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: 1033139
Sex: U
Age: 77
State: AZ

Vax Date: 02/04/2021
Onset Date: 02/16/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: No reaction initially except next day a little red. Over next days, some lumpiness at site. Now at 12 days, large splotchy eruption. 2 inches by 3 inches.

Other Meds: levothyroxine, symvastatin, fosamax, B 12, zyrtec

Current Illness: none

ID: 1033140
Sex: F
Age: 20
State: NE

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: ON 2/11/21, DEVELOPED PAIN ALL OVER THAT CAME AND WENT. FELT NAUSEOUS. BODY PAIN, JOINT PAIN, FATIGUE AND HEADACHE.

Other Meds:

Current Illness:

ID: 1033141
Sex: F
Age: 37
State: OH

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Required Emergency room visit the day after the vaccination for dehydration and headaches. Received a bag of fluids and discharged home. Over the weekend was weak and sore with delayed speech, had a full stroke workup (negative) at Emergency Department and returned to work on 2/8. However, symptoms had not resolved. Left school on 2/9 due to inability to walk due to severe muscle soreness/aching. Instructed to stay home for the rest of the week per her PCP. No further information available at this time.

Other Meds:

Current Illness:

ID: 1033142
Sex: F
Age: 47
State: NY

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Tingling in arms/hands and legs/feet

Other Meds:

Current Illness:

ID: 1033143
Sex: F
Age: 35
State: MN

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None. I sent a message to my primary care provider. She agreed I did have some sort of reaction to the vaccine. Her recommendation was to notify the physician at the vaccination site before receiving the second dose and waiting an hour at the facility for observation.

Allergies: Penicillin - history of rash

Symptoms: Moderna COVID-19 Vaccine EUA. Vaccine given at 2040 and waited 15 minutes before leaving site. On my drive home, between 2100-2110 started feeling tingly and numb around mouth and it spread to entire face. Tongue and inside of cheeks also felt tingly/numb. No visual swelling of face and breathing was ok. I didn't feel any airway obstruction. Heart rate also increased. I continued driving to the nearest store to get Benadryl (about an additional 20-25 minutes). Took 50mg at approximately 2145 and my symptoms slowly got better. As of today (02/16/2021) my face does not still feel 100% back to normal, very minimal numbness/tingly but more so on the left side which was also the same side as injection. I have had no facial drooping.

Other Meds: No medications/supplements taken at the time of vaccination.

Current Illness: None

ID: 1033144
Sex: F
Age: 52
State: AZ

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: none

Allergies: Penicillin, Sulfa, Morphine; Fennel seed

Symptoms: (during the night of sleep only) Fever, violent shaking, head ache, charlie horse in calves; (daytime) achy, sore joints, head ache, fever

Other Meds: Lisinopril 40mg, Atenolol 50mg, Amlodipine Besylate 2.5mg, Atorvastatin 20mg, Citalopram 40mg, low dose aspirin

Current Illness: none

ID: 1033145
Sex: F
Age: 67
State: WI

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: Penicillin

Symptoms: Headache, fever 100?, tired and chills. This lasted 2 days

Other Meds: Astra vista

Current Illness: None

ID: 1033146
Sex: F
Age: 75
State: MN

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

Lab Data: none

Allergies: Amoxicillin Azithromycin Cipro Cefaclor Codeine Darvon Tobramycin-dexamethasone

Symptoms: Pt was instructed to wait 30 minutes for observation following vaccination due to history of allergic reaction and anaphylaxis. About 33 minutes following injection, pt began feeling tightness and scratching of the throat and feeling the need to cough/clear throat frequently. Pt refused Epi-pen administration, but accepted Benadryl 50mg orally. EMS was called. Pt refused transport via ambulance but drove self to the ED for eval/monitoring.

Other Meds: Synthroid Combivent inhaler

Current Illness: none

ID: 1033147
Sex: M
Age: 42
State: MN

Vax Date: 12/21/2020
Onset Date: 01/01/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: Feb 2 Tsh<0.01 +thyroid antibodies

Allergies: None

Symptoms: Tremors, feeling hot. Diagnosed with autoimmune disorder graves disease.

Other Meds: Multivitamin, aspirin 81mg

Current Illness: None

ID: 1033148
Sex: F
Age: 47
State: IL

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: 2/11/21- cervical neck x-ray series- told by ER WNL

Allergies: Sulfa

Symptoms: Starting on 2/6/21, I felt fatigued, and had soreness at injection site, along with hot flashes. Fatigue, sluggish and joint pain 2/7/21. Continued fatigue, hot flashes and joint pain since. On 2/11/21 at 10am, felt stiffness on back of my neck that travelled to the front of my neck. By noon, it felt like the muscles in the front of my neck were tightening. By 1pm my head was tilting to the left. I went to Hospital, ER where I was given a muscle relaxer, lidocaine patch, and Tylenol. Symptoms were improved and was discharged home with medication. ER staff stated neck stiffness d/t working with telephone at work. Continued to have some neck stiffness through the weekend. On the evening on 2/14/21, left side of face and jaw swollen, hard to touch, painful. Have been taking muscle relaxer prescribed by ER Physician, and have appointment with PCP on 2/17/21.

Other Meds: Estroven, Vitamin D3, vitamin B 12, Multi-vitamin, Atvorstatin, Fish Oil

Current Illness: None

ID: 1033149
Sex: F
Age: 83
State: AZ

Vax Date: 02/10/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: First day following vaccine, very tired. some blurred vision the next few days. on fourth day following vaccination, blurred vision, unstable walking felt like having Vertigo. Today the 16th, all adverse symptoms are gone

Other Meds: 3 in the am and 3 in the pm heart and blood pressure meds

Current Illness: no

ID: 1033150
Sex: F
Age: 82
State: VA

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: no test possible

Allergies: All antibiotics, All antihistamines, all synthetics

Symptoms: Covid-19 Vaccine EUA; severe rash and itching over entire body except face and neck; no treatment possible; still on-going

Other Meds: Levothyroxine, Digoxin, Metformin, Buspirone, Vascepa, Valsartan, Forcus select vitamin/mineral supplement, Mirtazapine, Gabapentin, Ariprazole, Muprirocin, Centrum silver multi vitamin

Current Illness:

ID: 1033151
Sex: M
Age: 57
State: NE

Vax Date: 12/22/2020
Onset Date: 01/02/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: sore throat, congestion, fever. 01/02/2021: COVID positive. Given Balmlinivimab and Decadron. Admitted to hospital through ER on !/5/2021 with chest tightness and shortness of breath. Throughout stay given Cardizem, Amiodarone without conversion. 1/5/2021 1800 transported by ambulance to medical center. Cardioverted at medical center.

Other Meds:

Current Illness:

ID: 1033152
Sex: F
Age: 53
State: CA

Vax Date: 01/21/2021
Onset Date: 02/03/2021
Rec V Date: 02/16/2021
Hospital: Y

Lab Data: CT, UA, Labs at hospital A few days later contacted my primary care doctor and received prednisone and valacyclovir

Allergies: Shellfish, whey, multiple fruits,

Symptoms: Chills, aches, post dose 2 and left sick within 24 hours of receiving the injection but was fine approximately 16 hours post injection. On or about 2/03/2021 felt intense itching deeply in left flank area. On 2/52011 the pain became so intense that I missed work and went to the hospital, and had concerns there was a problem with my kidneys. On 2/9 itching, urning and pain in left flank area and later developed shingles for the first time.

Other Meds: Antihistamine Zyrtec,Singular, cyclosporine, lasix, potassium, cetirizine, fluoxetine,fenofibrate...daily regimen for both dose 1 and 2

Current Illness: Chronic autoimmune urticaria with angeoedema

ID: 1033153
Sex: F
Age: 48
State: CO

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

Lab Data:

Allergies: Sulfa flexerill

Symptoms: Sore throat fever body aches chest tightness headache

Other Meds: Lamictal Wellbutrin trazadone estradial vitamin D

Current Illness: None

ID: 1033154
Sex: F
Age: 61
State: NY

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: N/A

Allergies: N/A

Symptoms: vomiting, weakness, fever, chills, dizziness, pain

Other Meds: Levothyroxine

Current Illness: N/A

Date Died: 02/11/2021

ID: 1033155
Sex: M
Age: 64
State: SD

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: No known allergies

Symptoms: Vaccine given in clinic per protocol - patient monitored for 15 minutes, no adverse reactions noted at the time. Patient stated he felt fine following 15 minute monitoring time. Patient left facility- it was later reported that pt had a fall at home. Upon review of pt's medical record - Pt's wife had to initiate CPR and call EMS for transportation and life saving measures enroute to the Emergency Room. Pt was intubated as pt was in asystole upon arrival to the ER, ACLS was continued, pt was noted to have a traumatic brain injury from his fall at home, and pt was pronounced dead at 1620.

Other Meds: Amiodarone, Rosuvastatin, Prevacid, Zetia, ASA, MVI, Nitroglycerin, Metformin, Potassium, Bumex, Apixaban, Omega 3, Metoprolol, Midodrine,

Current Illness: Generalized ischemic myocardial dysfunction, lower leg edema with cellulitis

ID: 1033156
Sex: F
Age: 56
State: NC

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: 1/19/2021-vital signs including pulse ox; observation

Allergies: None

Symptoms: Within 15 minutes of injection the employee began to experience eyes burning and instant headache, lightheadedness, face itch numb and burning, face turned red immediately. She was taken to the urgent care center on the campus and evaluated by medical providers who ordered oral medication and she was d/c to home the same day. She had chills later in the day The next day she was fatigued and slept a lot. She was able to return to work as scheduled on the 3rd day.

Other Meds: None

Current Illness: None

ID: 1033157
Sex: F
Age: 76
State: CA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient experiencing a red rash below the injection site. She said this developed 12-24 hours post vaccine. She describes it as red, hot, and "a little firm." Patient did take some acetaminophen 2/12/2021 but has not taken any since. I advised to take IBU or acetaminophen, ice, and rest to help with symptom management. Advised that if symptoms worsen to come in to be seen at the clinic.

Other Meds:

Current Illness:

ID: 1033158
Sex: F
Age: 24
State: NJ

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

Lab Data:

Allergies: Hay fever, Bactrim when taken as child

Symptoms: Developed severe itching overnight Feb 15 into 16th. Woke up to red, raised, circle rash 3-4 inches long around injection site.

Other Meds: Wellbutrin, Larin FE birth control, women's multivitamin

Current Illness:

ID: 1033159
Sex: F
Age: 34
State: FL

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

Lab Data:

Allergies: Augmentin Cipro

Symptoms: Within 5 minutes of vaccine-Metallic taste, Tingling tongue, burning throat, coughing, lump in throat when swallowing, hot flushed feeling. Elevated blood pressure, elevated blood sugar. 1 hr after vaccine itchiness all over and itch welt on forehead

Other Meds: None

Current Illness: None

ID: 1033160
Sex: F
Age: 70
State: MI

Vax Date: 02/04/2021
Onset Date: 02/16/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: none

Allergies: sulfa and other antibiotics (unknown names)

Symptoms: Stated she woke up this morning and her arm itched. Shoulder had multiple bumps at site of vaccine. States the "bumps" looked like welts not blisters. Stated the bumps went under left breast near bra line and around to her back. No pain, just itching. States she is taking Benadryl which seems to be helping. No c/o chest tightness or difficulty breathing. Discussed to see her doctor if worsens or the ER if she has any difficulty breathing, chest pain or tightness, swelling of throat.

Other Meds: none

Current Illness: none

ID: 1033161
Sex: F
Age: 74
State: NY

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Initially, some soreness in the arm for about 24 hours. Then, eleven days after the injection, upper arm swollen, red, itchy and hot to the touch. Worse on the twelfth day following injection

Other Meds: Atorvastatin, levothyroxine, estradiol, Medroxyprogesterone , biotin, l-lysine, vitamins C, D3, B12

Current Illness: None

ID: 1033162
Sex: F
Age: 56
State: RI

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: PCN, Augmentin, Cipro

Symptoms: 2/4 Headache, dizziness, neck and shoulder aches, left hand and foot numbness which continued into 2/5.

Other Meds: IVIG infusions every three weeks, Irbesartan, Nortriptyline, Trazadone, Tumeric, Magnesium, MVI, Vit C, Vit D, Vit B complex, Zinc, Zyrtec

Current Illness: Guillain-Barre Syndrome (CIDP)

ID: 1033163
Sex: M
Age: 79
State: NV

Vax Date: 01/25/2021
Onset Date: 02/07/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Unilateral sensory peripheral neuropathy- ongoing

Other Meds: Acalabrutinib, Levothyroxine, losartan, Eliquis, flecainide, Ezetimibe, Tamsulosin

Current Illness:

ID: 1033164
Sex: F
Age: 40
State: NC

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: N/A

Allergies: Penicillin, hives

Symptoms: 102-degree fever 1st day after the vaccine, continued low-grade fever next day with excessive aches, the third day after vaccine extreme headache and lethargy. Recovered day 4.

Other Meds: N/A

Current Illness: N/A

ID: 1033165
Sex: F
Age: 47
State: ID

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: Sulfa

Symptoms: Approximately 12 hours after I received the injection, I started to experience muscle and joint pain. Soon after the pain started, I began feeling short of breath and feverish. Vitals were checked and I did not have a fever, but heart rate was elevated and oxygen saturation was low. Around 9:00 am, I began having restless leg symptoms in addition to other symptoms. I took oral Benadryl around 10:00 am and restless leg, tachycardia and low oxygen saturation began to subside. Muscle/joint pain and exhaustion continued for a couple days.

Other Meds: Levothyroxine, Simvastatin, Benadryl, Famotidine, Glucosamine Chondrointin, Probiotic

Current Illness: None

ID: 1033166
Sex: F
Age: 86
State: FL

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: none

Allergies: Sulfa

Symptoms: Pain. Swelling (hard area, size of lemon), redness, fatigue, headache, muscle pain joint pain , 4 hours of chills on and off,) nausea. loss of appetite, fever of low grade, duration, some lasted 1 week small vesicles on R face above R lip and R shoulder sutured area. Took tylenol and Benadryl which decreased pain and curbed itching.

Other Meds: Eliquis, levothyroxine, nadolol,Flecainide, Fammotidine. Ca

Current Illness: 2 small areas face and R shoulder removed for basal cancer

ID: 1033167
Sex: F
Age: 49
State: MN

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: allergic to penicillin

Symptoms: Pt described redness, itching, warmth peaking on 2/13/21 with fairly intense itching. Symptoms improved with a cold compress. Pt felt that the reaction may have had an impact on her mood or mental health. She felt fatigued in the week before the reaction and "cried all day" on 2/13/20 when the reaction was strongest. She acknowledged other factors in her life that might also impact her mood and did not feel certain it was related to the vaccine. Physical symptoms have improved but the redness is still visible.

Other Meds:

Current Illness:

ID: 1033168
Sex: F
Age: 32
State: PA

Vax Date: 02/08/2021
Onset Date: 02/15/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: Omnicef

Symptoms: Red, raised rash/welt at vaccine injection site.

Other Meds: Multivitamin, iron, b12, lactation supplements, magnesium, calcium, Reglan

Current Illness:

ID: 1033169
Sex: M
Age: 46
State: NY

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

Lab Data: EMS did an EKG strip at the location and it was normal, given patient still complaining of chest pain he was taken to Hospital

Allergies: SULFA, PENICILLIN, BERRIES AND NUTS

Symptoms: After 14 minutes in observation patient reported itching on the right arm, there was no visible rashes on the arm or the body at the time or any time later. Took patient to a stretcher for further observation and about 5 minutes later he said felt dizzy, his pulse was 84 and chest was clear but he then complained of chest pain and headache for which I called EMS at 2:31 PM. During the entire time in observation patient appeared well, not pale, no sweating, talking clearly and no visible rashes. Denies itchy throat and did not complained of pruritus again

Other Meds:

Current Illness:

ID: 1033170
Sex: F
Age: 40
State: CA

Vax Date: 01/04/2021
Onset Date: 01/07/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: Urgent care visit in 1/12/2021; Given Toradol shot for pain and prescription for anti inflammatory and Flexeril.

Allergies: Dairy

Symptoms: Weakness and Pain in muscles and nerves in legs. Swollen lymph node in right arm pit.

Other Meds: Acyclovir/Tylenol

Current Illness:

ID: 1033171
Sex: F
Age: 65
State: NC

Vax Date: 02/06/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: NKA

Symptoms: COVID19 Vaccine EVA; Seven days post vaccination Left deltoid skin: hives, redness, swelling, painful to the touch and itchy. As of today continues to be red (decrease area), decrease itchy & swelling, and minimal/trace pain to touch.

Other Meds: Multivitamins

Current Illness: NONE

ID: 1033172
Sex: F
Age: 61
State: MS

Vax Date: 02/01/2021
Onset Date: 02/14/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash at injection site

Other Meds:

Current Illness:

ID: 1033178
Sex: M
Age:
State: NC

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: accidently administered to a 5 year old patient instead of the correct vaccine intended (name not reported.); accidently administered to a 5 year old patient; This spontaneous report was received from a vaccine coordinator from HCP office and refers to a 5-year-old male patient. No information regarding the patient's concurrent conditions, medical history, drug reactions or allergies and concomitant medications was provided. On 21-JAN-2021, the patient was accidently vaccinated with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) injection, 0.5 milliliter (ml) intramuscularly (IM) x 1 dose, lot # S020255, expiration date: 09-DEC-2021 (dose number and anatomical location were not reported) for prophylaxis instead of the correct vaccine intended (name of vaccine was not reported) (wrong product administered and product administered to patient of inappropriate age). It was confirmed, that the vaccine administered to the patient has never experienced a temperature excursion. No other details given. The patient did not seek medical attention and there was no treatment given for the event. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: S020255; expirationdate: 09-DEC-2021; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability

Other Meds: GARDASIL 9 SYRINGE (DEVICE)

Current Illness:

ID: 1033179
Sex: U
Age: 0
State: VA

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE reported; VAQTA and MMR II being administered to a patient before 12 months of age.; This spontaneous report was received from a nurse (also reported as customer) referring to a 11-month-old patient of unknown gender. There was no information about the patient's concurrent conditions, drug reactions, allergies, medical history, and concomitant therapies provided. On 29-JAN-2021, the patient was vaccinated with hepatitis a vaccine, inactivated (VAQTA) (1 dose, lot # T020109, expiration date was reported as 31-DEC-2022, but upon internal validation established as 26-JAN-2022; route was not reported) and measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live(M-M-R II) (1 dose, lot # T001214, expiration date was reported as 31-DEC-2022, but upon internal validation established as 12-JAN-2022; route was not reported) for prophylaxis (product administered to patient of inappropriate age). Sterile diluent used for reconstitution. No additional adverse event (AE) reported. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp. devicelotnumber: T020109; expirationdate: 26-JAN-2022; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability

Other Meds: VAQTA SYRINGE (DEVICE) STERILE DILUENT

Current Illness:

ID: 1033180
Sex: U
Age:
State: CA

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

Lab Data:

Allergies:

Symptoms: Vaccine was improperly stored and administered; No additional AE; This spontaneous report was received from a medical assistant and refers to a patient of unknown age and gender. There was no information about the patients' concurrent conditions, concomitant therapies or medical histories provided. On an unknown date the patient was vaccinated with improperly stored dose of haemophilus b conjugate vaccine (meningococcal protein conjugate) (LIQUID PEDVAXHIB) dose of 0.5 milliliter (lot # T011167, expiration date 27-MAY-2022; exact dose, anatomical location and route of administration were not reported) for prophylaxis. Administered dose of vaccine was stored in a temperature below 36 degrees Fahrenheit (35.70 degrees Fahrenheit)for 1.5 hours on 27-OCT-2020 and in a temperature below 36 degrees Fahrenheit (30.20 degrees Fahrenheit) for 1.5 hours on 28-OCT-2020. Digital data logger was involved. Previous temperature excursions was experienced on 14-OCT-2020, and the vaccine was stored in temperature above 47 degrees Fahrenheit (64.36 degrees Fahrenheit) for 3 hours. No adverse event was reported.

Other Meds:

Current Illness:

ID: 1033181
Sex: U
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: No additional AE reported; Improperly stored administered VARIVAX; This spontaneous report was received from a medical assistant referring to a patient of unknown age and gender. The patient's pertinent medical history, drug reactions, allergies, current conditions, and concomitant medications were not reported. On 09-FEB-2021, the patient was vaccinated with an improperly stored varicella virus vaccine live (oka/merck)(VARIVAX) (lot # T021825 with an expiration date on 25-JUN-2022) at a dose of 0.5 milliliters (strength and route of administration were not reported) for prophylaxis (product storage error). The administered dose of the vaccine was stored at a temperature of 6 degrees Fahrenheit (F) to 14 F (6.1?F) during a time frame of 87 hours, as recorded by a digital data logger. There was not previous temperature excursi?n. No additional adverse events were reported.

Other Meds:

Current Illness:

ID: 1033182
Sex: U
Age:
State:

Vax Date: 01/04/2021
Onset Date:
Rec V Date: 02/16/2021
Hospital:

Lab Data: Test Name: Blood pressure; Result Unstructured Data: (Test Result:62/49,Unit:mm Hg,Normal Low:,Normal High:); Comments: lab test performed on an unknown date

Allergies:

Symptoms: low blood pressure 62/49; This case was reported by a consumer via interactive digital media and described the occurrence of low blood pressure in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. On 4th January 2021, the patient received the 2nd dose of Shingrix. On 4th January 2021, less than a day after receiving Shingrix, the patient experienced low blood pressure. On an unknown date, the outcome of the low blood pressure was recovered/resolved. It was unknown if the reporter considered the low blood pressure to be related to Shingrix. Additional information was provided as follows: The age at vaccination was not reported. The age group was selected as adult as per the vaccine indication. The patient received 2nd dose of Shingrix and had low blood pressure 62/49 mmHg all day.

Other Meds:

Current Illness:

ID: 1033183
Sex: F
Age: 53
State: IL

Vax Date: 01/06/2021
Onset Date: 01/01/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: Test Date: 20210107; Test Name: body temperature; Result Unstructured Data: (Test Result:101,Unit:degree C,Normal Low:,Normal High:)

Allergies:

Symptoms: soreness at the injection site; fever of 101; shivering; fatigue; headache; stuffy nose; This case was reported by a consumer and described the occurrence of injection site pain in a 53-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of injection site pain (for the tolerance of 1st dose, refer case- US2021AMR004190). Concurrent medical conditions included hashimoto's disease. On 6th January 2021, the patient received the 2nd dose of Shingrix. On 6th January 2021, less than a day after receiving Shingrix, the patient experienced injection site pain. In January 2021, the patient experienced fever, shivering, fatigue, headache and nasal stuffiness. The patient was treated with paracetamol (Tylenol). Rechallenge with Shingrix was positive. On an unknown date, the outcome of the injection site pain was not recovered/not resolved and the outcome of the fever, fatigue, headache and nasal stuffiness were recovering/resolving and the outcome of the shivering was recovered/resolved. It was unknown if the reporter considered the injection site pain, fever, shivering, fatigue, headache and nasal stuffiness to be related to Shingrix. Additional information was provided as follows: The patient received 2nd dose and experienced soreness at the injection site in her left arm. At 1 am, experienced shivering, fever (101 degree celsius), headache, stuffy nose and fatigue. The patient took Tylenol and the symptoms were resolving. The reporter did not consent to follow up. The case is linked with the case number- US2021003187, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021003187:same reporter

Other Meds:

Current Illness: Hashimoto's disease

ID: 1033184
Sex: F
Age: 53
State: OH

Vax Date: 12/24/2020
Onset Date: 12/25/2020
Rec V Date: 02/16/2021
Hospital:

Lab Data: Test Date: 202012; Test Name: MRI; Result Unstructured Data: vasculitis on her head, at the back on the brain; Test Date: 202012; Test Name: platelet count; Result Unstructured Data: above normal; Test Date: 202012; Test Name: sedimentation rate; Result Unstructured Data: doubled

Allergies:

Symptoms: Vasculitis on her head, at the back of the brain; Horrible pain in the neck; Pain on the back; Feeling dizzy; Motion sickness; Vertigo; Horrible headaches; raging headache; Nausea; awful nausea; feeling tired, fatigue; Sore arm; Body aches; A spontaneous report was received from a 53-year-old, female, patient who was also a physician who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced vasculitis on her head, at the back on the brain, sore arm, feeling tired; fatigue, body aches, awful nausea; nausea all day long, horrible headaches, motion sickness, feeling dizzy, horrible pain in the neck, vertigo, and pain on the back. There was no medical history provided. There were no concomitant medications reported. On 24 Dec 2020, the patient received the first of two planned doses of mRNA-1273 intramuscularly in the left arm, for prophylaxis of COVID-19 infection. On 25 Dec 2020, the patient experienced sore arm, feeling tired, body aches, and fatigue, which continued through Sunday, 26 Dec 2021. On 27 Dec 2020, she began experiencing awful nausea, horrible headaches, vertigo, and motion sickness in addition to the ones she suffered before. On 28 Dec 2020, the patient experienced nausea all day long. On 29 Dec 2020, she went to the emergency room (ER) as she was feeling dizzy, had nausea, and had a raging headache. In the ER, she was given IV fluids, diphenhydramine hydrochloride, and other non-specified medications that helped with her symptoms. The patient went home with prescriptions and the next day she had results from lab work done, which included sedimentation rate was 44 (doubled) and her plaquette count was above normal. Treatment form her primary care physician included steroids, acetylsalicylic acid, meclizine hydrochloride, and prednisone. The patient reported an MRI was done and her physician told her she had vasculitis on her head, at the back on the brain. She was referred to a neurologist and was asked to do more bloodwork. On 12 Jan 2021, the patient reported she was still experiencing horrible pain in the neck, nausea, vertigo, dizziness, and pain on the back, with symptoms beginning on an undisclosed date. Action taken with mRNA-1273 to the events was not provided. The outcome for the events, vasculitis on her head, at the back on the brain, sore arm, feeling tired, fatigue, body aches, horrible headaches, and motion sickness, was unknown. The events, pain in the neck, nausea, vertigo, dizziness, and pain on the back, were considered not resolved.; Reporter's Comments: This case concerns a 53 year old female patient experienced a serious unexpected event of Central nervous system vasculitis and NS events of sore arm, feeling tired; fatigue, body aches, awful nausea; nausea all day long, horrible headaches, motion sickness, feeling dizzy, horrible pain in the neck, vertigo, and pain on the back. The events occurred few days after first dose of the study medication administration. Treatment included IV fluids, diphenhydramine hydrochloride, steroids, acetylsalicylic acid, meclizine hydrochloride and prednisone. 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.

Other Meds:

Current Illness:

ID: 1033185
Sex: M
Age: 63
State: VA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Diarrhea with blood; Headache; Insomnia; A spontaneous report was received from a 63-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced diarrhea with blood, headache, and insomnia. The patient's medical history was not included. Concomitant medications were not reported. On 07 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (batch number: 012L20A), intramuscularly for the prophylaxis of COVID-19 infection. On 07 Jan 2021, the patient experienced diarrhea with blood, headache, and insomnia for couple days. Treatment included aspirin for the headache after 3-4 days from getting the vaccine. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, diarrhea with blood was resolved on 08 Jan 2021 and the outcome of the events insomnia and headache was resolved on unknown dates. ; Reporter's Comments: Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1033186
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: sick; Initial information received on 19-Jan-2021 regarding an unsolicited valid non-serious case received from a consumer/non-health care professional. This case involved patient who was sick (illness), while patient received INFLUENZA VACCINE [Flu shot]. The patient's past vaccination(s) included INFLUENZA VACCINE for prophylactic vaccination and had sickness. It was unknown if the patient had any medical history, concomitant disease or risk factor. Medical treatment and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer) [lot number and expiry date not reported] via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious sick (illness) unknown latency (for duration 1-2 week) following the administration of INFLUENZA VACCINE. It was reported that, patient asked why should patient get something they just made less than 1 years. It was unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome reported as unknown for event. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1033187
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: felt ill for a day or two following every flu shot when he/she ever got; Initial information was received on 04-Feb-2021 regarding an unsolicited valid non-serious case from a consumer/non-healthcare professional (patient). This case involves a patient (unknown demographics) who felt ill for a day or two (malaise) while he/she received INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor. Past medical treatment(s), vaccination(s), concomitant medications and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer) (lot number and expiry date not reported) via an unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, the patient felt ill for a day or two (malaise) (unknown latency) following the administration of INFLUENZA VACCINE. This event is non-serious. It was unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. On an unknown date, the patient recovered from the event. There will be no information available on batch number for this case.

Other Meds:

Current Illness:

ID: 1033188
Sex: F
Age: 72
State: SC

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: Blood work, blood pressure monitored EKG

Allergies: None that I know of

Symptoms: Fluctuating blood pressure, Premature Atrial Contractions, Shingles. Metoprolol Tartrate 25 mg. 2 times a day along with the Lisinopril 40 mg. for blood pressure issues. Antibiotic for Shingles for 7 days. Finished antibiotic and threw bottle in trash

Other Meds: Lisinopril 40 mg, Levothyroxine 50 mg, Folic Acid 1 mg, Orencia 125 mg, Donepezil Hyd 5 mg, Vit. D 2,000, Vit. E 800 325 Aspirin, Atorvastatin 10 mg., Dicyclomine 10 mg., Ondansetron 4 mg

Current Illness: Sinus infection, risen. bladder infection

ID: 1033189
Sex: M
Age: 70
State: TX

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Stomatitis, raw mouth, pain eating and drinking worse yesterday and today ( day 3 and day 4 )

Other Meds: Praluent, cartia xt, atorvastsin, zaleplon, valsartin, hydrochlorthiazide

Current Illness: None

ID: 1033190
Sex: F
Age: 54
State: MD

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

Lab Data:

Allergies: avocado, raspberry, shellfish, Cashews, Bacitracin, Tobradex

Symptoms: c/o sob, CP, throat tightness, tongue tingling minutes after administration of vaccine. Vitals were within normal limits. Alert and oriented. Given IM benadryl and Epi. Transported to ED.

Other Meds:

Current Illness:

ID: 1033191
Sex: F
Age: 59
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Individual developed palpitations and then high blood pressure on the day she received the COVID-19 vaccine (1/4/21). She started having joint pain on the fourth day (1/7/21) and it lasted until 1/11/21. On 1/10/21, she couldn't stand to do dishes. She went to Urgent Care on 1/12/21.

Other Meds:

Current Illness:

ID: 1033192
Sex: M
Age: 81
State: WA

Vax Date: 01/30/2021
Onset Date: 02/10/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: N/A

Allergies: None

Symptoms: Covid-19 arm - raised rash type swelling, itching, light redness. Currently treating with generic Benadryl, which seems to be resolving issue.

Other Meds: Metformin HGI 500mg, Atorvastatin 40mg, Tradjenta 5mg, Glimepiride 1mg, Losartan 25mg, Vitamin D3 2000IU, Fish oil 1000mg, Ozempic pen 9.5-1mg, Stelara syringe 1ml

Current Illness: None

ID: 1033193
Sex: F
Age: 74
State:

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: About 15 minutes after vaccination, patient began to experience acute pyrexia and nausea. No vomiting. No syncope. Vital signs within normal limits. Borderline tachy. No hypertension, but some shortness of breath and some lightheadedness.. After 1st vaccination , developed body aches and wrist burning on 2nd day. Taken to ED where BP 129/77, HR 80, O2 sat 97%. EKG showed NSR. Symptoms resolved on own.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm