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: 1046315
Sex: F
Age: 75
State: KY

Vax Date: 02/11/2021
Onset Date: 02/13/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: No laboratory Test were done.

Allergies: No Allergy

Symptoms: Full body diffuse rash red circles all over body, (completely covered) head to toe, extremely itchy. Patient was prescribed medrol dose pack and the rash is now almost completely gone 2/23 when I called and check on her again.

Other Meds: Metformin, Imdur, Effexor, Cartia, Flexeril, Crestor, metoprolol

Current Illness: None

ID: 1046316
Sex: F
Age: 65
State: IN

Vax Date: 02/06/2021
Onset Date: 02/18/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Large red rash patch on vaccine arm, about 3 inches in diameter, darker around the edge. Appeared on Day 12 after the first shot. Did not hurt, barely itchy only twice in two days, and just slightly warm to the touch. Lasted two days; faded nearly away by the third day after its appearance.

Other Meds: Atenolol Loratadine Amabelz Low-dose aspirin One-a-Day vitamin

Current Illness: None

Date Died: 02/12/2021

ID: 1046317
Sex: M
Age: 86
State: OH

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Patient passed away from chronic respiratory failure with cardiogenic shock 24 hours from 2nd dose of vaccine. Patient with longstanding history of pulmonary HTN and heart failure with desire for comfort care only. Entering into VAERS out of abundance of caution.

Other Meds: albuterol inhaler, allopurinol, amlodipine, aspirin, atorvastatin, bumex, cardura, lasix, mucinex, humulin NPH, synthroid, Opsumit, Toprol XL, singulair, multivitamin, Revatio, flomax

Current Illness:

ID: 1046318
Sex: F
Age: 61
State:

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: body aches, fatigue, low grade temp

Other Meds:

Current Illness:

ID: 1046319
Sex: F
Age: 33
State: FL

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

Lab Data: none

Allergies: Keflex

Symptoms: 2/17 @ 2000- hives on torso and upper body 2/17 @ 2200 shortness of breath 2/18 @ 1100-1400- angioedema (lip and facial swelling)

Other Meds: N/A

Current Illness: None

ID: 1046320
Sex: M
Age: 59
State: NJ

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

Lab Data: none

Allergies: none

Symptoms: After1st vaccine severe flatus, after 2nd vaccine chronic diarrhea; loose watery stools q 2hrs with onset 02/15/2021 . No other s/s. No improvement with OTC medicine and diet. Telemedicine appt. pending today with primary care physician.

Other Meds: none

Current Illness: none

ID: 1046321
Sex: F
Age: 19
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Dizziness, near syncope that resolved immediately when put in supine position

Other Meds:

Current Illness:

ID: 1046322
Sex: F
Age: 33
State: MN

Vax Date: 01/05/2021
Onset Date: 01/25/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: Beta HCGs and early OB pelvic ultrasounds

Allergies:

Symptoms: Missed abortion - received first shot while pregnant (did not know), missed abortion of ~5 weeks gestational age, diagnosed Feb 2021

Other Meds:

Current Illness:

ID: 1046323
Sex: F
Age: 23
State: MT

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills & Headache

Other Meds:

Current Illness:

ID: 1046324
Sex: F
Age: 79
State: TN

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: Sulfa

Symptoms: Pt had a little redness below the injection site after the COVID-19 vaccine that came and went. On 2/20/21 (a week after the vaccine) redness was more prevalent and pt had soreness, some swelling, itching, burning sensation, and warm to the touch.

Other Meds: Citalopram, estradiol, xanax

Current Illness: n/a

ID: 1046325
Sex: F
Age: 73
State: OH

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: Codeine

Symptoms: fever, chills, swollen lymph nodes in armpit under site of injection, which disappeared after 10 days. Metal smell and taste which lingers.

Other Meds: Xarelto, aspirin, calcium with D, Preservision vitamins, psyllium, probiotic, cranberry, Estradiol, Atorvastatin

Current Illness:

ID: 1046326
Sex: F
Age: 60
State: TX

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: N/A

Allergies: Unknown

Symptoms: Elevated blood pressure 144/93 heart rate 100 Saturation of peripheral oxygen 96 respiration 16 at 4:50pm Benadryl given at 4:55pm BP 138/106 HR 93 SpO2 94 RR 16 at 5:01pm. Patient reports swelling or edema to lip. Reports after injection previous reaction after another unknown injection in previous years. Patient refused transport via EMS advised to go to ER if symptoms worsen.

Other Meds: Unknown

Current Illness: Unknown

ID: 1046327
Sex: M
Age: 83
State: PA

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: Chest xrays and blood work (all normal)

Allergies: Latex

Symptoms: on 15th he had body aches and a temperature(102) and extremely tired and fatigued. went to the ER on 2/20 and took chest xrays and blood work, temp was 98.1, O2 was normal, pulse was normal.

Other Meds: atenolol atorvastatin bethanechol calcium 600 finasteride flecainide Irbesartan Tylenol protonic Tamsulosin

Current Illness: No

ID: 1046331
Sex: U
Age:
State: AL

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional AE reported; VAQTA that was inadvertently administered after its labeled expiry date; This spontaneous report has been received from a registered nurse, concerning a patient pf unknown age and gender. The patient's medical history, concurrent conditions and concomitant medications were not provided. On 18-JAN-2021, the patient was vaccinated with an inadvertently expiry dose of hepatitis a vaccine, inactivated (VAQTA) lot # S032359 with expiration date 11-JAN-2021 (frequency, route and anatomical location were not provided) for prophylaxis. There were no known temperature excursions and no additional adverse events were reported. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: S032359; expirationdate: 11-JAN-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: VAQTA SYRINGE (DEVICE)

Current Illness:

ID: 1046332
Sex: M
Age: 58
State: NJ

Vax Date: 01/08/2021
Onset Date: 01/13/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Started to feel the tops of his arm and his legs/above his ankles itch / started to come back again; burned a little / burning at the tops of his arms; Had a tingling underneath [the skin]; Has dark spots/ his skin is dark on the top of his arms; His muscles hurt intensely; This case was reported by a consumer via call center representative and described the occurrence of localized itching in a 58-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of injection site pain (1st dose received in September 2020, reference case US2021012496) and flu shot with an associated reaction of injection site pain (received every year, reference case US2021AMR013295). On 8th January 2021, the patient received the 2nd dose of Shingrix. On 13th January 2021, 5 days after receiving Shingrix, the patient experienced localized itching, burning sensation, tingling skin, darkened skin and muscle pain. The patient was treated with benadryl (nos) (Benadryl Spray). On an unknown date, the outcome of the localized itching, burning sensation and darkened skin were not recovered/not resolved and the outcome of the tingling skin was unknown and the outcome of the muscle pain was recovered/resolved. The reporter considered the localized itching, burning sensation, tingling skin, darkened skin and muscle pain to be related to Shingrix. Additional details were provided as follows: The patient had reported the case for himself. The patient started to feel the tops of his arm and his legs/above his ankles itch after vaccination. The patient sprayed Benadryl spray on there and itching went away. The reporter mentioned that it was burned a little and then itching started to come back again and had a tingling underneath the skin and burning and at the tops of his arms. The ankles/leg area has resolved fully. The area on the arms has not resolved and was continuing and it now looks like he has dark spots/ his skin is dark on the top of his arms. The reporter mentioned that spraying Benadryl helps his symptoms. The patient's muscles hurt intensely after vaccination. The reporter consented to follow-up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021012496:Same reporter. US-GLAXOSMITHKLINE-US2021AMR013295:Same reporter

Other Meds:

Current Illness:

ID: 1046333
Sex: F
Age: 81
State: CA

Vax Date: 12/31/2020
Onset Date:
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: her vision is blurry; pain on her left leg, left arm and back; pain on her left leg, left arm; Rash; This case was reported by a consumer via call center representative and described the occurrence of blurred vision in a 81-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of headache (1st dose received on an unknown date, refer case US2021027610). On 31st December 2020, the patient received the 2nd dose of Shingrix. On an unknown date, less than 2 months after receiving Shingrix, the patient experienced blurred vision, back pain, pain in extremity and rash. On an unknown date, the outcome of the blurred vision, back pain and pain in extremity were not recovered/not resolved and the outcome of the rash was recovered/resolved. It was unknown if the reporter considered the blurred vision, back pain, pain in extremity and rash to be related to Shingrix. Additional details were provided as follows: The patient reported for herself. It was reported that patient had a severe reaction to the first and second dose of the shingrix vaccine. After getting the 2nd dose, patient's vision was blurry, she had pain on her left leg, left arm and back. The patient gave consent to contact her health care professional, but she did not have contact information available. The reporter consented to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021027610:same reporter, 1st dose

Other Meds:

Current Illness:

ID: 1046334
Sex: F
Age:
State:

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pain at the injection site / only symptom that persisted; Fatigue / taking a nap at the 4 hour; Chills; Headache; This case was reported by a consumer and described the occurrence of injection site pain in a 16-year-old female patient who received Men B NVS (Bexsero) (batch number ABXB27AA, expiry date unknown) for prophylaxis. Co-suspect products included meningococcal B recom vaccine + aloh + omv pre-filled syringe device (Bexsero Pre-Filled Syringe Device) injection syringe for prophylaxis and Men ACWY-CRM NVS (Meningococcal ACWY Vaccine (potential Menveo)) (batch number U68788BB ?, expiry date unknown) for prophylaxis. On 3rd February 2021, the patient received the 1st dose of Bexsero, Bexsero Pre-Filled Syringe Device and Meningococcal ACWY Vaccine (potential Menveo). On 3rd February 2021, 3 hrs 30 min after receiving Bexsero, Bexsero Pre-Filled Syringe Device and Meningococcal ACWY Vaccine (potential Menveo), the patient experienced injection site pain, fatigue, chills and headache. The patient was treated with ibuprofen (Advil). On an unknown date, the outcome of the injection site pain was not recovered/not resolved and the outcome of the fatigue, chills and headache were recovered/resolved. It was unknown if the reporter considered the injection site pain, fatigue, chills and headache to be related to Bexsero, Bexsero Pre-Filled Syringe Device and Meningococcal ACWY Vaccine (potential Menveo). This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were reported as follows: This case was reported by the patient's parent. The reporter reported an adverse reaction, the patient experienced after receiving the 1st dose of Bexsero and MCV4 shot on the day of reporting. Approximately 3.5 hours after the receiving the vaccine, the patient started to experience the symptoms of fatigue, pain at the injection site and headache. The patient took 2 Advil (200mg ea) right before taking the nap at the 4 hours. The patient woke up 45 minutes later feeling better. The only symptoms that persisted was the pain at the injection site. The reporter plead to let her/ him know if there was any further action that they need to take. The information regarding consent to follow up was not reported.

Other Meds:

Current Illness:

ID: 1046335
Sex: F
Age: 61
State: CA

Vax Date: 09/10/2020
Onset Date: 09/10/2020
Rec V Date: 02/22/2021
Hospital:

Lab Data: Test Name: Blood work; Result Unstructured Data: (Test Result:unknown,Unit:unknown,Normal Low:,Normal High:); Comments: lab test was performed on an unknown date

Allergies:

Symptoms: sore arm; This case was reported by a consumer via call center representative and described the occurrence of pain in arm in a 61-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 10th September 2020, the patient received the 1st dose of Shingrix (intramuscular). On 10th September 2020, less than a day after receiving Shingrix, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was recovered/resolved. It was unknown if the reporter considered the pain in arm to be related to Shingrix. Additional information was provided as follows: The patient received 1st dose of Shingrix and experienced sore arm. The patient had done blood work for a rheumatology consult and would visit an orthopedic surgeon. The reporter called back and updated the correct date for the 1st dose as 10th September 2020. For the tolerance of 2nd dose of Shingrix, refer case US2021AMR002842. The case is linked with the case number US2021002013, reported by the same reporter. The reporter consented to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021002013:Same reporter US-GLAXOSMITHKLINE-US2021AMR002842:

Other Meds:

Current Illness:

ID: 1046336
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Mild rash / slept it off; So tired they slept; This case was reported by a nurse and described the occurrence of rash in an unknown number of patients who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced rash and tiredness. On an unknown date, the outcome of the rash was recovered/resolved and the outcome of the tiredness was unknown. It was unknown if the reporter considered the rash and tiredness to be related to Shingrix. Additional details were provided as follows: Age at vaccination was not applicable for this report. It was reported that the patients had experienced a mild rash following Shingrix and then slept it off. The reporter believed it occurred after the second dose. These patients were so tired they slept and by the next day the rash was gone. The reporter didn't think it was of any severity because they didn't report it. They just mentioned it. No information was available regarding patients or product (lot/expiry dates). The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1046337
Sex: F
Age: 65
State: MI

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash throughout her upper body / ER Visit Required / still have not resolved; Throat tightening / ER Visit Required / still have not resolved; Trouble breathing / ER Visit Required / still have not resolved; Coughing / ER Visit Required / still have not resolved; This case was reported by a consumer via call center representative and described the occurrence of rash in a 65-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 26th December 2020, the patient received the 2nd dose of Shingrix (intramuscular) .5 ml. On 26th December 2020, several hours after receiving Shingrix, the patient experienced rash, throat tightness, difficulty breathing and cough. The patient was treated with steroids nos (Steroids) and antihistamine. On an unknown date, the outcome of the rash, throat tightness, difficulty breathing and cough were not recovered/not resolved. It was unknown if the reporter considered the rash, throat tightness, difficulty breathing and cough to be related to Shingrix. Additional details were provided as follows: The case was reported by patient's husband. The patient had her 2nd dose of Shingrix and a few hours later, she began to experience a rash throughout her upper body, throat tightening, trouble breathing and coughing. She had to go to the Emergency Room on 28th December 2020 for these symptoms and again on 31st December 2020 for these same symptoms. She was being treated with steroids and antihistamines. These symptoms still had not resolved. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1046338
Sex: U
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: One patient 14 years old received their first dose of the Moderna vaccine; A spontaneous report was received from a pharmacist concerning a 14-year-old patient who received their first dose of Moderna's COVID-19 vaccine (mRNA-1273) at the age of 14. The patient's medical history was not provided. Concomitant product use was not provided. Between 11 Jan 2021 and 21 Jan 2021 (date not specified), the patient received their first of two planned doses of mRNA-1273 (No Specific Batch numbers provided: 011L20A - 013L20A - 039K20A) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date in Jan-2021 (between 11/Jan/2021 and 21/Jan/2021), at the age of 14, the patient received their first dose of vaccine. Action taken with mRNA-1273 in response to the event was not provided. The event, one patient 14 years old received their first dose of the Moderna vaccine was considered resolved on an unspecified date in Jan-2021.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273. There were no reported adverse events associated with this case.; Sender's Comments: US-MODERNATX, INC.-MOD-2021-011617: US-MODERNATX, INC.-MOD-2021-011581:

Other Meds:

Current Illness:

ID: 1046339
Sex: F
Age:
State: NY

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: received the second dose of the vaccine yesterday and a lot of it leaked out; The facility realized this and administered a third dose; Syringe Connection Issue; A spontaneous report was received from a healthcare provider, HCP concerning an unknown age female patient who was administered Moderna Covid-19 Vaccine, the patient was administered second dose of mRNA-1273 Vaccine, but a lot of it leaked out. The facility realized this and administered a third dose. On an unknown date, the patient received first dose of two doses of the Moderna mRNA-1273 vaccine, for prophylaxis of COVID-19 infectious, batch number unknown, date first dose administered unknown. Route unknown. The nurse called on behalf of her friend which in this case was the patient. The patient received the second dose of the vaccine yesterday and a lot of it leaked out. The facility realized this and administered a third dose. The nurse would not disclose the patient's information and shared that she would inform her friend the patient to reported the adverse event. The patient medical history was not provided, no concomitant medications were reported. On 04 Feb 2021, the patient was administered the second dose of mRNA-1273 no batch number unknown for prophylaxis of COVID-19 infectious. Action Taken was to administer a third dose. The event was considered resolved after the third dose was administered.; Reporter's Comments: This report refers to a case of underdose, extra dose administered and device connection issue for mRNA-1273 (lot# not provided) with no associated AEs. Causality of these events is not applicable.

Other Meds:

Current Illness:

ID: 1046340
Sex: M
Age: 19
State: MA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A nurse was administering the vaccine when it leaked between the needle and the piston; A nurse was administering the vaccine when it leaked between the needle and the piston; A spontaneous report was received from a healthcare facility staff member concerning a 19 year old, male patient who experienced the vaccine syringe connection issue and vaccine under dose as it leaked between the needle and the piston. The patient's medical history was not provided. Concomitant product use was not provided/unknown by the reporter. The patient received their first of two planned doses of mRNA-1273 (batch number not provided) on 06-FEB-2021 intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. On 6FEB2021, he took his son "Jr." who has the same first and last name to an vaccination location. He is a dental assistant in the office and a first responder. A nurse was administering the vaccine when it leaked between the needle and the piston. He is unsure how much of the vaccine was administered and how much was lost. The injection was attempted by intramuscular injection to the left deltoid. He has had no symptoms following vaccination and has not taken any treatments. Action taken with mRNA-1273 in response to the event(s) was not provided/unknown. The event vaccine under dose and syringe connection issues were considered resolved.; Reporter's Comments: This report refers to a case of syringe connection issue and underdose for mRNA-1273 (lot number: not provided) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1046341
Sex: M
Age: 65
State: NM

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

Lab Data:

Allergies:

Symptoms: Unknown amount of vaccine ran down the back of his arm; A spontaneous report was received from a consumer concerning a 65-year old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and had an unknown amount of vaccine drip down his arm. The patient's medical history was not provided. Concomitant product use was not provided/unknown by the reporter On an unknown date, the patient received their first of two planned doses of mRNA-1273. On 01 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection. On 01 Feb 2021, during administration, some of the vaccine dripped down the back of the patient's arm and onto his pants. The amount of vaccine administered was unknown. Treatment information was not provided/unknown. The patient received both scheduled doses of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event is not applicable. The event vaccine dripped down arm was considered resolved on 01 Feb 2021.; Reporter's Comments: This report refers to a case of Incorrect dose administered for mRNA-1273, lot # 030L20A with no associated AEs.

Other Meds:

Current Illness:

ID: 1046342
Sex: F
Age:
State: WA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Swelling on injection site; Fatigue; Joint pain; Vaccinated subcutaneous instead of intramuscular; A spontaneous report received from a Consumer concerning, unknown age, female patient who received first dose of the Moderna COVID-19 vaccine subcutaneous instead of intramuscular. /MedDRA PT: [Incorrect route of product administration] and experienced swelling on injection site, fatigue, and joint pain. The patient's medical history was not included. Patient's concomitant was not included. On 13 JAN 2021, the patient received their 1st dose of the two planned doses of mRNA-1273 in unknown arm (Batch #: unknown) intramuscularly for prophylaxis of COVID-19 infection. Patient stated she received the Moderna COVID-19 vaccine subcutaneous instead of intramuscular on 13 JAN 2021. Patient stated she experienced swelling on injection site, fatigue, joint pain. Patient stated that the swelling came back in her arm on 21 JAN 2021. c dx Patient stated she was put on antibiotics for treatment. Action taken with mRNA-1273 in response to the event was not provided/unknown. The outcome of the event was unknown/not reported.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their first of two planned doses of mRNA-1273 (Lot: unknown), reporting Incorrect route of product administration associated with vaccination site swelling, fatigue and arthralgia. Based on the current available information and temporal association between the use of the product and the onset date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1046343
Sex: U
Age:
State:

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

Lab Data:

Allergies:

Symptoms: very sick; Initial information was received on 15-Oct-2020 regarding an unsolicited valid non-serious social media case from the patient. This case was linked to case 2020SA292550 (same report). This case involved an adult patient (age and gender were not reported) who was very sick (malaise), after he/she received INFLUENZA VACCINE. It was unknown if the patient had any medical history, concomitant disease or risk factor but he/she had not been sick for a number of years and the patient's past medical treatment(s), vaccination(s), family history and concomitant medication were not reported. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer, batch number and other dosing details were not reported) for prophylactic vaccination as the patient was a volunteer at a hospital. Since the comment received from a public post on the internet, they are assuming that the consumer was referring to the Sanofi flu vaccine. On an unknown date, the patient became very sick (malaise) (non-serious event and unknown latency), following the administration of INFLUENZA VACCINE. Hence reportedly the patient decided to not get flu shot this year (at the time of reporting). It was unknown if the patient experienced any additional symptoms/events. It was unknown if there were lab data/results available. It was not reported if the patient received any corrective treatment. At the time of reporting, the outcome of the event was unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1046344
Sex: F
Age: 79
State: MI

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/22/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Short of Breath, Spo2 74%

Other Meds:

Current Illness:

ID: 1046345
Sex: F
Age: 76
State: CT

Vax Date: 02/11/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pt received vaccine on 2/11/21. She reported onset of redness (approx. 5-6" diameter) and itching at the site on 2/17/21. She was seen by a dermatologist on 2/19/21 and was diagnosed with cellulitis and started on a five day course of cephalexin. Pt reports redness and itching is resolving and that no further follow up is necessary.

Other Meds:

Current Illness:

ID: 1046346
Sex: F
Age: 84
State: MI

Vax Date: 01/30/2021
Onset Date: 02/01/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: T. 99.8

Other Meds:

Current Illness:

Date Died: 01/01/2021

ID: 1046347
Sex: M
Age: 79
State: NJ

Vax Date: 01/20/2021
Onset Date: 01/01/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: When family members came to receive the second dose of their COVID vaccine, they informed us that the above patient had passed away.

Other Meds:

Current Illness:

ID: 1046348
Sex: M
Age: 66
State: FL

Vax Date: 01/05/2021
Onset Date: 01/10/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: none

Allergies: none known

Symptoms: rash ,itching , 5 days after dose prednisone 5 days, Pepcid 5 days, antihistamine shot ,mostly cleared up. received 2nd dose 2-2-21, 7 days later itching restarted, no rash , doctor prescribed same treatment, have some minor itching.

Other Meds: warfarin 3mg,clopidogrel75mg,atorvastatin40mg,metoprolol25mg,fenofibrate160mg,amloplipine2.5mg,theralith xr

Current Illness: none

ID: 1046349
Sex: F
Age: 98
State: VT

Vax Date: 02/07/2021
Onset Date: 02/09/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: Telehealth visit with Primary MD diagnosed patient with shingles

Allergies: None

Symptoms: Patient did not feel well and reports general malaise day 2 and day 3 post vaccination. She noticed itching of Right Breast on Day 3 and later that evening, noticed a rash with blisters.

Other Meds: Chlordiazepokide HCL, Colace,Excedrin, Mutlivitamins, Simvastin, Tylenol, Losartan, Hydrochlorthiazide

Current Illness: None

ID: 1046350
Sex: F
Age: 59
State: MO

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Fever, aches and fatigue.

Other Meds: None

Current Illness: None

ID: 1046351
Sex: M
Age: 61
State:

Vax Date: 02/15/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chilly Nausea weak

Other Meds:

Current Illness:

ID: 1046352
Sex: M
Age: 69
State: SC

Vax Date: 02/16/2021
Onset Date: 02/18/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: none

Allergies: penicillin

Symptoms: dizziness, nausea; took antivert without noticeable effect, recovered in 12 hrs

Other Meds: amlodipine xarelto atorvastatin metoprolol vitamine C

Current Illness: none

ID: 1046353
Sex: M
Age: 83
State:

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Administration error - Vaccine was under diluted, and patient received dose calculated to be approximately 25% more than recommended.

Other Meds:

Current Illness:

ID: 1046354
Sex: F
Age: 59
State: PA

Vax Date: 02/12/2021
Onset Date: 02/20/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: none

Allergies: no known allergies

Symptoms: Itchy rash/small bumps at the site of the injection. Appeared approximately 1 week after initial vaccine injection.

Other Meds: Crestor 5mg, multivitamin, standardized elderberry extract

Current Illness: none

ID: 1046355
Sex: F
Age: 48
State: MT

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash, Fatigue, & Body aches

Other Meds:

Current Illness:

ID: 1046356
Sex: F
Age: 81
State: WA

Vax Date: 02/18/2021
Onset Date: 02/20/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Rash and itching at injection site, continued for one day

Other Meds: Standard HBP, statin, and thyroid meds

Current Illness: None

ID: 1046357
Sex: F
Age: 16
State: FL

Vax Date: 01/13/2021
Onset Date: 01/01/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Age under the requirement for EUA (<18 years of age). No other adverse symptoms noted.

Other Meds:

Current Illness:

ID: 1046358
Sex: F
Age: 63
State: TX

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: n/a

Allergies: no known allergies

Symptoms: papular rash bilateral arms chest and back

Other Meds: aspirin 81 MG EC tablet atorvastatin (LIPITOR) 40 MG tablet cholecalciferol, vitamin D3, 5,000 unit capsule multivitamin capsule

Current Illness: coronary artery disease

ID: 1046359
Sex: F
Age: 75
State: CO

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies: Penicillin,

Symptoms: I have had every effect listed on the paper of side affect including, difficulty of breathing, fainted, dizzy, nauseous, I have spent days in bed

Other Meds:

Current Illness:

ID: 1046360
Sex: F
Age: 71
State: CA

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: None

Allergies: Sulfa, latex, neosporin, polysporin

Symptoms: Itching, red rash on upper left arm 37 hours after vaccine and still present

Other Meds: Levothyroxine, amlodopine, hydrochlorothiazide, B12, D3, ONE-A-DAY multivitamins, potassium

Current Illness: None

ID: 1046361
Sex: F
Age: 50
State: CO

Vax Date: 02/05/2021
Onset Date: 02/15/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: R hand finger happened 2/15 and L hand palm 2/21

Allergies: amoxcillin, clindamycin, celebrex, lisinopril , cefxil

Symptoms: bursting blood vessels on hand x 2 now. One is R hand finger and now in L hand palm. No reason of injury.

Other Meds: Vitamin D

Current Illness: no illness - this is my second vaccine - 1st one was at 01-15-21

ID: 1046362
Sex: F
Age: 47
State: NH

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

Lab Data: N/A

Allergies: Latex Demerol Percocet Furonol

Symptoms: Symptoms onset occurred approx 10 min post administration. Case reports shortness of breath and midsternal chest pain that radiates around her back. She has a history of a cardiac stent one year ago. BP 110/80 HR 80 SpOx 00% room air LS-CTAB Patient evaluated, she presents anxious and admits to anxiety upon arrival. Highly recommended transfer to a higher level of care. Patient refused EMS transport multiple times, she was accompanied by a passenger in the vehicle. She agreed to stay an additional 30 minutes for continued monitoring and then felt well enough to drive home. She was advised to follow up with her PCP and cardiologist.

Other Meds: heart meds psych meds

Current Illness: strep throat

ID: 1046363
Sex: F
Age: 39
State: NY

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Administration error - some vaccine spilled from the needle/syringe. Vaccinator administered a full dose afterwards.

Other Meds:

Current Illness:

ID: 1046364
Sex: F
Age: 36
State: TX

Vax Date: 01/29/2021
Onset Date: 02/05/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: started out with a rash around injection site and is now full blown on left arm from top to wrist and under to arm pit area of arm. rash is a burning sensation and very itchy.

Other Meds:

Current Illness:

ID: 1046365
Sex: F
Age: 32
State: FL

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: N/A

Allergies: None

Symptoms: Day of shot 2/19/21: fatigue, sluggish tired, low grade fever 99.8, nausea, headache. Day #1 after shot 2/20/21: tired, sore, body aches, low grade fever 99.6, nausea, headache. Day #2 after shot 2/21/21: nausea, vomiting, woke up with rash on pelvis, hips and thighs. Severe itching with rash. Day #3 after shot 2/22/21: Hives/rash on lower abdomen, more severe below umbilical area and suprapubic area; rash on bilateral upper anterior thighs, and rash on bilateral hips; severe itching; raised red nodules with circular white base.

Other Meds: Women's One-a-day multivitamin, magnesium, calcium, zinc, vitamin C, biotin

Current Illness: Exploratory Laparoscopic abdominal surgery on 2/11/2021

ID: 1046366
Sex: F
Age: 27
State: MT

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills, Headache, & Fever

Other Meds:

Current Illness:

ID: 1046367
Sex: F
Age: 51
State: OK

Vax Date: 02/09/2021
Onset Date: 02/17/2021
Rec V Date: 02/22/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: About a week later I experienced a large red circular raised itchy rash around the injection site.

Other Meds: Estrogen, Progesterone, Alive 50+ gummy vitamins, Caltrate

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm