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: 1062407
Sex: F
Age: 29
State: NY

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies: Sulfa; Red wine

Symptoms: Chills, body aches beginning at around 3:30 AM Sunday 2/28. Felt like low fever but I don?t have a thermometer. Fatigue all day Sunday with aches and chills, no appetite. I took Tylenol every 6 hours. Then around 1:00 AM Monday 3/1 I began vomiting every half hour or so until 3:30 AM. Feeling fatigue and nausea still at this time.

Other Meds: Sertraline-200 mg daily; Clonazepam-.25 mg as needed (took day of vaccination)

Current Illness: None

ID: 1062408
Sex: F
Age: 58
State: KS

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: Morphine rash Nexium depression

Symptoms: Daily headaches continue since second vaccine. Significant change in mood and concentration/depression from aproximately 1-2 wks post vaccine,

Other Meds: Duloxitine, synthroid, vit b12, vit d, ibuprofen.

Current Illness: None

ID: 1062409
Sex: F
Age: 47
State:

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Throat tightness, chest tightness-cleared by EMS

Other Meds:

Current Illness:

ID: 1062410
Sex: U
Age: 67
State: VA

Vax Date: 02/14/2021
Onset Date: 02/19/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: allergic to penicillin...makes me nauseated

Symptoms: COVID arm.....big red circle and rash, swelling, itching

Other Meds: Levothyroxin, Nefazadone, alledundrum sulfate, flax oil, women's vitamin, vitamin D and calcium, magnesium

Current Illness: none

ID: 1062411
Sex: F
Age: 47
State: PA

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: latex, sulfa drugs, PCN, morphine, ketamine, E-mycin, HCTZ,

Symptoms: At roughly 2:30pm, started with nausea and chills, went home went to bed. Severe muscles cramping and soreness. Went to ER for this was perscribed naproxen for inflammation. Still nothing helped. Went back to ER with elevated heart rate and BP due to the discomfort was accused of being a pill seeker. I just want the pain and muscle cramps to stop. I hurt from head to toe.

Other Meds: tylenol and motrin

Current Illness:

ID: 1062412
Sex: F
Age: 72
State: TX

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Initially I had large red areas around my upper arm which was not painful. This redness lasted several days and finally went away. My arm has remained very sore. After the first injection it was sore for a few days and went away. This soreness has not gone away. It feels like a very sore muscle and is painful with certain range of motion. It has of today been over 6 weeks since the 2nd injection.

Other Meds: Lysinopryl

Current Illness: none

ID: 1062413
Sex: F
Age: 68
State:

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Palpitations, weakness-cleared by EMS

Other Meds:

Current Illness:

ID: 1062414
Sex: F
Age: 30
State: NY

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever, Nausea, Muscle and Join pain, headache, fatigue, chills, large red welt around injection site hot and painful to touch. It also itches. Took Tylenol and slept the symptoms out. Back to mostly normal Sunday 2/28, but on Monday 3/1 still feeling headache, some aches, chills, and nausea, but can tell it is starting to taper off.

Other Meds:

Current Illness:

ID: 1062415
Sex: F
Age:
State: TX

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: N/A

Allergies: Ages ago string reaction to mini in which is no longer in use

Symptoms: Mild rash over entire body. Headache. Cough that developed and worsened over several days similar to an asthmatic cough following bronchitis. Severe fatigue. Sluggish focus Slight dizziness. Slight difficult if reading after a brief time of reading. Slight nausea. Swelling over entire body.

Other Meds: Pramipecole, aspirin, raberpazole, loratadine, duloxetine, levithyroxine, diltiazem, vitamin D, centrum Silver multi-vitamins

Current Illness: None

ID: 1062416
Sex: F
Age: 19
State: IL

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills, body ache, low grade fever

Other Meds:

Current Illness:

ID: 1062423
Sex: F
Age:
State: VA

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

Lab Data:

Allergies:

Symptoms: Developed chills; Fever; This case was reported by a consumer via call center representative and described the occurrence of chills in a female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix with an associated reaction of pain in extremity (1st dose received on an unknown date,refer case US2021AMR001133). Concomitant products included valaciclovir hydrochloride (Valtrex). On 2nd January 2021, the patient received the 2nd dose of Shingrix. On 3rd January 2021, 1 days after receiving Shingrix, the patient experienced chills and fever. The patient was treated with paracetamol (Tylenol). On 3rd January 2021, the outcome of the chills was recovered/resolved. On 4th January 2021, the outcome of the fever was recovered/resolved. It was unknown if the reporter considered the chills and fever to be related to Shingrix. Additional details were provided as follows: This case was reported by patient herself. The age at vaccination was not reported. The patient developed chills and a fever. On 03 January 2021, the patient was treated with tylenol for chills and fever. The reporter stated that on 4th January 2021 she had a slight fever that has resolved. The reporter refused to provide any additional information and hunged up abruptly. The reporter did not consented to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR001133:Same reporter

Other Meds: Valtrex

Current Illness:

ID: 1062424
Sex: F
Age:
State: DE

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: (Test Result:102,Unit:degree F,Normal Low:,Normal High:)

Allergies:

Symptoms: palpitations; fever of 102.; This case was reported by a consumer via call center representative and described the occurrence of palpitation in a female patient 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 palpitation and fever. On an unknown date, the outcome of the palpitation and fever were unknown. It was unknown if the reporter considered the palpitation and fever to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported. The patient received dose of Shingrix and experienced palpitations and fever of 102 degree fahrenhiet. The reporter did not consent to follow up. Limited demographics and details due to caller's refusal to provide information for safety report.

Other Meds:

Current Illness:

ID: 1062425
Sex: M
Age: 60
State: PA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: Test Date: 20210207; Test Name: Body temperature; Result Unstructured Data: (Test Result:102,Unit:degree F,Normal Low:,Normal High:)

Allergies:

Symptoms: diarrhea; lethargic; fever of 102; shivering; weak; This case was reported by a consumer via call center representative and described the occurrence of diarrhea in a 60-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. Concomitant products included Herpes zoster (Shingrix). On 6th February 2021, the patient received the 2nd dose of Shingrix .5 ml. On 7th February 2021, 1 days after receiving Shingrix and an unknown time after receiving Shingrix, the patient experienced diarrhea, lethargy, fever, shivering and weakness. On an unknown date, the outcome of the diarrhea, lethargy, fever, shivering and weakness were not recovered/not resolved. The reporter considered the diarrhea, lethargy, fever, shivering and weakness to be related to Shingrix. Additional information was provided as follows: The patient received vaccine in left arm. The patient received 1st dose 2 month before reporting, the patient did not remember if he experienced any side effects after his first dose. The patient woke up a day before reporting, experienced shivering and a fever of 102 Degree F. The patient was also lethargic and weak and experiencing some diarrhea. All symptoms improved till the time of reporting except for the diarrhea which had worsened. The reporter did not consent to follow up.

Other Meds: Shingrix

Current Illness:

ID: 1062426
Sex: F
Age: 66
State: OH

Vax Date: 09/01/2020
Onset Date:
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: arm has been hurting / when she moves it, it hurts; This case was reported by a consumer via call center representative and described the occurrence of pain in arm in a 66-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. In September 2020, the patient received the 1st dose of Shingrix. On an unknown date, immediately 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: Since the patient got the vaccine, her arm has been hurting. She stated that if she did not move her arm, its fine, but when she move it, it hurts and has done so for 5 months. The patient did not want to get the second dose of shingrix. She did not want to provide HCP (Health Care Professional) information until she went to an appointment The reporter did not consent to follow up.

Other Meds:

Current Illness:

ID: 1062427
Sex: F
Age:
State: CO

Vax Date: 12/09/2020
Onset Date: 12/30/2020
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: First dose on 09Dec2020 and 4 weeks later contracted Zoster; This case was reported by a other health professional via call center representative and described the occurrence of shingles in a 69-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 9th December 2020, the patient received the 1st dose of Shingrix. On 30th December 2020, 21 days after receiving Shingrix, the patient experienced shingles. On an unknown date, the outcome of the shingles was unknown. It was unknown if the reporter considered the shingles to be related to Shingrix. Additional details were reported as follows: The age at vaccination was not reported. The reporter called for information regarding the second dose of the Shingrix vaccine. The patient received first dose and 4 weeks later contracted zoster. No other information was reported.

Other Meds:

Current Illness:

ID: 1062428
Sex: U
Age: 17
State: CA

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

Lab Data:

Allergies:

Symptoms: 17 year old patient received Moderna vaccine; A spontaneous report was received from a nurse concerning a 17 years-old patient (demographics not provided) who received Moderna's COVID-19 vaccine (mRNA-1273). The patient's medical history was not provided. Concomitant product use was not provided by reporter. On 16 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (lot #: 013M20A) (site of administration not specified), intramuscularly for prophylaxis of COVID-19 infection. On 16 Feb 2021, the 17 years-old patient was administered Moderna vaccine. The nurse was inquiring what to do next. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not reported. On 16 Feb 2021, the event 17 year old patient received Moderna vaccine was considered resolved.; Reporter's Comments: This report refers to a case of 17- year-old patient who received for mRNA-1273, lot # 013M20A (Inappropriate age at vaccine administration) . There were no reported AEs associated with this case of Inappropriate age at vaccine administration.

Other Meds:

Current Illness:

ID: 1062429
Sex: F
Age: 72
State: NJ

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: within a minute of each other the nurse gave 2 full doses of vaccine; hard time breathing; lightheadedness; tinnitus, ringing in ears; redness on left arm; headache; A spontaneous report was received from a relative concerning a 72-year old, female patient who received both Moderna's COVID-19 vaccine (mRNA-1273) doses within a minute of each other and experienced having a hard time breathing, headache, redness on left arm, lightheadedness, and tinnitus- ringing in ears. The patient's medical history was not provided. No relevant concomitant medications were reported. On 14 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 011M20A) intramuscularly for prophylaxis of COVID-19 infection. Within one minute, the nurse gave her the second dose of mRNA-1273 (Batch number not provided). The patient had a hard time breathing, bad headache, large redness on left arm, lightheadedness, and tinnitus (ringing in ears). The patient took ibuprofen (400 mg) on 14 Feb 2021 and 15 Feb 2021. On 16 Feb 2021, the patient took Advil (200 mg). The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the event, within a minute of each other the nurse gave 2 full doses of vaccine, was considered resolved on 14 Feb 2021. The outcomes of the events: hard time breathing, redness on left arm, lightheadedness, tinnitus-ringing in ears, and headache is unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1062430
Sex: F
Age: 17
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: daughter who is under 18 received the vaccine; A spontaneous report received from a Consumer concerning, 17-year-old, female patient who received dose of Moderna COVID-19 vaccine. The patient's medical history was not included. Patient's concomitant was not included. On 19JAN2021, the patient received their 1st dose of the two planned doses of mRNA-1273 in unknown arm (Batch #: 025L20A) intramuscularly for prophylaxis of COVID-19 infection. Patient father stated that his daughter who was under 18 received her 1st dost of the Moderna COVID-19 vaccine. Father stated when he took her back for the 2nd dose of the Moderna COVID-19 vaccine the facility denied her. Treatment information was not included/ unknown. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event was considered as recovered.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age (17 year old) for mRNA-1273 (lot number 025L20A) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1062431
Sex: F
Age: 89
State: WI

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

Lab Data:

Allergies:

Symptoms: Warm to the touch; Tender; Swollen; Red spot; A little off from deltoid muscle; A spontaneous report received from a consumer concerning, 90-year-old, female patient who received Moderna's COVID-19 vaccine a little off from the deltoid muscle and experienced redness, swelling, warm to the touch, and tenderness. PT: [Product administered at inappropriate site, injection site erythema, injection site swelling, injection site warmth, and tenderness]. The patient's medical history was not included. Patient's concomitant included calcium, vitamin D, levothyroxine sodium, atorvastatin, citalopram hydrochloride, amitriptyline, triamterene/hydrochlorothiazide, acetylsalicylic acid, and lorazepam. On 02 FEB 2021, the patient received their 1st dose of the two planned doses of mRNA-1273 in left arm (Batch #: 007M20A) for prophylaxis of COVID-19 infection. On 02 Feb 2021, the patient received the vaccine 'a little off from the deltoid muscle' as described by the patient's daughter (nurse). Approximately 9 days later, the patient developed a red spot on her arm and it was swollen and warm to the touch. At the time of the report, the patient's arm was still swollen. The redness was fading and her arm was tender. Treatment for this event included paracetamol. Action taken with mRNA-1273 in response to the event was not provided/unknown. The event, vaccine administered at inappropriate site, was considered recovered/resolved on 02 Feb 2021 The event, redness was considered recovering/resolving. The events, swelling and tenderness, was considered not recovered/not resolved. The outcome of the event, tenderness, was unknown/ not reported.; Reporter's Comments: This report refers to a case of product administered at inappropriate site for mRNA-1273, (lot # 007M20A) with associated injection site erythema, swelling, warmth, and tenderness. Based on the current available information and temporal association between the use of the product and the start date of the injection site events, a causal relationship cannot be excluded.

Other Meds: CALCIUM; VITAMIN D NOS; SYNTHROID; ATORVASTATIN; CELEXA [CITALOPRAM HYDROBROMIDE]; AMITRIPTYLINE; TRIAMTERENE & HCTZ; BABY ASPIRIN; LORAZEPAM

Current Illness:

ID: 1062432
Sex: F
Age:
State: CA

Vax Date: 02/14/2021
Onset Date: 02/14/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Dose leaked during administration of vaccine; did not receive the full dose of the vaccine; vaccine leaked down arm; A spontaneous report was received from a consumer concerning a 71 year old, female patient who experienced the syringe connection issue, vaccine underdose, and exposure via skin contact. The patient's medical history was not provided. Concomitant product use was not provided/unknown by the reporter. On 14-FEB-2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 011M20A) intramuscularly in the arm for prophylaxis of COVID-19 infection. While receiving the vaccine, the patient said the vaccine leaked down her arm and did not receive the full dose. Treatment information was not provided. Action taken with mRNA-1273 in response to the event(s) was not provided. The outcome of the events,syringe connection issue, vaccine underdose, and exposure via skin contact were recovered.; Reporter's Comments: This case concerns a 71-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot 011M20A), reporting Underdose, device connection issue, and exposure via skin contact without any associated adverse events.

Other Meds:

Current Illness:

ID: 1062433
Sex: F
Age: 59
State: PA

Vax Date: 01/05/2021
Onset Date: 01/18/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Missed second dose; COVID-19; A spontaneous report was received from a health care professional concerning a 59-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was diagnosed with COVID-19, missed second dose. Crosslinked case is MOD21-031684. The patient's medical history was not provided. Relevant concomitant medications were reported i.e., methotrexate, Prozac, lamictal, Ritalin. On 05Jan2021 prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273(lot/batch: 026L20A) intramuscularly in the left dominant arm for prophylaxis of COVID-19 infection. Laboratory data was not provided. Treatment details included steroids and ibuprofen. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event was reported that with help of steroids the patient felt better at the third week window.; Reporter's Comments: The event of COVID-19 was consistent with infection in pandemic set up. Very limited information regarding these events has been provided at this time. The event of COVID-19 is assessed as not related to company product.

Other Meds: METHOTREXATE; PROZAC; LAMICTAL; RITALIN

Current Illness:

ID: 1062434
Sex: F
Age:
State: MN

Vax Date: 02/03/2021
Onset Date: 02/14/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pt received 1st dose on 03FEB2021 and 2nd dose on 14FEB2021; A spontaneous report was received from a caregiver regarding a 94-year-old female patient who received Moderna's mRNA-1273 vaccine first dose on 03 February 2021 and second dose on 14 February 2021/Inappropriate schedule of vaccine administered. The patient's medical history was not provided. Concomitant medications were not provided. On 03 February 2021, the patient received the first of two planned doses of mRNA-1273 (Batch: unknown) for prophylaxis of COVID-19 infection. On 14 February 2021, the patient received the second of two planned doses of mRNA-1273 (Batch: unknown) for prophylaxis of COVID-19 infection. This dose was administered earlier than guidelines recommend. Treatment information was not provided. Action taken with mRNA-1273 was not applicable. The outcome of the event, receiving first dose on 03 February 2021, and the second dose on 14 February 2021, was considered resolved.; Reporter's Comments: This report refers to a case of inappropriate schedule of vaccine administered for mRNA-1273 (lot #unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1062435
Sex: U
Age:
State: AK

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

Lab Data:

Allergies:

Symptoms: faulty needle and syringe that caused leakage to occur; Not the entire quantity was injected into the patient; incomplete dose administered; A Spontaneous report was received from a pharmacist concerning a patient of unknown age and gender who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a faulty needle and syringe that caused leakage to occur and not the entire quantity was injected into the patient. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received a dose of two planned doses of mRNA-1273 (Lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date, it was reported that a faulty needle and syringe caused leakage to occur and the patient did not receive the entire quantity of the vaccine. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not reported. The events of faulty needle and syringe that caused leakage to occur and not the entire quantity was injected into the patient was considered resolved on an unspecified date.; Reporter's Comments: This report refers to a case of a patient of unknown age and gender who experienced non-serious unexpected event of faulty needle and syringe that caused leakage to occur and not the entire quantity was injected into the patient (device connection issue, incomplete dose administered) for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of device connection issue and incomplete dose administered

Other Meds:

Current Illness:

ID: 1062436
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: flu; sick; Initial information was received on 16-Feb-2021 regarding an unsolicited valid serious case received from a consumer/non-health care professional (patient) via media. This case involves female patient (age not specified) who had flu (influenza), while she received INFLUENZA VACCINE. The patient's past vaccination(s) included influenza vaccine in 1973 with first shot as sick for prophylactic vaccination. Past medical treatment(s) concomitant medication and family history were not provided. It was unknown if the patient had any medical history, concomitant disease or risk factor. On an unknown date in 1975, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date were not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient was sick (sickness) hours after each shot and Flu (influenza) (serious, unknown latency) following the administration of INFLUENZA VACCINE. The patient was hospitalized for these events. It was unknown if the patient experienced any additional symptoms/events. Patient vowed never again will I take it. There were no lab data/results available. It was not reported if the patient received any corrective treatment. At the time of reporting, the outcome of events were unknown.; Sender's Comments: This case concerns female patient who had influenza and their symptom sickness after vaccination with INFLUENZA VACCINE (unknown manufacturer). The time to onset is unknown. Additional information regarding patient's past medical history, condition at the time of vaccination, lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1062445
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Slightly sore arm; This spontaneous case from the was received on 22-Jan-2021 from other non-health professional (consumer) via Agency (reference number: SEQW21-00272) and concerned a female patient of an unreported age. The patient's concurrent conditions included allergy to polyethylene glycol. The patient's concomitant medications were not reported. On an unknown date, in the past as reported, the patient was vaccinated with a Fluad Quadrivalent (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59, dose: 0.5 ml, route of administration and anatomical location: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified date, an unknown amount of time after receiving Fluad Quadrivalent, the patient experienced slightly sore arm. On an unspecified date, the patient recovered from the event. The reporter did not provide a causality assessment. The case was assessed as non-serious. Company comment: A patient of unknown age was administered Fluad Quadrivalent. On an unspecified date, an unknown amount of time after receiving Fluad Quadrivalent, the patient experienced slightly sore arm. Causal role of the suspect vaccine is assessed as possibly related.; Sender's Comments: A patient of unknown age was administered Fluad Quadrivalent. On an unspecified date, an unknown amount of time after receiving Fluad Quadrivalent, the patient experienced slightly sore arm. Causal role of the suspect vaccine is assessed as possibly related.

Other Meds:

Current Illness: Allergic reaction to excipient

ID: 1062448
Sex: F
Age: 73
State:

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Mental state delayed, arm felt heavy, dry mouth, odd sensation in head-transfer to ER

Other Meds:

Current Illness:

ID: 1062449
Sex: M
Age: 48
State: MA

Vax Date: 02/25/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None. I plan on seeing letting my doctor know about this today as the hot flashes began yesterday and the headaches remain. I figured this may have been normal so I gave it a few days in the hopes it would all go away by now.

Allergies: Since I was a child I was told I am allergic to sulfa drugs. I have no idea if that is true or if would be an allergic reaction. I do believe I am allergic to coconut as I do get a runny nose and cough due to post nasal drip. When I was in the hospital with a kidney stone years ago I was given morphine and I felt extremely drugged and did not like it they switched to Demerol and I felt fine. So I am not sure if I am just sensitive to morphine. My sister is extremely sensitive to Propofol but I have never had it. I do have seasonal allergies, usually in the fall and I take over the counter Zyrtec.

Symptoms: MODERNA COVID-19 Vaccine Per my sheet instructions I am to report any side effects to this website. While I do report my daily progress on V-SAFE it does not allow for detailed reporting and it does not have a radio button for hot flashes that WILL NOT GO AWAY. Approx 30-60 min after the vaccine I did get a headache which has continued (still have it). I did get dizziness and fatigue which has somewhat subsisted and has gotten better (comes and goes) but the headache remains and now I have hot flashes that came out of nowhere last night. It continues with the headache. Nothing has changed from my routine nor have I been around anyone new or traveled recently.

Other Meds: none

Current Illness: None. During my physical in March the doctor did say I may have a minor viral infection as I did have some congestion but nothing was given and I did not take anything. It went away.

ID: 1062450
Sex: M
Age: 55
State: AZ

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Headache, Chills, weakness, Normal flu like symptoms.

Other Meds:

Current Illness: None

ID: 1062451
Sex: F
Age: 71
State:

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Weakness, dizziness, numbness in face, hypertension-evaluated by EMS and refused transportation.

Other Meds:

Current Illness:

ID: 1062452
Sex: F
Age: 44
State: OH

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: CMP: Sodium 138, Potassium 2.9, Chloride 99, CO2 27, Glucose 97, BUN 12, Creat 0.7, GFR >60, Calcium 9.3, AST 20, ALT 17, Alk phos 56, Bili total 0.6, Protein 8.2, Albumin 5.0, Globulin 3.2. Magnesium 2.3 CBC: WBC 6.0, RBC 4.74, HGB 14.4, HCT 42.6, MCV 89.9, Platelet 225, neutrophils 61.8, lymphocytes 30.2, monocytes 7.1 C-reactive Protein: 0.6 02.04.2021 CBC: WBC 13.2, RBC 4.61, HGB 14.0, HCT 41.5, MCV 90.0, Mean cell HGB 30.4, Platelet 228, neutrophils 88.0, lymphocyte 8.3, monocytes 3.4 CMP: Sodium 137,Potassium 3.7, Chloride 103, CO2 25, Glucose 115, BUN 11, Creat 0.6, GFR >60, Calcium 9.0, AST 20, ALT 16, Alk Phos 53, Bili total 1.1, Protein 7.3, Albumin 4.3 Globulin 3.0 Troponin <0.02

Allergies: Ananphylaxis to iron infusion, blood transfusion

Symptoms: Pt presented to ED 45 minutes after receiving 1st dose Pfizer COVID vaccine with elevated BP, itching, rash and hives. Pt PE upon arrival stated that she was in acute distress. Itching,rash,hives,swelling and redness present on pt's back, chest and left arm. Progression: worsening. Moderate severity. Pt had taken lisinopril 10 mg with no improvement. Pt was treated with steroids, H1 and H2 blockers with good response. 02.01.2021 Pt presented to ED with BP of 200/140. Pt reports BP has been elevated since receiving her COVID vaccine on 01.29.2021. Pt exam positive for tinnitis. BP @ 1253 144/98, 1152 170/107, 1130 185/112, 1126 190/124. Pt BP came down with self administered hydralazine. 02.04.21 Pt presents to Ed with elevated BP of 161/111 and chest pressure. Pt has not had relief with dose of clonidine and hydralazine. She also took a dose of steroid. Pt ROS pos for chest tightness, chest pain and leg swelling. BP improved with anxiolysis.

Other Meds:

Current Illness: None

ID: 1062453
Sex: M
Age: 51
State: IL

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Lethargic and run down

Other Meds: Divoprolex

Current Illness: Tuberous Sclerosis 1 and Bipolar

ID: 1062454
Sex: F
Age: 67
State: CA

Vax Date: 02/16/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: Seeing primary doctor today about seeing allergist and no taking second dose of COVID vac.

Allergies: Morphine Poison Oak Wasp/bee stings

Symptoms: Extreme hive spots beginning at scalp and spreading to knees between 6-12 midnight. Area between hive welts filling in with rash or redness. Following day, began to spread again around 5 PM - went to ER - prednisone and benedryl administered. Hives intensified over night disallowing sleep. Next two days hives continued to welt up especially late in the day (having spread to face and neck). Sunday night seeing the redness between welts start to subside in some areas completely. Itching continues into Monday morning but not as intense.

Other Meds: Omeprazole 30mg Anastrozole 1 mg Vit D 1000mg Calcium 1200 mg

Current Illness: None

ID: 1062455
Sex: M
Age: 19
State: NY

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: - Uncontrollable Shivering - Fever - Sore left Arm - Tiredness and fatigue - Kept me up at night

Other Meds: -Amlodipine -Hydrochlorothaizaide

Current Illness: None

ID: 1062456
Sex: F
Age: 44
State: FL

Vax Date: 02/17/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: none

Allergies: PCN, amoxicillin, depo provera, adhesive, gabapentin, lyrica, carafate

Symptoms: "Moderna COVID-19 Vaccine EUA" large reddened area on upper arm, approximately the size of a softball. warm to touch but does not itch, or hurt

Other Meds: Flexeril, Multivitamin, Calcium, Levothyroxine, birth control, zyrtec, biotin, B Complex, fiber gummies

Current Illness: none

ID: 1062457
Sex: M
Age: 81
State: WI

Vax Date: 02/02/2021
Onset Date: 02/09/2021
Rec V Date: 03/01/2021
Hospital: Y

Lab Data:

Allergies: NKDA

Symptoms: Patient admitted for fatigue, dry throat, generalized weakness, dyspnea on exertion. Durion hospitalization was identified to have an acute ischemic CVA -- unclear time of symptom onset, possibly evening of 2/9 or morning of 2/10. Time course suspicious for possible COVID vaccine adverse event. He received his first Moderna COVID vaccine on 2/2/21 per WIR. Per PCP note on 2/9/21: Patient is here today accompanied by his wife with concerns for fatigue, headaches, head pressure and tremors. Received vaccine last Tuesday. Around 10 PM that evening he developed pressured in the head. On Wednesday morning, he states he got out of bed and was in a cold sweat - he states he pajamas were soaked in sweat and he felt chilled. He experienced brief numbness of the left arm down to his fingers. On Thursday, he felt fine - he went out to snow blow. Friday he developed headaches and head pressure. At night, he felt his breathing was labored as he was "gasping for air." On Saturday and Sunday, he sat and laid around all day. On Monday, he wakes up at 125 AM and his blood pressure was 165/104 and it remained elevated for 3 separate readings. Patient was then admitted on 2/10/21 with weakness and confusion, then on 2/11 MD noted ?word finding difficulty, slurred speech, possible subtle right upper lip droop, and possibly some mild right hemineglect? with MRI showing likely embolic source of infarcts and cerebral MRA with possible acute thrombus. His symptoms the day after the vaccine seem a bit suspicious for TIA. Per Drug Policy Manager call to Moderna, no current reports of TIA/stroke secondary to COVID vaccine, so time course may be incidental. Patient had echocardiogram without right to left shunt or clot identified, no known history of atrial fibrillation. Was monitored on telemetry for the duration of his hospitalization without any noted arrhythmias, discharged on e patch for 14-day outpatient monitoring.

Other Meds: acetaminophen alprazolam Execdrine Hydroxyzine ibuprofen

Current Illness:

ID: 1062458
Sex: M
Age: 1
State: MD

Vax Date: 04/11/2016
Onset Date: 04/11/2016
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: unknown

Symptoms: On 4/11/2016, child received two vaccinations that were expired (Hep B, expired 11/1/2015 and Hib expired 10/28/2015)

Other Meds: unknown

Current Illness: unknown

ID: 1062459
Sex: F
Age: 45
State: MA

Vax Date: 02/19/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies: Penicillin, sulfa

Symptoms: Covid arm. Red hard rash at injection site

Other Meds: Synthroid, celexa, topomax, gabapentin, multivitamin

Current Illness: None

ID: 1062460
Sex: F
Age: 67
State: FL

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: Feb. 12: Dilated ocular exam, flourecsien angiogram Feb. 26: Dilated ocular exam

Allergies: Trees and grass

Symptoms: Spontaneous vitreous hemorrhage in right eye 46 hours after receiving shot. Dr. reluctant to attribute to vaccine, and he MAY be correct, but I thought I should report it as a possible adverse event. Hemorrhage dissipating after 2 weeks and expected to clear completely.

Other Meds: Premarin, Prozac, Synthroid

Current Illness:

ID: 1062461
Sex: F
Age: 55
State: NC

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: I have made an appointment this am at 930 with the PA in my family doctor's office. I had thought the other numbness and tingling would go away in time and advil had been decreasing the symptoms before this morning. I took 400mg of advil around 2am for the numbness in my neck and face. I had attributed it to swelling in the facial nerve, thinking it might go away after a few days, but it hasn't. I'm not sure what they will do today.

Allergies: Sulfa drugs, prilosec

Symptoms: Thursday after walking down 2 flights of stairs and getting into car numbness occurred in the left neck and lower side of my face. I took advil and it has came and went for the last several days along with numbness and tingling in my left arm and hand. Yesterday and today the numbness in my face is along my mandible and throughout sometimes I feel strange sensations in my left ear. This morning I woke with additional numbness and tingling in my left foot and leg. As I have been awake this morning, my left leg feels heavier, tingly and my lower right leg is having some issues. I am also having an extreme cold sensation in my feet and the thermostat reads 70 and I am dressed with socks and shoes on. My feet are white with no discoloration.

Other Meds: Atenlol Vitamin D

Current Illness: Sinusitis

ID: 1062462
Sex: F
Age: 61
State: VA

Vax Date: 02/20/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies:

Symptoms: Day 6 - Itching injection site Day 7 - tender injection side. Red circle. Itching. Painful. Soreness into neck and shoulder on left side. Day 8 and 9 - reactions continue Day 9 this report filed.

Other Meds: Celexa, Montelukast, Lisinopril. Occasionally HCTZ or Propranolol. Vitamin D3 and C. Zinc, multi-vitamin.

Current Illness: None.

ID: 1062463
Sex: F
Age: 54
State: CO

Vax Date: 02/25/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: None

Allergies: PCN, Sulfa, Emycin

Symptoms: 1st lot # given in right arm, 2nd in left arm. About 3 days after first shot my eyes swelled to the point where my upper and lower eyelids were almost touching. I didn?t think much of it but now it?s happened after the second dose as well. First time I took 50mg of Benadryl but it didn?t help and took almost 2 days to subside.

Other Meds: Lipitor 40mg /day

Current Illness: None

ID: 1062464
Sex: F
Age: 42
State: OH

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: Na

Allergies: PCN

Symptoms: Swollen tongue with ulcers and blisters.

Other Meds: Atorvastatin; Celexa; Flexeril; Mobic

Current Illness: None

ID: 1062465
Sex: F
Age: 66
State: OH

Vax Date: 02/16/2021
Onset Date: 02/20/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Itching and large rash across my arm around injection site

Other Meds: Simvasatin 40 MG, B3, C, Calcium

Current Illness:

ID: 1062466
Sex: F
Age: 63
State: TX

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: Doctor assessed pt. Vital signs: 175/80, P 82, oxygen 99%, respiration 22, 2/25/21, 11:10am, As per Dr, 911 called. EMS arrived around 11:15am and pt taken to the hospital for further Assessment. I called patient today 3/1/21 for further assessment, however, pt did not answer.

Allergies: Hydrochlorothiazide, metoprolol, bupropion, penicillin, sulfa

Symptoms: Vaccine administered, 10 minutes later pt stated she felt dizzy. She did mention she was anxious after reading possible side effects of COVID vaccine. She started to cry and mentioned the recent loss of a family member. Five minutes later, stated she felt nauseous. Pt crying and requesting for us to call her sister. Denied chest pain, tightness of chest or trouble swallowing. Denied shortness of breath,

Other Meds: Pt currently on several prescriptions for hypertension

Current Illness: No other illnesses

ID: 1062467
Sex: F
Age: 47
State: PA

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: pending

Allergies: PCN

Symptoms: fatigue, burning in nose, myalgia, fever, chills, insomnia, palpitations

Other Meds: Melatonin Flonase Claritin Estroeve

Current Illness: none allergic rhinitis hx Covid Nov 2020

ID: 1062468
Sex: F
Age: 59
State: MA

Vax Date: 02/25/2021
Onset Date: 02/28/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: Sulfa Ace inhibitors Flexoril

Symptoms: Developed a new SHV1 cold sore outbreak on lower left side of lip. Haven?t had one in a while, so it is possibly related to stimulating my immune system. I keep valacyclovir 500 mg on hand for occasional outbreak, so I began my course of treatment immediately upon feeling the cold sore appear.

Other Meds: Aspirin 80mg AM Furosemide 20mg x2 AM Hydralazine 37mg 2x a day (1.5 25mg) Clonazepam 1mg AM and PM Carvedilol 25mg AM and PM Amlodipine 10mg PM Irbesartan 300 AM Atorvastatin 40mg PM Calcitriol 0.25 mg M-W-F PM Ambien 5 mg pm Addyi 100mg p

Current Illness:

ID: 1062469
Sex: F
Age: 70
State: MN

Vax Date: 02/13/2021
Onset Date: 02/18/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: none, NKDA

Symptoms: "70 yo wo/man presents for COVID vaccination reaction Began with rash at injection site and on front anterior neckline on 2/18/21. Patient reports tenderness at L upper arm (site of injection)."

Other Meds: nexium, zyrtec

Current Illness: none

ID: 1062470
Sex: F
Age: 52
State: TX

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data: I haven?t done anything. I couldn?t sleep all night long

Allergies: None

Symptoms: Severe diarrhea, chills, lack of balance, weakness, arm pain. Pain in the back of my head.

Other Meds: None

Current Illness: None

ID: 1062471
Sex: F
Age: 81
State: OH

Vax Date: 01/21/2021
Onset Date: 02/19/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies:

Symptoms: First dose given Moderna, second dose was given Pfizer.

Other Meds:

Current Illness:

ID: 1062472
Sex: F
Age: 43
State: WV

Vax Date: 02/19/2021
Onset Date: 03/01/2021
Rec V Date: 03/01/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Over a week after first shot, arm became painful, hot, and itchy.

Other Meds: Levothyroxine Lisinopril HCTZ

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm