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: 1048735
Sex: F
Age: 100
State: SC

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1048736
Sex: F
Age: 57
State: MI

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: tachycardia heart rate in the teens

Other Meds: none

Current Illness: none

ID: 1048737
Sex: F
Age: 70
State: SC

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Error: Wrong Dose of Vaccine - Too Low

Other Meds:

Current Illness:

ID: 1048738
Sex: F
Age: 32
State: MA

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: PT STATES THAT SHE WAS FEELING WEIRD . PT WAS PALE, STARTED SHAKING AND SAYING THAT SHE WAS GOING TO PASS OUT. PT SLUMPED IN HER CHAIR, SUPPORTED BY 2 RNS, PT UNABLE TO ANSWER PROMPTS. PT TRANSFERRED TO ED. BEDSIDE VITALS IN OBSERVATIONBP 90/66 HR 79

Other Meds:

Current Illness:

ID: 1048739
Sex: F
Age: 66
State: MN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1048740
Sex: F
Age: 54
State: MA

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: PATIENT IN OBS AREA FOR 10 MIN WHE SHE BEGAN TO FEEL"PANICKY WITH HEART RACING. HR 144 BP 148/88. REDIRECTION AND REFOCUS ATTEMPTED WITH GOOD EFFECT AS NOTED BY HR DECREASE TO 88-103 AND BP 130/88 100% PATIENT DENIED SOB AND CHEST PAIN. MARKED DECREASE IN SYMPTOMS WHEN CALM, HOWEVER, DIFFICULT TO KEEP HER CALM AND SHE WAS CONVINCED THE VACCINE WAS THE CAUSE OF THE SYMPTOMS. DECISION MADE TO TAKE PATIENT TO THE ER FOR EVALUATION. VS ON D/C 98- 138/73 100%; REPORT GIVEN TO RN ER CHARGE

Other Meds:

Current Illness:

ID: 1048741
Sex: M
Age: 47
State: VA

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 0720: pt c/o feeling "faint, lightheaded, dizzy" 10 minutes post second dose of Pfizer COVID-19 vaccine. pt appears pale and diaphoretic. laid to the ground with bilateral lower extremities elevated above level of heart. pt states he feels better a few minutes after intervention. VS BP 121/76, HR 68, RR 16, SPO2 96 on RA, T 97.9.

Other Meds:

Current Illness:

ID: 1048742
Sex: F
Age: 44
State: GA

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: Swelling and redness in cheeks. Patient described feeling swelling in lips but no swelling was visible. She was given 25mg Benadryl and monitored for approximately an hour with no additional swelling seen and was driven home by a relative.

Other Meds:

Current Illness:

ID: 1048743
Sex: F
Age: 41
State:

Vax Date: 02/01/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: NA

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds:

Current Illness:

ID: 1048744
Sex: M
Age: 21
State: CA

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Systemic: Syncope -Severe, Systemic: Hypotension-Severe, Additional Details: Reported blood pressure after 911 paramedics arrived was 56/59. Patient was transported to facility. Called facility 3 times to follow up, but no response yet from facility director. Will follow up again on 2/23/21 in the AM.

Other Meds:

Current Illness:

Date Died: 02/12/2021

ID: 1048745
Sex: F
Age: 66
State: MD

Vax Date: 02/08/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Autopsy performed February 18, 2021

Allergies: Gabapentin- Pain in eye

Symptoms: Death on February 12, 2021 acute cardiac tamponade

Other Meds: Aspirin 81 MG Calcium Carb 600mg Loratadine 10 Mg Multivitamin Lisnopril 10 MG Mirtazapine 30 MG at bed for mood Simvastatin 20 MG

Current Illness:

ID: 1048746
Sex: F
Age: 76
State: TN

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Systemic: Seizure-Medium

Other Meds:

Current Illness:

ID: 1048747
Sex: F
Age: 42
State: FL

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Bactrum

Symptoms: Client reported "tingling in back of tongue and throat." Sensation lasted 15-20 minutes. Resolved without medication intervention. Client reported, "Sensation is gone. I feel okay now."

Other Meds: none

Current Illness:

ID: 1048748
Sex: F
Age: 67
State: NC

Vax Date: 02/10/2021
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The needle came out prematurely (I flinched when the nurse injected it) and some amount of the vaccine just dripped down my arm. It seemed like a lot spilled out.

Other Meds: Alendrenol

Current Illness:

ID: 1048749
Sex: F
Age: 74
State: NH

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Shellfish, iodine

Symptoms: Site of vaccine injection started turning red. Itchiness began within twenty minutes of receiving shot. Itchiness was bad enough to put an histamine cream on it. Next morning the arm was swelling and the injection spot swollen more. The redness was worse and the area now hot. I had a slight temperature for a day, The temp went away, chills followed and I was ice cold. Day two after shot the chills left. The spot of injection was getting redder, swelling more and itchy. I am on day three and my arm is swollen, red and itchy.

Other Meds: Hydrochloratheazide

Current Illness:

ID: 1048750
Sex: F
Age: 63
State: MA

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pt reported feeling "woozy" w/ "tunnel vision" whileamb w/ PT to observation area. Pt immediately sat in chair at 9:10am w/ BP 149/82 and HR 74. Pt then t/f to stretcher and placed in supine position. VS cont to be monitored:9:33 - supine - 146/84, 67 denied symptoms c/o "tunnel vision"9:49 - supine - 138/81, 68 denied symptoms 9:55 - pt sat at EOB and denied symptoms pt was givenwater and crackers w/o issue 10:12 - standing - 132/90, 80 denied symptoms, pt amb across room and back (about 50') w/o LOB or sx

Other Meds:

Current Illness:

ID: 1048751
Sex: M
Age: 76
State: KY

Vax Date: 02/19/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital: Y

Lab Data:

Allergies: Contrast Dye

Symptoms: 1st vaccine 1/26/21; 2nd vaccine 2/19/21; developed chest pain 2/22/21 and went to ED and admitted to hospital, DX: Chest pain, unspecified type R07.9 786.50

Other Meds:

Current Illness:

ID: 1048752
Sex: F
Age: 24
State: MI

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: N/A

Symptoms: Fever 101-103, soreness, fatigue and chills

Other Meds: Soma, Ibuprofen

Current Illness: N/A

ID: 1048753
Sex: M
Age: 49
State: MI

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: N/a

Allergies: Lisinopril

Symptoms: Patient came into the office for a routine appointment and I was told by the provider, he was going to be getting Hepatitis A and Hepatitis B injections at checkout. I went and checked his insurance, and went to our fridge that holds private stock injections and found private doses of both Hepatitis A and Hepatitis B injections, grabbed them and the supplies needed for his injection and doubled check to ensure I had the right Patient, Right insurance and gave him both injections. He then checked out and I went back to my desk and charted and documented injections in between patients. - It was actually a Pediatric dose of both Hepatitis A and B he received. When I was notified about him receiving the pediatric injection, the Vares form was filled out, an incident report was documented, and the patient was informed that at his next appt he would have to come in and get the Adult dose of the injection.

Other Meds: N/a

Current Illness: None reported

ID: 1048754
Sex: F
Age: 71
State: FL

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Vital signs

Allergies: Penicillin, Codeine

Symptoms: Client verbalized feeling dizzy after receiving the vaccine. Client was then evaluated by Fire Rescue and cleared to go home at 8:57 am after symptoms resolved.

Other Meds: none

Current Illness: none

ID: 1048755
Sex: F
Age: 19
State: MI

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: N/a

Allergies: Adhesive Tape

Symptoms: Patient came into the office for a routine appointment and I was told by the provider, she was going to be getting Hepatitis A injection at checkout. I went and checked her insurance, and went to our fridge that holds private stock injections and found private doses of both Hepatitis A , grabbed them and the supplies needed for her injection and doubled check to ensure I had the right Patient, Right insurance and gave injection. She then checked out and I went back to my desk and charted and documented injections in between patients. - It was actually a Pediatric dose of both Hepatitis A she received. When I was notified about her receiving the pediatric injection, the Vares form was filled out, an incident report was documented, and the patient was informed that at her next appt she would have to come in and get the Adult dose of the injection.

Other Meds: N/a

Current Illness: None reported

ID: 1048756
Sex: F
Age: 35
State: IN

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: avocado

Symptoms: between 7-8 days after the vaccination, itchiness occurring near the injection site. Within 12 hours after initial itchiness, large (2.5" diameter) hive like spot appearing: red splotchiness, raised skin, hard to the touch, round, warm, extremely itchy. Still in the process of symptoms; this reaction started less than 24 hours ago.

Other Meds: none

Current Illness: none

ID: 1048757
Sex: F
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: #1 Moderna vaccine 1/22/21 @1210hours at right deltoid Date of second shot was not recorded for report 2nd vaccine caused side effects started the next day - woke up feeling very weak, headache, eyes hurting, fever not measured, felt confused, dizzy, vomited x2

Other Meds: Pravastatin Vit D +Calcium

Current Illness:

ID: 1048758
Sex: F
Age: 43
State: OK

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: N/A

Allergies: Sulfa; gluten meal

Symptoms: Tightness in left arm immediately; dizziness - 2 hrs later; significant diarrhea from 8pm - 4am.

Other Meds: Celebrex; Soma; Percocet; Wellbutrin; Lexapro

Current Illness: none

ID: 1048759
Sex: F
Age: 71
State: NY

Vax Date: 02/14/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: One week after the injection the site got hard with a red itchy rash . I am using ice and cortisone cream to treat it. It has been 2 days at this point with no change.

Other Meds: Livothyroxin and Dexilant

Current Illness: None

ID: 1048760
Sex: M
Age: 25
State: PA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/23/2021
Hospital: Y

Lab Data: TestOrdered ByDateCurrently sorted descending Lab CBC WITH WBC DIFFERENTIALOrdered by MD Feb 22, 2021 Lab BASIC METABOLIC PANELOrdered by MD Feb 22, 2021 Lab CBCOrdered by MD Feb 22, 2021 Lab Auto DifferentialOrdered by MD Feb 22, 2021 Lab MAGNESIUMOrdered by MD Feb 22, 2021 Lab PHOSPHORUSOrdered by MD Feb 22, 2021 Lab CBC WITH WBC DIFFERENTIALOrdered by MD Feb 21, 2021 Lab BASIC METABOLIC PANELOrdered by MD Feb 21, 2021 Lab CBCOrdered by MD Feb 21, 2021 Lab Auto DifferentialOrdered by MD Feb 21, 2021 Lab ALBUMINOrdered by MD Feb 21, 2021 Lab CBC WITH WBC DIFFERENTIALOrdered by MD Feb 20, 2021 Lab BASIC METABOLIC PANELOrdered by MD Feb 20, 2021 Lab CBCOrdered by MD Feb 20, 2021 Lab Auto DifferentialOrdered by MD Feb 20, 2021 Lab VITAMIN B12Ordered by MD Feb 20, 2021 Lab CBC WITH WBC DIFFERENTIALOrdered by MDFeb 19, 2021 Lab BASIC METABOLIC PANELOrdered by MD Feb 19, 2021 Lab CBCOrdered by MD Feb 19, 2021 Lab Auto DifferentialOrdered by MDFeb 19, 2021 Lab PT INROrdered by MD Feb 18, 2021 Lab APTTOrdered by MDFeb 18, 2021 Lab CRYPTOCOCCAL ANTIGEN, CSFOrdered by MD Feb 18, 2021 Lab GLUCOSE, CSFOrdered by MD Feb 18, 2021 Lab LACTATE, BODY FLUIDOrdered by S MDFeb 18, 2021 Lab PROTEIN, CSFOrdered by MDFeb 18, 2021 Lab LD, Body FluidOrdered by MDFeb 18, 2021 Lab CELL COUNT WITH DIFFERENTIAL, CSFOrdered by MDFeb 18, 2021 Lab CELL COUNT, CSFOrdered by MDFeb 18, 2021 Lab MANUAL DIFFERENTIAL, CSFOrdered by MDFeb 18, 2021 Imaging MRI - BRAIN WITH & WITHOUT CONTRASTOrdered by DOFeb 18, 2021 Other type of result EKGOrdered by MDFeb 18, 2021 Lab TSH WITH FREE T4 IF INDICATEDOrdered by DOFeb 18, 2021 Lab CERULOPLASMINOrdered by DOFeb 18, 2021 Lab Hepatic Function PanelOrdered by DOFeb 18, 2021 Lab LIPID PANEL WITH DIRECT LDL IF TG IS HIGHOrdered by DOFeb 17, 2021 Lab HEMOGLOBIN A1COrdered by DOFeb 17, 2021 Lab INFLUENZA A/B RSV SARS-COV2,PCROrdered by DOFeb 15, 2021 Lab Urinalysis, Reflex to MicroscopicOrdered by DOFeb 15, 2021 Lab Toxicology, Urine Screen w/ ConfirmationOrdered by DOFeb 15, 2021 Lab CBC WITH WBC DIFFERENTIALOrdered by DOFeb 15, 2021 Lab BASIC METABOLIC PANELOrdered by DOFeb 15, 2021 Lab CBCOrdered by DOFeb 15, 2021 Lab Auto DifferentialOrdered by DOFeb 15, 2021 Lab Manual DifferentialOrdered by DOFeb 15, 2021 Lab ETHANOL, MEDICALOrdered by DOFeb 15, 2021

Allergies: NA

Symptoms: Insomnia, mania, severe psychosis

Other Meds: Prozac

Current Illness: NA

ID: 1048761
Sex: F
Age: 43
State: OH

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: none

Allergies: amoxicillin

Symptoms: The day after the shot the injection site and left arm were extremely sore, and it was very difficult to lift my arm. I have been having headaches and body aches. I have had trouble sleeping and wake up with soreness and aching in my joints where I typically do not have soreness. Today, I am experiencing some soreness and muscle strength loss in the arm where I received the injection.

Other Meds: Amlodipine and levothyroxine

Current Illness: none

ID: 1048762
Sex: M
Age: 63
State: MI

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The next day, developed mild peri-orbital edema. No other symptoms. It resolved in one week. He received the second dose in the series. The same thing happened.

Other Meds:

Current Illness:

ID: 1048763
Sex: F
Age: 85
State: OH

Vax Date: 02/17/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: ECG

Allergies:

Symptoms: New onset Atrial Fibrillation

Other Meds:

Current Illness:

ID: 1048764
Sex: F
Age: 59
State: VA

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: No e

Allergies: Penicillin, sulfa

Symptoms: Fever (99.9) Severe muscle and joint pain all over Exhaustion Moderate by 4 hours post injection Much more severe the first day after Moderate the second day after Gone by third day after

Other Meds: Mycophenolate mofetil 1500 mg 2x/day Progesterone 100 mg /day Estrogen patch Baby aspirin Vitamin d

Current Illness: None

ID: 1048765
Sex: M
Age: 71
State: NY

Vax Date: 02/11/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Severe pain at injection site started 11 days after vaccination. Pain is constant even if not moving arm. Minor pain after injection lasted about 2 days.

Other Meds: None

Current Illness: None

ID: 1048772
Sex: U
Age:
State: VA

Vax Date: 09/20/2016
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: facial paralysis; postherpetic neuralgia; bronchitis; painful rash, herpes zoster; Information has been received regarding a case in litigation from a lawyer referring to a currently approximately 63 years old patient of unknown gender. No information was provided regarding medical history, concurrent conditions, or concomitant medications. On or about 20-SEP-2016, the patient was vaccinated with zoster vaccine live (ZOSTAVAX) (strength, dose, route, lot# and expiration date unknown) at a pharmacy for the long-term prevention of shingles and zoster-related conditions. Subsequently, the patient was treated by providers for the following injuries resulting from the patient's zoster vaccine live (ZOSTAVAX) use: painful rash, herpes zoster, postherpetic neuralgia, facial paralysis and bronchitis. The outcome of the events herpes zoster, postherpetic neuralgia, facial paralysis and bronchitis was unknown. Upon internal review, facial paralysis was determined to be medically significant.

Other Meds:

Current Illness: Prophylaxis

ID: 1048773
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pain and weakness in the arm; weakness in the arm; This case was reported by a consumer via interactive digital media and described the occurrence of pain in arm in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (received 1st dose on an unknown date). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced pain in arm and weakness of arms. On an unknown date, the outcome of the pain in arm and weakness of arms were not recovered/not resolved. It was unknown if the reporter considered the pain in arm and weakness of arms to be related to Shingrix. Additional details were provided as follows: The age group was not reported but was captured as adult as per the vaccine indication. The age at vaccination was not reported. The patient received Shingrix in an unknown arm. At the time of reporting, the patient was still feeling pain and weakness in the arm of injection.

Other Meds:

Current Illness:

ID: 1048774
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever; This case was reported by a consumer via interactive digital media and described the occurrence of fever in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced fever. On an unknown date, the outcome of the fever was unknown. It was unknown if the reporter considered the fever to be related to Shingrix. Additional details were provided as follows: The age group was not reported but was captured as adult as per the vaccine indication. The age at vaccination was not reported. After receiving Shingrx, the patient experienced fever.

Other Meds:

Current Illness:

ID: 1048775
Sex: M
Age: 60
State: FL

Vax Date: 01/18/2021
Onset Date: 01/01/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: Test Date: 20210122; Test Name: Blood pressure; Result Unstructured Data: (Test Result:133/88,Unit:mm Hg,Normal Low:,Normal High:); Test Date: 20210122; Test Name: BMI; Result Unstructured Data: (Test Result:36.68,Unit:unknown,Normal Low:,Normal High:) 36.0 to 36.9; Test Date: 20210122; Test Name: Body temperature; Result Unstructured Data: (Test Result:98.1,Unit:degree F,Normal Low:,Normal High:); Test Date: 20210122; Test Name: Pulse rate; Result Unstructured Data: (Test Result:101,Unit:/min,Normal Low:,Normal High:); Test Date: 20210122; Test Name: Oxygen saturation; Test Result: 96 %; Test Date: 20210122; Test Name: Respiration rate; Result Unstructured Data: (Test Result:18,Unit:/min,Normal Low:,Normal High:)

Allergies:

Symptoms: Red spots started showing up, mainly on my back; Diagnosed with Shingles (Herpes Zoster) / confirmed my diagnosis; Feeling a burning sensation on my back and right side of my chest; Severe pain / some strong pain; today's blister stage; This case was reported by a consumer and described the occurrence of shingles in a 60-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. On 18th January 2021, the patient received Shingrix. In January 2021, less than a week after receiving Shingrix, the patient experienced pain and blister. On 20th January 2021, the patient experienced shingles and burning sensation. On 22nd January 2021, the patient experienced red spotty rash. The patient was treated with valaciclovir hydrochloride (Valacyclovir) and gabapentin (Neurontin (Gabapentin)). On an unknown date, the outcome of the shingles, burning sensation, red spotty rash, pain and blister were not recovered/not resolved. It was unknown if the reporter considered the shingles, burning sensation, red spotty rash, pain and blister to be related to Shingrix. Additional details were reported as follows: This case was reported by patient himself. Two days after receiving Shingrix, the patient started feeling a burning sensation on his back and right side of his chest. The patient stated that 4 days after receiving Shingrix, the burning sensation had increased, and red spots started showing up, mainly on his back. On 22nd January 2021, in the morning, he got a response from his primary care physician and he was able to go to an appointment, where they confirmed his diagnosis of Herpes zoster without complication and had BMI (body mass index) 36.0 to 36.9 and because the patient was in severe pain, he was prescribed with Neurontin (Gabapentin) (Drug Code 69097-0813-12) 100 mg (quantity 30) to take at bedtime and was advised to return in about 6 week for annual (next visit, around 5th March 2021) and was discussed to exercise 3x per week (30 min per time). On 22nd January 2021, blood pressure measurement result was 133/88 mm hg, body mass index result was 36.68, body temperature result was 98.1 degree F, heart rate result was 101 /min, oxygen saturation result was 96 percent and respiratory rate result was 18 /min. On 23rd January,2021, the patient's symptoms increased and in the early morning, the patient went and was diagnosed with Shingles (Herpes Zoster) and was prescribed with Valacyclovir (Drug Code 59746-0325-37) 1 gm tablets (quantity 21) to take 3 times a day for 7 days. The patient had provided the picture of reporting day blister stage. The patient stated that the results of receiving the vaccination had been a huge source of worry and had taken a significant toll in his life and he would like to know what steps we were able to take to make things right in this difficult situation.

Other Meds:

Current Illness:

ID: 1048776
Sex: F
Age: 68
State:

Vax Date: 08/03/2020
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills; Fever; Pain in the arm of the injection site; This case was reported by a consumer via call center representative and described the occurrence of injection site pain in a 68-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 3rd August 2020, the patient received the 1st dose of Shingrix (intramuscular). On an unknown date, less than 6 months after receiving Shingrix, the patient experienced injection site pain, chills and fever. The patient was treated with paracetamol (Tylenol). On an unknown date, the outcome of the injection site pain was recovered/resolved and the outcome of the chills and fever were unknown. It was unknown if the reporter considered the injection site pain, chills and fever to be related to Shingrix. Additional details were provided as follows: The patient had reported the case for herself. The patient experienced pain in the arm of the injection site for one week, she did not recall which arm. The patient took Tylenol for the pain, and it was relieved. The patient also had fever and chills, she did not recall exactly when she experienced these symptoms. The reporter did not consent to follow-up. All information was not available. The consumer did not want to share her address.

Other Meds:

Current Illness:

ID: 1048777
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Hives; facial swelling; felt throat closing; late phase reaction; This case was reported by a physician via call center representative and described the occurrence of hives in a patient who received Flu Seasonal QIV Quebec (FluLaval Tetra 2020-2021 season) for prophylaxis. Co-suspect products included flu seasonal qiv quebec pre-filled syringe device (Flulaval Tetra Pre-Filled Syringe Device) injection syringe for prophylaxis. On an unknown date, the patient received FluLaval Tetra 2020-2021 season and Flulaval Tetra Pre-Filled Syringe Device. On an unknown date, immediately after receiving FluLaval Tetra 2020-2021 season and Flulaval Tetra Pre-Filled Syringe Device, the patient experienced hives (serious criteria other: as per reporter), facial swelling (serious criteria other: as per reporter), throat constriction (serious criteria other: As per reporter) and delayed type hypersensitivity (serious criteria other: as per reporter). The patient was treated with benadryl (nos) (Benadryl). On an unknown date, the outcome of the hives, facial swelling and throat constriction were recovering/resolving and the outcome of the delayed type hypersensitivity was recovered/resolved. It was unknown if the reporter considered the hives, facial swelling, throat constriction and delayed type hypersensitivity to be related to FluLaval Tetra 2020-2021 season and Flulaval Tetra Pre-Filled Syringe Device. 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 provided as follows: Age at vaccination was not reported. The patient experienced Immediate severe reaction as hives, facial swelling, felt throat closing. The patient was given 50 mg Benadryl and symptoms improved but the patient had a late phase reaction that clear with Benadryl. No adrenaline given. The reporter asked what are the ingredients in the Flulaval Quadrivalent season 2020-2021? The reporter wanted to know if the vaccine contain Flulaval Q contain PEG or polysorbate? The reporter did not consent to follow-up. No additional information was provided.

Other Meds:

Current Illness:

ID: 1048778
Sex: F
Age: 16
State: NY

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 16 year old received moderna vaccine; A spontaneous report received from a Consumer concerning, 16-year-old female patient who received Moderna COVID-19 vaccine /MedDRA PT: [Inappropriate Age]. The patient's medical history was not included/ unknown. Patient's concomitant was not included/ unknown. On 13-JAN-2021, the patient received their first of two planned doses of mRNA-1273 in her left arm (Batch #: 012L20A) intramuscularly for prophylaxis of COVID-19 infection. On 10-FEB-2021 patient's mother stated that her 16-year-old daughter received the first dose of the Moderna COVID-19 vaccine. Mother stated that her daughter was scheduled to receive the second dose on 10Feb2021. The local health department denied patient the second dose and advised patient to reach out to the Moderna clinical trial so she could receive the second dose. Treatment information was not provided/ unknown. 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 16 year old female who received their first of two planned doses of mRNA-1273 (Lot number: 012L20A) intramuscularly for prophylaxis of COVID-19 infection. There were no reported adverse events associated with this event of product administered to patient of inappropriate age.

Other Meds:

Current Illness:

ID: 1048780
Sex: M
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 16 year old patient vaccinated; A spontaneous report was received from a consumer concerning a 16-year-old female patient who received both doses, The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On unknown date, the patient received their second of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. The patient received both doses and is only 16-years old. She forgot when she got vaccinated. Treatment information was not provided. 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 outcome for the event was considered resolved.; Reporter's Comments: This case concerns a 16 year old female who received her second of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. There were no reported adverse events associated with this event of product administered to patient of inappropriate age who received both doses.

Other Meds:

Current Illness:

ID: 1048781
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: speculation that a patient may have been administered a second dose subcutaneously; A spontaneous report was received from a pharmacist concerning a patient, who experienced an event of inappropriate route of vaccine administration. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number: not provided) on an unspecified date. On an unspecified date, the patient received their second dose of mRNA-1273 (Batch number: not provided) subcutaneously for the prophylaxis of COVID-19 infection. On an unspecified date, the patient received the second dose of vaccine resulting in the event of inappropriate route of vaccine administration. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, inappropriate route of vaccine administration, was considered resolved.; Reporter's Comments: This report refers to a case of incorrect route of product administration for mRNA-1273 (lot# unknown) after the second dose was administered with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1048782
Sex: M
Age:
State: NM

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: patient did not get the full 0.5 ml dose; Part come out between the needle and syringe; A spontaneous report was received from a nurse concerning a male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and did not get the full 0.5 ml dose and part come out between the needle and syringe. The patient's medical history was not provided. No concomitant medications were reported. On 08 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 031M20a) intramuscularly for prophylaxis of COVID-19 infection. While receiving the vaccine, the nurse stated that part of it went into the patient's arm and part come out between the needle and syringe. The patient did not get the full 0.5 ml dose and the nurse couldn't guess how much he received. Action taken with mRNA-1273 in response to the events was not provided. The events did not get the full 0.5 ml dose and part come out between the needle and syringe were considered resolved on 08 Feb 2021.; Reporter's Comments: This report refers to a case of syringe issue and underdose with mRNA-1273 (Lot number: 031M20a) with no associated AEs.

Other Meds:

Current Illness:

ID: 1048783
Sex: F
Age: 35
State: CT

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Some of the vaccine came out and was not completely administered; The syringe and needle came apart; A spontaneous report was received by a pharmacist regarding a 35-year-old female patient who experienced the needle and syringe coming apart while administering vaccine/syringe connection issue and the dose was not completely administered/vaccine underdose. The patient's medical history was not provided. No concomitant medications provided. On 10 Feb 2021, the patient received the second of two planned doses of mRNA-1273 (Batch number: 010M20A Expiration date: 19 Jul 2021) administered intramuscularly into the arm for prophylaxis of COVID-19 infection. The patient received the second injection on 10 Feb 2021 and the pharmacist reported that the needle and the syringe came apart and some of the vaccine came out and was not administered. They believe the patient got approximately half of a dose. Treatment information was not provided. Consent to contact was obtained. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, needle and the syringe came apart and some of the vaccine came out and was not administered, was considered resolved.; Reporter's Comments: This report refers to a case of vaccine underdose and syringe issue for mRNA-1273 (lot # 010M20A) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1048784
Sex: F
Age:
State: OH

Vax Date: 01/04/2021
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Unable to receive second dose within the extended dosing window of 42 days; A spontaneous report was received from a consumer concerning a female patient, of unknown age, who was administered Moderna's COVID-19 vaccine (mRNA-1273) and the patient would be unable to receive second dose within the extended dosing window of forty-two days/ inappropriate schedule of product administration. The patient's medical history included a broken hip. No relevant concomitant medications were reported. On 04 JAN 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. The patient was originally scheduled for her second Moderna COVID-19 vaccine on 02 FEB 2021. The patient was hospitalized due to a broken hip that occurred prior to receiving her first dose of the vaccine and has not been released to receive her second dose. The patient was kept at the hospital for a scheduled hip replacement on 16 FEB 2021 and will not be released to receive the second vaccine. The hospital would not allow a vaccination provider to administer at the hospital where she was staying and therefore would be unable to receive her second dose within the extended dosing window of forty-two days. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was unknown. The outcome of event, would be unable to receive second dose within the extended dosing window of forty-two days was considered as resolved.; Reporter's Comments: This case concerns a female patient of unknown age who would be unable to receive second dose within the extended dosing window of forty-two days(inappropriate schedule of product administration )for mRNA-1273 vaccine. ( Lot # not available as vaccine is yet to be administered) .

Other Meds:

Current Illness: Broken hip

ID: 1048785
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pneumonia; Initial information received on 15-Feb-2021 regarding an unsolicited valid serious case received from a consumer or non-healthcare professional (reference number: US-SA-SAC20210218000391, other: SAC20210218000391). This case involves a patient (gender and age not reported) who experienced pneumonia, after receiving INFLUENZA VACCINE. Medical history, past medical treatment, past vaccination, concomitant medication 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 serious pneumonia (unknown latency) following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. Details of laboratory data not reported. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome reported as unknown for the event. Information on the batch number was requested.; Sender's Comments: This case concerns a patient (gender and age not reported) who experienced pneumonia after vaccination with INFLUENZA VACCINE. The time to onset is unknown. Further information regarding medical history, concurrent condition during vaccination, laboratory investigations excluding alternative etiologies for the reported event are needed to fully assess this case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1048787
Sex: F
Age: 39
State: TX

Vax Date: 02/14/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: Latex, flonaise, cephlex, tramadol

Symptoms: Red itchy injection site, swollen nodes under right arm, itchy right arm pit

Other Meds: None

Current Illness: None

ID: 1048788
Sex: F
Age: 49
State: PA

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Redness, soreness at the site of the smallpox vaccine scar. Smallpox was administered in childhood in the country. COVID vaccine injection site is about two inches away from the smallpox scar.

Other Meds: atenolol, atorvastatin, synthroid, xolair

Current Illness:

ID: 1048789
Sex: M
Age: 61
State: NC

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: None

Allergies: Sulfa

Symptoms: Muscle and joint pain Exhaustion Fever (101) Chills All began by 4 hours post injection and resolved by morning of 2nd day post injection

Other Meds: Testosterone supplement

Current Illness: None

ID: 1048790
Sex: F
Age: 18
State: SC

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies:

Symptoms: significant arm pain x1 week at time of reporting

Other Meds:

Current Illness:

ID: 1048791
Sex: F
Age: 50
State: OH

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data: ?

Allergies: Penicillin, Sulpha drugs

Symptoms: pain in armpit on left arm that extends into elbow

Other Meds: RX - synthroid, diltiazem, folic acid, lamotrigine, hydroxyzine OTC - allegra, multivitamins, melatonin, supplements

Current Illness: Rheumatoid Arthritis, raynaud's, hypothyroidism, coronary artery vasospasms, vitiligo,

ID: 1048792
Sex: F
Age: 53
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
Hospital:

Lab Data:

Allergies: Scallops ( upset stomach vomiting )

Symptoms: Aside from the usual chills arm pain aches and general malaise for 5 days , I?ve had more frequent and looser stools and stomach cramping since the day of the vaccine .

Other Meds: Maxide 1/2 tab daily ( have been on for 9 years )

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm