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: 1033446
Sex: M
Age: 69
State: FL

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: pain muscles and joints-----Moderna covid19vaccine

Other Meds: metoprolol, lisinopril, atorvastatin, pantoprazole

Current Illness: none

ID: 1033447
Sex: F
Age: 39
State: AR

Vax Date: 12/31/2020
Onset Date: 01/21/2021
Rec V Date: 02/16/2021
Hospital: Y

Lab Data: Hospital COVID Drive Thru 1/22, 1/24 Urgent Care 1/25 Hospital 1/25

Allergies: Ultram

Symptoms: 1/21/21 pt started experiencing fever about 3:30 PM, went to Urgent care received rapid COVID test which was negative, 1/22/21 still has fever drive thru at hospital covid drive thru pt had PCR and it was also negative, went back to same drive thru on 1/24/21 and had another PCR which was negative, 1/25/21 urgent care visit, pt was tested for flu-Negative, lab work was done which showed CBC all counts were low resulted in ER visit, admitted 1/25/21 afternoon with panside apnea and sepsis and patient stayed in hospital for 9 days 2/2/21 pt was released to go home. Lots of labs and test were done while patient was inpatient, Pt is still weak and has no energy.

Other Meds: Gabapentin, Keppra, Plaquenil, Imuran, Protonic, Vitamin D every other week, Flexural as needed, Lunesta as needed, Buspar, Remeron, Multivitamins

Current Illness:

Date Died: 02/01/2021

ID: 1033448
Sex: F
Age: 82
State: MN

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever by the next day, difficulty breathing, pneumonia, and then DEATH within a few days. (Died 02/01/2021)

Other Meds: Blood Thinners Pyschotropics

Current Illness: Had Covid-19 one month prior

ID: 1033449
Sex: F
Age: 17
State: IL

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

Lab Data: Medical tests run at ER were: EKG, CT scan of the head and blood work. All test came back with no findings.

Allergies: PCN

Symptoms: Patients menstrual cycle started the day she received the moderna vaccine, the next day,02/13/2021, she stated it was heavier than she had ever had. Patient reported changing birth control 1-2 months previously. On 02/16/2021 Patient's father reported she was standing in the kitchen and her pupils were huge. Patient told parents she couldn't see or hear. Patient became unconscious for approximately 3 seconds. took patient to ER. ER was unable to find a cause. Loss of vision and hearing lasted approximately 3-5 minutes.

Other Meds: yasmin birth control zyrtec one a day

Current Illness: N/A

ID: 1033450
Sex: F
Age: 78
State: CA

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

Lab Data:

Allergies:

Symptoms: I had my second Maderna shot at 10:30 am. No problem with my first one three weeks ago. At 10:00 pm I started to get extremely cold and could not get warm. At 10:45 my upper body started shaking very, very bad. I couldn't control the shaking and my teeth were chattering. I had to lay down and put my arms under my body to keep them from shaking and I was so cold even though I was wearing warm things and under a comforter. The shaking lasted an hour and a half. I took my temperature during the night and it was 102. I am very week this morning, temp. is 99.9. I was expecting the temperature and pain in the injection site but I can't find out anywhere on line whether the uncontrollable shaking was normal for the second shot. .

Other Meds: Lyrica, Arimidex, Lisinopril

Current Illness:

ID: 1033451
Sex: F
Age: 49
State: MN

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

Lab Data: CT scan, Pelvic, and multiple lab tests.

Allergies: Latex, Cipro

Symptoms: Fever to muscle aches, to not able to walk and severe localized pain through out both legs. Hospital ED visit.

Other Meds: None

Current Illness: None

ID: 1033452
Sex: F
Age: 67
State: NC

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

Lab Data: none

Allergies: Seasonal allergies, wheat, latex, Oats, perfumes,

Symptoms: minor lip swelling, hives and itching 20 minutes after 1st shot; minor lip swelling and worse hives and itching, worse than 1st vaccine, which have continued 10 days later.

Other Meds: Wellbutrin, Clarinex, Zyzal, Flonase, vivelle patch, progesterone, testosterone, Colchicine, Armour thyroid, ranitidine

Current Illness: none

ID: 1033453
Sex: F
Age: 34
State: NJ

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

Lab Data: NA

Allergies: unknown

Symptoms: "...noted she had back, neck & four extremity rigidity with tonic / clonic seizure movements. It appeared like a petit grand mal seizure with facial pallor, loss of consciousness, some saliva foaming formation on lips. ...The patients pallor and bradycardia (48 bpm) was evident, the patient was breathing on her own and able to respond to direction and pain stimuli.(2 minutes from initial evaluation.) The seizure like signs and symptoms resolved quickly She was able to place her head between her knees after 30 seconds with her feet on the floor. Her mentation improved rapidly..." Evaluated by EMS, refused transport to ED. PMD followup unknown

Other Meds: unknown

Current Illness: unknown

ID: 1033454
Sex: F
Age: 71
State: MI

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

Lab Data:

Allergies: anaphylactic to Penicillin, mushrooms, bee stings

Symptoms: "Pt began complaining of dizziness approximately 15 minutes following her COVID-19 vaccination while she was waiting in the waiting room for the recommended 30 minutes post-immunization due to having anaphylaxis to other allergens. Pt was brought back to an exam room and 50 mg IM Benadryl was administered by RN. Following this, patient claimed to begin feeling better within 5 minutes and denied any further symptoms. Patient refused EMS or additional care because she had a scheduled Dr appointment with at 1:40PM that day."

Other Meds:

Current Illness:

ID: 1033455
Sex: F
Age: 41
State: PA

Vax Date: 02/06/2021
Onset Date: 02/15/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Local injection site reaction about 9 days after injection - red and hot to touch

Other Meds:

Current Illness:

ID: 1033456
Sex: F
Age: 79
State: MI

Vax Date: 02/03/2021
Onset Date: 02/09/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: 2/12/21- CT Head without IV contrast; 2/12/21 CT Angio Head Neck with IV contrast; 2/12/21- lab tests complete blood count w/ differential, Comprehensive Metabolic Panel ( CMP), Magnesium, Blood level, COVID-19 PCR Rapid ( not detected), POCT creatinine, urinalysis. 2/16/21- referral for MRI consult scheduled with neurosurgery 3/15/21.

Allergies: DemerolHives Adhesive TapeItching Bactrim [Sulfamethoxazole W-trimethoprim]Skin Rashes/Hives Contrast Dye [Ivp Dye, Iodine Containing]Swelling Hctz [Hydrochlorothiazide]Nausea Only, Difficulty concentrating PenicillinsRash Pepcid [Famotidine]Diarrhea Prevacid [Lansoprazole]Diarrhea Sulfa DrugsRash TramadolDizziness

Symptoms: On 2-8-21, she had the chills, and on 2-9-21, she developed double-vision which has continued. Documentation double-vision still present on 2/12/21. Patient sought treatment in the emergency department 2/12/21 dx. Binocular vision disorder with diplopia .

Other Meds: acetaminophen (TYLENOL) 500 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG tablet atorvastatin (LIPITOR) 40 MG tablet CALCIUM-MAGNESIUM-VITAMIN D PO levothyroxine (SYNTHROID) 50 MCG tablet methocarbamol (ROBAXIN) 750 MG tab

Current Illness:

ID: 1033457
Sex: F
Age: 46
State: VA

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

Lab Data: 2/11/2021- COVID Testing- Negative; 2/11/2021- Blood Work - clear.

Allergies: None

Symptoms: I started 2/11/21 at 11:45 am to have stomach cramps. The stomach cramps started mildly. Around 1:30 pm, the stomach cramps became very intense followed by hot flashes and nausea. I vomited twice and caused my head to ache. I decided to be observed. Once I arrived at clinic, I started to have chills and muscle pain.

Other Meds: Micardis, Vitamins, Plant Sterols

Current Illness:

ID: 1033458
Sex: F
Age: 41
State: NY

Vax Date: 02/13/2021
Onset Date: 02/15/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: NO KNOWN

Symptoms: red rash at injection site and on most of upper torso. severe allergy symptoms; nonstop runny nose and frequent sneezing (though may be unrelated to the vaccine due to cat allergies); arm muscle tiredness/soreness. Next day after this (2/16), also developed swelling around injection site where rash is.

Other Meds: DAILY: multivitamins, Vitamin D supplement, magnesium supplement, fexofenadrine hydrocholoride over the counter allergy medication, fish oil capsule

Current Illness:

ID: 1033459
Sex: F
Age: 57
State: CO

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

Lab Data: none

Allergies: amoxicillan

Symptoms: Injection site became very painful (more than just sore) at about 10pm and is still painful today (2/16/21), that it hurts to elevate my left arm. At approx. 3am on 2/16/21 - 12 hrs after shot, I was sleeping and awoke to chills, the coldest I've been, and extremely thirsty. I got up to put more clothes on and some sips of water and returned to bed. The chills lasted for approx. 5 hours, and subsided. I awoke at 11am, feeling dehydrated, weak, and like my body had been through the washing machine! It is now noon on 2/16/21 as I type this report, and I will be returning to bed for the day. I hope my immune system settles down so I can work tomorrow.

Other Meds: levothyroxine 25mcg Vitamin D3 4000IU Zinc chelate 30mg

Current Illness: none

ID: 1033460
Sex: F
Age: 75
State: SC

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: Celiac - Gluten allergy; Fire ants (old allergy; received allergy injections prior); Sterile wash pad used prior to surgery - Benzalkonium?

Symptoms: Swollen tongue, swollen and numb left arm, pain in arm, pain behind ear.

Other Meds: Levothyroxin; Atenolol; Lumigen eyedrops; Lemon essential oil in water

Current Illness: Celiac - Autoimmune disorder

ID: 1033461
Sex: F
Age: 1
State: SC

Vax Date: 01/25/2021
Onset Date: 02/09/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Small reaction site, sore, red, and somewhat hard.

Other Meds: None

Current Illness: None

ID: 1033462
Sex: F
Age: 27
State: IL

Vax Date: 02/05/2021
Onset Date: 02/15/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: On the 10th day, I developed a large itchy, warm, hard rash near the injection site. It spread minorly overnight and circled the injection site itself.

Other Meds: Syeda (birth control pills)

Current Illness: None

ID: 1033463
Sex: M
Age: 58
State: CA

Vax Date: 12/28/2020
Onset Date: 12/31/2020
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: Unknown

Symptoms: Is taking Augmentin for COVID with possible secondary infection of PNA. COVID positive January 1st, symptoms started on December 31. Will finish Augmentin in 6 days.

Other Meds: Unknown

Current Illness: Unknown

ID: 1033465
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: 68-year-old female evaluated for painful movement of her extremities. Patient reports that her symptoms started the day after receiving the Pfizer COVID-19 vaccine at pharmacy. Patient was admitted. Patient has been evaluated by Neurology, Rheumatology and the Ortho-Spine Service. Symptoms improved with prednisone. Although unclear, a diagnosis of polymyalgia rheumatica was being considered due to elevated CRP (inflammatory marker). Relationship to vaccine administration is also unclear. Pt with Hx of arthritis, COPD, CAD, CHF, and HTN received first dose of Pfizer COVID-19 Vaccine. Within 24 hours of vaccine administration, pt went to hospital c/o of painful movement of extremities. Pt was treated with prednisone and symptoms improved. She was evaluated by multiple specialties including neurology, rheumatology and orthopedics without a clear diagnosis. Her CRP was elevated to 17.2 mg/dL and Sed Rate to greater than 130 mm/hr and reactive ANA titer. Total CK was normal at 23 IU/L. Rheumatology wrote this is highly suggestive of COVID-19 vaccine induced polymyalgia rheumatica which has been reported with other vaccines but not with COVID-19 vaccines.

Other Meds:

Current Illness:

Date Died:

ID: 1033466
Sex: M
Age:
State:

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

Lab Data:

Allergies:

Symptoms: 70 yo man with multiple severe medical comorbidities received his first dose of Moderna COVID-19 vaccination without incident. 8.5 hours later, he was noted by his family to be in his usual state of health. 9.5 hours after the vaccination, he was found down by his family in cardiac arrest. Resuscitation attempts were not successful, and the patient died.

Other Meds:

Current Illness:

ID: 1033468
Sex: U
Age:
State: IL

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

Lab Data:

Allergies:

Symptoms: No additional AEs reported; an adult patient receiving a pediatric dose of VAQTA; an adult patient receiving a pediatric dose of VAQTA; This spontaneous report was received from a pharmacist and refers to an adult patient of unknown gender and exact age. No information regarding the patient's concurrent conditions, medical history, drug reactions or allergies and concomitant medications was provided. On 22-JAN-2021, the patient was vaccinated with hepatitis a vaccine, inactivated (VAQTA) syringe injection, 25 U/0.5 ml, 1 pediatric dose (route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis (product administered to patient of inappropriate age and incorrect dose administered). The pharmacist was inquiring on next steps for an adult patient receiving a pediatric dose. No additional adverse event was reported. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; 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)

Current Illness:

ID: 1033469
Sex: F
Age: 53
State: IL

Vax Date: 09/01/2020
Onset Date: 09/01/2020
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: soreness at the injection site; fever of 101; shivering; fatigue; headache; This case was reported by a consumer and described the occurrence of injection site pain in a female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2020-2021 season) for prophylaxis. Concurrent medical conditions included hashimoto's disease. In September 2020, the patient received the 1st dose of Shingrix and Influenza vaccine Quadrivalent 2020-2021 season. In September 2020, less than a day after receiving Shingrix and Influenza vaccine Quadrivalent 2020-2021 season, the patient experienced injection site pain, fever, shivering, fatigue and headache. The patient was treated with paracetamol (Tylenol). On an unknown date, the outcome of the injection site pain, fever, shivering, fatigue and headache were recovered/resolved. It was unknown if the reporter considered the injection site pain, fever, shivering, fatigue and headache to be related to Shingrix and Influenza vaccine Quadrivalent 2020-2021 season. Additional details were reported as follows: The patient had 1st dose of Shingrix n September 2020 in her right arm. The patient experienced soreness at the injection site that lasted 24-36 hours. The patient received the 1st dose late morning and by bedtime, she started to experienced symptoms fever, shivering, headache and fatigue. The patient took tylenol and the symptoms resolved 8-10 hours later. The patient had also had a flu shot at the same time when she received her 1st dose. For tolerance with 2nd dose refer the case US2021003181. The reporter consented to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021003187:same reporter

Other Meds:

Current Illness: Hashimoto's disease

ID: 1033470
Sex: F
Age: 63
State: TX

Vax Date: 11/01/2020
Onset Date:
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: chills; flu like symptoms; This case was reported by a consumer and described the occurrence of chills in a 63-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2020-2021 season) for prophylaxis. In November 2020, the patient received the 1st dose of Shingrix and Influenza vaccine Quadrivalent 2020-2021 season. On an unknown date, less than 2 months after receiving Shingrix and Influenza vaccine Quadrivalent 2020-2021 season, the patient experienced chills and influenza-like symptoms. On an unknown date, the outcome of the chills and influenza-like symptoms were recovered/resolved. It was unknown if the reporter considered the chills and influenza-like symptoms to be related to Shingrix and Influenza vaccine Quadrivalent 2020-2021 season. Additional information was provided as follows: The patient received 1st dose of Shingrixin left arm and a dose of Flu vaccine in right arm. The patient experienced chills and flu like symptoms which resolved in 1 day. The reporter consented to follow up. For the tolerance of 2nd dose, refer case- US2021AMR008962, reported by the same reporter. The case is linked with the case number- US2021008406, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021008406:same reporter US-GLAXOSMITHKLINE-US2021AMR008962:same reporter, same product, different dose

Other Meds:

Current Illness:

ID: 1033471
Sex: M
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Made his arm hurt; Felt bad for 48 hours; This case was reported by a consumer and described the occurrence of pain in arm in a male patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced pain in arm and feeling bad. On an unknown date, the outcome of the pain in arm and feeling bad were recovered/resolved. It was unknown if the reporter considered the pain in arm and feeling bad to be related to Shingles vaccine. Additional information was provided as follows: The age at vaccination was not reported. The case was reported via web chat. The reporter abandoned the chat before any other additional information could be provided. The patient received a shingles shot which made his arm hurt and he felt bad for 48 hours. No further information was provided.

Other Meds:

Current Illness:

Date Died:

ID: 1033472
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Resident coded and expired; A spontaneous report was received from a consumer concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and coded and expired. The patient's medical history was not provided. No concomitant product use was reported. On an undisclosed date, the patient received their first of two planned doses of mRNA-1273 (Lot number: not provided) for prophylaxis of COVID-19 infection. On undisclosed date, the patient coded and expired. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on an undisclosed date. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter's Comments: MEDICAL COMMENT: MOD 2021 009822 DEATH NOS This case concerns a patient of unknown age and gender who received their first of two planned doses of mRNA-1273 (Lot number: not provided) for prophylaxis of COVID-19 infection and had died. Very limited information regarding this event has been provided at this time to make a proper medical assessment, therefore, the causality is unlikely related to the vaccine in this case of death not otherwise specified. No contact information provided. Follow up is not expected.; Reported Cause(s) of Death: Unknown cause of death

Other Meds:

Current Illness:

ID: 1033473
Sex: F
Age: 79
State: CO

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

Lab Data:

Allergies:

Symptoms: Blacked out; fell down the stairs; concussion; damaged or severed 6th cranial nerve to right eye; brain bleed; split lip; A spontaneous report was received from a consumer concerning a 79-years-old, female patient who received Moderna's COVID-19 Vaccine, and who blacked out, fell down the stairs, brain bleed, concussion, damaged or severed 6th cranial nerve to right eye and split lip. The patient's medical history included diabetes, two unspecified high blood pressure medications and naproxen sodium. Products known to have been used by the patient, within two weeks prior to the event, included Sitagliptin and blood pressure medication. On 21 Jan 2021, approximately one and half hours prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Lot number 027L20A) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2021, the patient "blacked out" while walking downstairs after one in and half hours of receiving vaccination. Patient was hospitalized from 21 Jan 2021 until 22 Jan 2021. Patient has a brain bleed and a concussion, damaged 6th cranial nerve to right eye, and split her lip which need stitches. Treatment for the event included Tylenol as needed. Action taken with mRNA-1273 in response to the events was withdrawn. The events blacked out and fell down the stairs was resolved on 21 Jan 2021. The outcome of the events brain bleed, concussion, damaged or severed 6th cranial nerve to right eye and split lip was unknown.; Reporter's Comments: This case concerns a 79 year old female patient with medical history of diabetes, two unspecified high blood pressure medications and naproxen sodium, who experienced serious unexpected events of fall, cerebral hemorrhage, loss of consciousness, concussion, damaged or severed 6th cranial nerve to right eye and split lip. The event occurred approximately one and half hours after first dose of the study medication administration. Treatment included Tylenol as needed. 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. Noting the subject's underlying medical condition could remain a confounder.

Other Meds: JANUVIA [SITAGLIPTIN]; ALEVE; Blood pressure medication

Current Illness: Diabetes; Hypertension

ID: 1033474
Sex: M
Age:
State: NC

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

Lab Data:

Allergies:

Symptoms: About a week later developed MRSA; A spontaneous report was received from a pharmacist concerning a 36-year-old, male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and about a week later developed MRSA (Methicillin-resistant Staphylococcus aureus). The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (Batch number: 011J20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On an unknown date, about a week after vaccine administration, the patient developed MRSA. No further information was provided regarding the patient. No treatment information was provided. Action taken with RNA-1273 in response to the event was unknown. The outcome of the event, about a week later developed MRSA, was unknown.; Reporter's Comments: Very limited information regarding the event has been provided at this time and is insufficient for causality assessment. Further information has been requested.

Other Meds:

Current Illness:

ID: 1033475
Sex: M
Age: 68
State: DC

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

Lab Data:

Allergies:

Symptoms: delayed reaction; WBC in blood; felt tired; diagnosed with Urinary tract infection; blood in urine; soreness in the arm lasted 24 hours; A regulatory authority report was received from a consumer regarding himself, a patient who is a 68-year-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced soreness in the arm that lasted 24 hours, diagnosed with a urinary tract infection, blood in the urine, WBC in the blood, felt tired as a delayed response to the vaccine. The patient's medical history was not explicitly provided, however the patient noted that he takes "blood pressure medication" and "Benign Prostatic Hypertrophy medication." On 12 Jan 2021, prior to the onset of the events, the patient received one of two planned doses of mRNA-1273 (Lot number: 013L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On the same day, patient stated that he had soreness in the arm that lasted 24 hours. No treatment information was reported and event is considered recovered/resolved. On 13 Jan 2021, after the mRNA-1273 vaccine was given, the patient was reported to have been diagnosed with a urinary tract infection and had blood in his urine. On 15 January 2021, the patient reported that there were white blood cells in his urine and felt tired. He was questioning if this is a delayed reaction to the vaccine. Treatment information included antibiotic for the urinary tract infection. Action taken with mRNA-1273 was not reported. The outcome of the events, soreness in arm for 24 hours is considered resolved as of 12 Jan 2021. The outcome of the events, urinary tract infection, blood in urine, white blood cells in urine, and feeling tired were not reported.; Reporter's Comments: The events of urinary tract infection, blood in the urine, WBC in the blood is more likely associated with the patient's suspected underlying condition of benign prostatic hypertrophy Hence assessed as unlikely related to mRNA-1273. Fatigue and muscle soreness are temporarily associated with mRNA-1273 use and consistent with the known safety profile of the vaccine. Thus, causal association cannot be excluded.

Other Meds:

Current Illness:

ID: 1033476
Sex: F
Age: 66
State: TX

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

Lab Data:

Allergies: Codeine

Symptoms: Felt "bubble" in throat, sudden onset. mucus sensation in throat. 1600. Patient returned to stadium . Patient left with her daughter after wating 15 minutes in observation after her injection. returned at 4pm complaining of "bubble " in throat. BP 184/149 HR92 o2 sat 95% 1601 blood pressure 177/94 1605 BP 176/103 HR93 o2 96% 1609 BP 176/98 HR 96 o2 94%, 911 called for EMS 1611 EMS arrived, patient care transferred to EMS, patient continues to complain of "bubble sensation". Transferred to Hospital

Other Meds: Blood Pressure medication Cholesterol Medication Antidepressant

Current Illness:

ID: 1033477
Sex: F
Age: 50
State: MD

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

Lab Data:

Allergies:

Symptoms: anxiety after vaccine with no SOB no airway issues

Other Meds:

Current Illness: Anxiety Disorder

ID: 1033478
Sex: M
Age: 67
State: CA

Vax Date: 02/04/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: None yet.

Allergies: Pramoxine Hydrochloride. | Methylisothiazolinone | Benzisothiazolinone | Compositae (Botanical family)

Symptoms: New, red Rash on my Right side (ribs area), about 3" x 9". Part of rash emitted pus when touched. Also. having aching pain where Rash located, as well as on my back. My wife, a retired ICU nurse, said it absolutely looked like Shingles/Herpes Zoster. Two days later, Rash spread Horizontally to Middle of my chest and to my spine (right side). Pain increased to 3 to4 on 1~10 scale.

Other Meds: Dupixent - 300mg, twice a Month. | Atorvastatin - 20mg/Day. | Cetirizine - 10mg/Day. | Lisinopril - 40mg/Day. | Magnesium Citrate - 200mg/Day. | Multi-Vitamin - once a Day. | Fluocinonide - .05% Ointment, once a Day. | Aspirin or Ibuprofen

Current Illness: None

ID: 1033479
Sex: F
Age: 38
State: HI

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: Rash develops after multiple days of Amoxicillin use.

Symptoms: Red, inflamed skin around injection site. 2 days of skin irritation on upper arm/shoulder.

Other Meds: adult multi-vitamin. Paraguard

Current Illness:

ID: 1033480
Sex: M
Age: 70
State: FL

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

Lab Data: n/a

Allergies: nka

Symptoms: After client received his vaccine client stated he is experiencing tingling around his mouth and watery eyes. Vital signs obtained by EMS. BP 123/73, HR 62, O2 sat 99%, Temp 98.0; Client stated she feels better. Client discharged home by EMS.

Other Meds: HTn, cholesterol, thyroid meds

Current Illness: n/a

ID: 1033481
Sex: F
Age: 34
State: PA

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

Lab Data: EKG-2/10/2021 at clinic not aware of testing/labs done at hospital

Allergies: Iodine, Benadryl, Flu Vaccine

Symptoms: Patient reported feeling hot, having a headache and developing some chest-tightness approximately 10 minutes after receiving the vaccine; because of allergy to Benadryl EMS transport to hospital advised

Other Meds: Emgality, Synthroid, Topiramate

Current Illness: None Known

ID: 1033482
Sex: F
Age: 74
State: CA

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

Lab Data: None

Allergies: Bees, insects, olive trees

Symptoms: With 2nd dose, hives on other parts of my body, severe on back. Received cortosone injection at urgent care and am now on methylprednisone pack from primary doctor. Still active 2/16/21. Took benedril on own for first 2 days. Highly allergic only to insects.

Other Meds: Lisinipril, amlodopine,sertraline,trazodone,

Current Illness:

ID: 1033483
Sex: F
Age: 66
State: AZ

Vax Date: 02/05/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: A one-time reaction to Cephalosporin. (hives)

Symptoms: 9 days after the vaccine was given I had swelling, rash and itchiness at the site of the vaccine (mild). Now have had that for 3 days. Applied anti-itching cream to site and it helped. Have not seen my health provider.

Other Meds: levothyroxine 150, calcium, fish oil, vitamin C, D3, selenium

Current Illness: None

ID: 1033484
Sex: F
Age: 62
State: OR

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

Lab Data: EKG with abnormality noted. Have appointment to follow up with PCP on Thursday 2/18/2021

Allergies: Rocephin, morphine, X-ray dye, iron sucrose, tree nuts, peanuts, bee stings

Symptoms: Anaphylaxis. Used epiPen, taken to ER. Given solumedrol 125 mg, bendadryl, 25 mg IV monitored 4hours. Sent home with solumedrol dose packet and new epipen

Other Meds: Levothyroxine, zafirlukast, Trintellix, clonazepam, Allegra, vitamin d, multiple vitamin,

Current Illness: None

ID: 1033485
Sex: F
Age: 67
State: FL

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

Lab Data: n/a

Allergies: Penicillen

Symptoms: Extreme Dizziness Could not move head or lie back on pillow without the room spinning. This began 4.5 hours after the injection (after dinner), and subsided 16 hours after it began (noon the next day).

Other Meds: Metaprolol 50 mg. Benicar 5 mg. Levothyroxine .088 mg Vit D, magnesium

Current Illness: n/a

ID: 1033486
Sex: F
Age: 83
State: NJ

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

Lab Data:

Allergies: unknown

Symptoms: Patient complained of severe chest pain radiating to back within 5 minutes of vaccination. Significant language barrier but patient grimacing and clutching chest. Pain described as burning by family member. Evaluation by EMS, vital signs stable, Oxygen given and transported to Hospital ED - disposition unknown.

Other Meds: unknown

Current Illness: unknown

ID: 1033487
Sex: F
Age: 65
State: NY

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

Lab Data: None

Allergies: None known

Symptoms: No reaction at all until today when I woke up with a red rash at the injection site which was veryitchy and very slightly swollen

Other Meds: 1200 mg fish oil; 25 mcg Vitamin D3; calcium, magnesium & zinc tablet

Current Illness: none

ID: 1033488
Sex: F
Age: 47
State: FL

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

Lab Data:

Allergies: Bananas carrots casein

Symptoms: Left Arm hives, swelling, hot and very sore lasted 2/12/21-2/16/21.

Other Meds: Heather- Birth Control Allegra D Nasacort Pepcid

Current Illness:

ID: 1033489
Sex: F
Age: 37
State: AL

Vax Date: 02/08/2021
Onset Date: 02/13/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: Initial reaction: pain at the injection site, nausea Delayed reaction: red circle, swelling, itching, pain to touch, fever at the injection site. Now it has a double red ring.

Other Meds: Synthroid Zoloft Adderall

Current Illness: N/A

ID: 1033490
Sex: F
Age: 78
State: SC

Vax Date: 01/14/2021
Onset Date: 01/21/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The patient was administered the Moderna Covid-19 vaccine on 1/14/2021. The patient reported experiencing arm pain around the injection site during the 2 days following the vaccination. The patient reported experiencing hip pain and trouble with her legs on 1/21/2021. On 1/22/2021 the patient reported not being able to stand without bracing. The patient visited a doctor on 1/25/2021 and there was suspicion for inflammation of the spinal cord leading to the patient being prescribed prednisone for 6 days. The patient visited the doctor again on 2/2/21 and another course of prednisone was initiated. The patient reports that she can stand from a sitting position without help getting up about half the time and that she had no such trouble standing prior to the vaccination. The patient returned to the second vaccination clinic on 2/11/2021, which was 4 weeks after receiving the first dose, to report her symptoms. The patient was not administered the second dose of the Moderna Covid-19 vaccine.

Other Meds:

Current Illness:

ID: 1033491
Sex: F
Age: 0
State: MS

Vax Date: 01/26/2021
Onset Date: 02/02/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: Blood work and made appointment with a dermatologist

Allergies:

Symptoms: Moderna Covid-19 My hair comes out when I comb it also without being combed.

Other Meds:

Current Illness: none

ID: 1033492
Sex: F
Age: 38
State: CA

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

Lab Data: Labs - bloodwork - for rheumatoid factor - It was taken on January 19th. Normal results.

Allergies: No

Symptoms: Woke up feeling fatigued and I took it easy. That week I began having pains - joint pain. Joint pain would move around - knees and then hands and then ankles. It didn't stay in one area. I had this pain for 2 1/2 - 3 weeks. Called my Rheumatologist because of my history of auto-immune disease. January 7th was the date. She told me to take Plactinele- anti-malaria medication. I took it for a week. I took Vit D, C and Zinc with this medication. I still had symptoms the week after the medication stopped. The pain didn't stop decreasing until about 3 weeks. Symptoms were not resolved entirely by the time I got second dose of vaccine.. Got the second dose on the 4th week after the 2nd dose of vaccine.

Other Meds: Vit D

Current Illness: No

ID: 1033493
Sex: F
Age: 72
State: FL

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

Lab Data:

Allergies: Peppers Valium

Symptoms: About a week after vaccine, i developed a rash in the area of the vaccine. It itched, was hot and raised. I thought it might be a spider bite but I read online exactly same rash, size of rash and symptoms as related to the vaccine. I used Benadryl cream and after 5 days or so the rash is gone.

Other Meds: Prevastatin 20mg Calcium Vitamin D3

Current Illness:

ID: 1033494
Sex: F
Age: 82
State: GA

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

Lab Data:

Allergies:

Symptoms: From the patient's chart (regarding the vaccination on 02/03/2021): "The nurse states that when she gave the injection that upon exit of the needle there was some bleeding. This was stopped with a Band-Aid. After the vaccination there was a slight area of erythema that may be more contusion or bruising from the injection. The area is not tender but we will need to keep a watch on this. The patient was told to elevate this and put some ice to this for the next hour or so. Waiting 15 minutes after the injection for evaluation and other side effects was unremarkable." The patient later stated that the injection site got somewhat warm on the day of the vaccination after she received the vaccine. She stated that she placed some ice packs on her arm for about 15 minutes on that day and that she and the injection site had no issues or adverse reactions after that. - 02/10/2021 "I tried reporting this today electronically but was unable to submit it because the website would not let me submit it. When my cursor hovered over the "Submit" button, my cursor turned to a circle with a line through it. I checked the electronic form to make sure I was not missing required information then called the contact number and left a message explaining the situation so they can call me back to assist me in reporting this information." 02/10/2021

Other Meds:

Current Illness:

ID: 1033495
Sex: M
Age: 89
State: CO

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: no

Allergies: no

Symptoms: caller stated the pt had some swelling in the right arm the day of the vax and has been really cold at night. Three days later he developed extreme swelling in his right breast. Caller states he looks like he has had a breast implanted. Pt has not contacted his PCP regarding his symptoms since the swelling seems to be better today.

Other Meds: Tylenol Arthritis

Current Illness: no

ID: 1033496
Sex: F
Age: 55
State: IN

Vax Date: 01/26/2021
Onset Date: 01/29/2021
Rec V Date: 02/16/2021
Hospital:

Lab Data: none

Allergies: Motrin 800mg

Symptoms: Rash all over body, except face and feet for two weeks and continues.

Other Meds: Synthroid

Current Illness: none

ID: 1033497
Sex: F
Age: 46
State:

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

Lab Data:

Allergies:

Symptoms: Anxious, feeling hot, and claustrophobic .

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm