
Sex: F
Age: 40
State: IN

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Extremely fatigue, nauseA, headace, right eye blood shot, right side jaw pain, swelling right side face , right side ear pqin

Other Meds: Vitamin D Albterol inhaler Breo Singular Prozac Xanax

Current Illness: Bronchitis

ID: 1035608
Sex: F
Age: 42
State: WA

Vax Date: 01/27/2021
Onset Date: 01/29/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: "Brain Fog"; Difficulty Concentrating; Difficulty Focusing; Difficulty Finding Words when Trying to Speak; Waves of Fatigue

Other Meds: Multivitamin

Current Illness: None

ID: 1035609
Sex: F
Age: 55
State: NJ

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: **I WAS GIVEN A SUB Q INJECTION; NOT AN IM INJECTION. I NEED SOMEONE TO CONTACT THE SITE TO FIND OUT WHO THE NURSE WAS SO THIS DOES NOT HAPPEN TO OTHER PEOPLE.

Other Meds: NONE

Current Illness: NONE

ID: 1035610
Sex: F
Age: 24
State: AZ

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Deep Pain through your my entire arm, under my arm pit and into my rib on the left side Not sore to the touch The pain is bad enough to wake me up every two hours

Other Meds: None

Current Illness: None

ID: 1035611
Sex: M
Age: 85
State: FL

Vax Date: 01/07/2021
Onset Date: 01/20/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NO

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: SHINGLES(NEVER HAD IT EVER)..THE DOC SAID IT WAS THE WORST CASE HE HAD EVER SEEN

Other Meds: NONE

Current Illness: NO ILLNESS HEALTH WAS FINE

ID: 1035612
Sex: F
Age: 67
State: NH

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Raised red rash bump at injection site

Other Meds: None

Current Illness: None

ID: 1035613
Sex: F
Age: 64
State: WA

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, Amoxicillin, TMP with sulfa

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Swollen lymph node under Left arm. Other sxs included fever, chills, malaise, nausea x 48 hours.

Other Meds: Vitamin C, MVI, Zn

Current Illness: N/A

ID: 1035614
Sex: M
Age: 66
State: PA

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Vomiting

Symptoms: Patient developed symptoms on 2/13/2021 with epistaxis. Then developed blood blisters in mouth and petechiae over lower extremities. Saw me on 2/16 and labs showed platelet count less than 3000.

Other Meds: mvi aspirin 81 mg daily

Current Illness: none

ID: 1035615
Sex: M
Age: 47
State: MI

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 47 YEAR OLD MALE THOUGHT HE WAS HAVING AN ALLERGIC REACTION. ONSITE EMS AND PHYSICIAN RESPONDED. BP 142/80 HR 98 PATIENT REFUSED ADDITIONAL EVALUATION AND CARE. RELEASED AGAINST MEDICAL ADVICE.

Other Meds:

Current Illness:

ID: 1035624
Sex: F
Age: 22
State: AL

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Aggravated very quickly; Everything went blank; She can't talk and when she tries to talk she feels like she has the hiccups where she can barely get the words to talk; when she has a hiccup her whole chest hurts; Hiccup; Numbness; Her whole right side would jerk uncontrollably; Weak; fever; itching; sore arm / burning; chills; A spontaneous report (United States) was received from a consumer who was also a 22-year-old female patient, who received Moderna's COVID-19 vaccine who experienced sore arm/ burning (injection site pain), fever (pyrexia), chills, itching (injection site pruritus), numbness (injection site numbness), weak (asthenia), whole right side would jerk uncontrollably (myoclonus), everything went blank (loss of consciousness), couldn't talk and when she tried to talk she felt like she had the hiccups (aphasia), her whole chest hurt (chest discomfort), and quickly became aggravated (anger). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 06 Jan 2021, the patient received her first of two planned doses of mRNA-1273 intramuscularly in her right deltoid for prophylaxis of COVID-19 infection. On 06 Jan 2021, the patient experienced a sore arm, fever, chills, itching and burning. On 07 Jan 2021, on the site where the patient received the injection, she felt numbness and weak. Her whole right-side body would jerk uncontrollably. The patient went to two emergency rooms where they stated they did not know what was wrong and gave her a steroid injection that temporarily helped calm her down. On 08 Jan 2021, the patient stared at the door and everything went blank. She could not talk and when she tried to talk, she felt like she had the hiccups. She experienced her whole chest hurting when she had a hiccup. On 25 Jan 2021 and 26 Jan 2021, the patient saw two neurologists, who did testing. The patient's jerking was random, there were no triggers for it, and she did not know how to control or stop it. These adverse reactions made the patient become aggravated very quickly, which was not like her. On an unknown date, the patient stated it was the first day in the past month she had been able to talk all day. Treatment for the events included a steroid shot. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the events, sore arm/ burning, fever, chills, itching, numbness, weak, whole right side would jerk uncontrollably, everything went blank, couldn't talk and when she tried to talk she felt like she had the hiccups and her whole chest hurt, and quickly became aggravated, was not reported.; Reporter's Comments: Based on the current available information which indicates a strong temporal association between the use of the product and the onset of the reported events a causal relationship cannot be excluded. Chills, fever, injection site pruritus and injection site pain are consistent with the known safety profile of mRNA-1273.

Other Meds:

Current Illness:

ID: 1035625
Sex: F
Age: 63
State: NY

Vax Date: 01/05/2021
Onset Date:
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fluid in the pericardium; Heart skips a beat; Out of breath; Heart pound when sedentary; A spontaneous report was received from a consumer who was also a 63-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced fluid in the pericardium (pericardial efflusion), heart skips a beat (heart rate irregular) when out of breath (dyspnoea), and heart pounds when sedentary (palpitations). The patient's medical history included irregular heartbeat. Relevant concomitant medications taken within two weeks prior to the events were not provided. On 05 Jan 2021 at 12: 30 pm, the patient received their first of two planned doses of mRNA-1273 (Lot: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 02 Feb 2021, at 12:30 pm, the patient received their second of two planned doses of mRNA-1273 (Lot: 011J20A) intramuscularly for prophylaxis of COVID-19 infection. On an undisclosed date, the patient developed fluid in the pericardium, and her heart skipped a beat when out of breath. It would happen when she was sedentary, and her heart would pound when not walking. She had irregular heartbeat before and was prescribed a concomitant medicine which was a nasal steroid. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the drug in response to the events was not applicable. The outcome of the events, fluid in the pericardium, heart skips a beat when out of breath and heart pound when sedentary, were unknown.; Reporter's Comments: Very limited information regarding these events has been provided at this time in this case of serious unlisted event of pericardial effusion and non-serious unlisted events of heart rate irregular, dyspnea, and palpitations. However, patient's medical history of irregular heartbeat is a confounding factor that may play a contributory role providing an alternative explanation. Further information has been requested.

Other Meds:

Current Illness:

ID: 1035626
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Covid; Initial information received on 04-Feb-2021 regarding an unsolicited valid serious case from a non-health care professional via media (under reference SAC20210210000330 and comment id 701063607238447). This case involves patient of unknown demography who experienced covid (Coronavirus disease) (covid-19), after receiving INFLUENZA VACCINE. The patient's did not get the flu shot for the past 30 years. Past medical treatment(s), vaccination(s) , concomitant medication(s) and family history were not provided. On an unknown date (in November, year unspecified), the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiration date not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date (in December, year unspecified), the patient went to the hospital in December with the COVID for 13days, approximately one month following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. The patient was hospitalized for the event. No laboratory data reported. It was not reported if the patient received a corrective treatment. At the time of reporting, the event outcome was not reported. Information on the batch number for this case to be requested.; Sender's Comments: This case concerns a patient who presented with covid-19, after vaccination with INFLUENZA VACCINE. The time to onset is unclear. However, patient's medical condition at the time of vaccination and lab tests were not reported. Based upon the reported information, the role of vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1035627
Sex: M
Age: 32
State: CA

Vax Date: 12/01/2020
Onset Date:
Rec V Date: 02/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: right shoulder pain/ patient complaining of scapular pain; patchy weakness and pain in the upper body; patchy weakness and pain in the upper body; Initial information received on 02-Feb-2021 regarding an unsolicited valid non-serious case from a nurse practitioner via Agency (under reference number US-SANOFI-00457309). This case involves a 32 years old male patient who experienced right shoulder pain/ complaining of scapular pain (arthralgia) and patchy weakness and pain in the upper body (pain) (asthenia), after receiving INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT]. The patient's medical history, medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. On an unknown date in December 2020, the patient received a dose of suspect INFLUENZA QUADRIVAL A-B VACCINE (lot U7045DA and expiration date not reported) via intramuscular route in the right deltoid for prophylactic vaccination. On an unknown date, the patient reported at the neurology office having right shoulder pain/ complaining of scapular pain (arthralgia) and patchy weakness and pain in the upper body (pain) (asthenia), 2-3 weeks after administration. Patient has had an MRI (Magnetic resonance imaging) on an unknown date which was unremarkable. Treatment included OT and PT (Physical and Occupational Therapy). At the time of reporting the patient did not recovered from any of the events.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm