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: 1068996
Sex: F
Age: 50
State: CA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: hearing test on 1/14/21

Allergies: none

Symptoms: Woke up the next morning (1/9/21) with severe vertigo. Was unable to walk without assistance. Got worse by the afternoon, unable to tolerate lying down, vomiting. Went to urgent care. Prescibed meclizine and zofran. Meclizine did not really help but able to lay down. By next morning was 70% better, able to walk on my own, slowly. The following Monday (1/11/21) saw ENT, unsure of cause, ears clear of infection. Sent me for hearing test which was done on 1/14/21, normal hearing. Had video visit with doctor on 1/15/21. suggested exercise for benign positional vertigo. Follow up with ENT on 1/29/21. Symptoms much beter, able to go back to work, room spinning happens ocasionally when lying down.

Other Meds: Zyrtec, atorvastatin 10 mg

Current Illness: none

ID: 1068997
Sex: F
Age: 75
State: FL

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

Lab Data: no

Allergies: Amoxicillin

Symptoms: Second dose was received on February 13 and instantly when the needle went in, I started having instant pain that went right to the rotator cuff and the next morning I tried to raise my arm and it was sore in the joint. I?ve done heat, cold presses, Tylenol and everything to try to help the pain, the pain is bad. I received my first dose in January and had the exact same reaction.

Other Meds: Levothyroxine, Omeprazole, Vagifem, Xanax, Ambien, Cletal Mirelax, vitamins, D3, PRN Advair and Ventolin, Pregavlin

Current Illness: no

ID: 1068998
Sex: F
Age: 73
State: NC

Vax Date: 02/11/2021
Onset Date: 02/20/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: none

Allergies: alergic to silk, some antibiotics

Symptoms: Red spot on injection site 9 days after vaccine.faded by day 7 but still seen in shower.

Other Meds: Potassium/Prolia/Voltarin

Current Illness: none

ID: 1068999
Sex: F
Age: 71
State: WI

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

Lab Data:

Allergies: aloe, tape, EES,

Symptoms: lf arm & shoulder pain, fever alternating with chills

Other Meds: Gabapentin, Tramadol, Celebrex, Zinc, Multivit

Current Illness: chills for 12 hrs day prior to receiving vacc #2 on 2/25

ID: 1069000
Sex: F
Age: 66
State: NJ

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

Lab Data:

Allergies: Penicillin my reaction is minor I get hives Salmon

Symptoms: 48 hrs after moderna dose 2 my face swelled. No other symptoms. Lasted approximately 30 hrs. My throat was 100% not affected

Other Meds: Atorvastatin 20 mg tablet

Current Illness:

ID: 1069002
Sex: F
Age:
State: NJ

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

Lab Data: None

Allergies: None

Symptoms: Allergic Reaction throat closed up

Other Meds: Benadryl

Current Illness: None

ID: 1069003
Sex: F
Age: 69
State: MI

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

Lab Data:

Allergies: Penicillins.

Symptoms: Patient received dose 1 of the Moderna COVID vaccine on 02/12/21. Patient received a dose of the Pfizer vaccine on 03/03/21. No adverse event occurred at the time of administration; this was an error where the patient received a different brand for their second dose 19 days after the first dose. Patient was observed for 15 minutes after administration and no adverse effects were noted.

Other Meds: None on record.

Current Illness: None known.

ID: 1069004
Sex: M
Age: 64
State: NY

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

Lab Data: Had negative COVID RT-PCR on 1/25 and 2/22 Labs 2/22 BMP: Na 139, K 4.2, CO2: 26, BUN 22, Cr. 1.09, AST: 20, ALT: 30 Vitamin D 25- Hydroxy: 19 CBC : WBC 7.9, Hemoglobin 14.4, Platelets 204 HDL: 51, Total Cholesterol: 162, Triglycerides 339, LDL: 70 CD4: 1024, VL: 24

Allergies: Bactrim

Symptoms: The patient reports fatigue beginning the day of the vaccine, and persisting to the time of this report. He had residual episodes of fatigue (1 per week) after his stroke 11/20, however after the vaccine he has been fatigued all day. His neurologist changed his Plavix to Brilinta on 2/11/2022 due to fatigue, without effect. During these episodes he sleeps excessively He does not report insomnia, dysarthria, focal weakness/numbness, dizziness or fainting, or new memory issues.

Other Meds: Brilinta Metoprolol Crestor Selzentry Descovy Tivicay Aspirin 81mg Welbutrin Lexapro

Current Illness: No other acute illnesses

ID: 1069005
Sex: F
Age: 46
State: PA

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

Lab Data: None

Allergies: None

Symptoms: Fever, chills, achy, fatigue- began on 2/27/21 @1am Fever went as high as 101.3 degrees. Soreness on arm at injection site as well.

Other Meds: None

Current Illness: None

ID: 1069006
Sex: F
Age: 51
State: WI

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Sulfa

Symptoms: patient reports lacey rash to left upper arm s/p approximately 7 days after 1st dose of moderna; itching; still present today; reports localized swelling and firmness to area at day 7 but has since resolved

Other Meds: Triamcinolone cream; DHEA; Vitamin D; Lexapro; Hydrocortisone cream

Current Illness: NA

ID: 1069007
Sex: F
Age: 61
State: TX

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

Lab Data:

Allergies: Had reaction to shingles Shringrix dose

Symptoms: Diarrhea started 24 hours after and for five days out so far

Other Meds: Levothyroxine 88 mcg, Omeprazole 40mg, Metoprolol Succiante XL 25 mg,, Paroxetine 10mg Benadryl, Herbal-CoQ10, Magnesium, Proactyzme, Nutri Calm, Everflex, Adrenal Support, Vitamin D3, Probiotics, Mineral Chi

Current Illness:

ID: 1069008
Sex: F
Age: 63
State: IN

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

Lab Data:

Allergies: Iron, sulfa

Symptoms: Hives started 1 week after vaccine. Started on medrol dose pack, now improving - not yet resolved.

Other Meds: Bentyl prn, Levsin prn, Remeron 7.5mg daily at night, Singulair 10mg daily,Multivitamin, Protonix 40 mg Simvastatin 20mg; Tizanidine 4mg qhs prn, Tramadol 50mg tid prn.

Current Illness: Migraine headaches, HTN, IBS, GERD, Osteoporosis, OA, Vitamin D Def, HL, Former smoker, allergies.

Date Died: 02/05/2021

ID: 1069009
Sex: M
Age: 94
State: PR

Vax Date: 01/21/2021
Onset Date: 01/30/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Chest X ray

Allergies: None

Symptoms: Several days after vaccination his left arm turned red. He was taken to the hospital where he was evaluated and admitted with a diagnosis of left axillary vein thrombosis. A chest X-ray was taken and he presented bibasilar atelectasis and pneumonia with pleural effusions.

Other Meds: None

Current Illness: Swollen hands

ID: 1069010
Sex: F
Age: 40
State: CA

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

Lab Data: N/A

Allergies: Contrast dye

Symptoms: At roughly 9:00pm I was scrolling through my phone when it became very difficult to focus and I felt nauseous. I got up to go to the bathroom and became extremely dizzy and my heart felt like it was going to beat out of my chest. I was having difficulty breathing and felt disorientated. I crawled up the stairs and when I reached the top I stood up to walk and promptly fainted/passed out. According to my husband I was out for roughly 30 seconds. He described my body as completely tense (formed fists, shaking). I don't have any recollection of passing out. When I came to I was overwhelmed with nausea and immediately vomited. I was sweating profusely and struggling to breath. After I vomited, within minutes (less than three) I felt fine. My heart rate returned to normal and I wasn't dizzy or nauseous.

Other Meds: Symbicort Inhaler 2x/day Celexa 10mg/day

Current Illness: N/A

ID: 1069011
Sex: M
Age: 36
State: WY

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

Lab Data: None.

Allergies: Amoxicillian

Symptoms: Dizzy, all day Brain fog, all day Hands tingled, for about hour after shot. Muscle spasms/sore. Sporadically all over the body but last 1-30 minutes at a time. About a week. Headache everyday since the first dose. Rash and eye problems came back after the first dose. On going.

Other Meds: None

Current Illness: High RH.? Ruhmatoid? Might want to call health service

ID: 1069012
Sex: M
Age: 22
State: TX

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

Lab Data:

Allergies: Cefzil

Symptoms: Tiredness, sore throat (mild), sore arm on the injection side

Other Meds: None

Current Illness: None

ID: 1069013
Sex: M
Age: 47
State: MI

Vax Date: 01/29/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: 2/26/2021 PCR positive for COVID-19

Allergies: none

Symptoms: Patient vaccinated 12/29/20 and 1/19/21. Patient asymptomatic on 2/26/2021 but tested for COVID-19. PCR positive.

Other Meds: Vitamin D3, lexapro, lisonopril, naltrexone, prilosec

Current Illness: depression

ID: 1069014
Sex: F
Age: 66
State: MI

Vax Date: 02/10/2021
Onset Date: 02/17/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: had ultra sound and have svt

Allergies: none known

Symptoms: about 5-7 days after 1st dose i developed swelling and tenderness on the side and behind my right knee

Other Meds: lisinopril calcium vitamin d xanax generic

Current Illness: none

ID: 1069015
Sex: F
Age: 30
State: MN

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

Lab Data:

Allergies: Aspirin and adhesive

Symptoms: 1 week after injection, swelling, redness, inflammation and itchiness as injection site. 4"x3" in area

Other Meds: None

Current Illness: None

ID: 1069016
Sex: M
Age: 30
State: TX

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

Lab Data:

Allergies: None

Symptoms: Flu-like symptoms: fever, chills, headache and nausea

Other Meds: Xyzal, Vitamin D

Current Illness: None

ID: 1069017
Sex: F
Age: 54
State: MN

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

Lab Data: ER observation

Allergies: NKDA

Symptoms: SOB, visual disturbances, hand numbness and weakness. PATIENT REQUESTED SOMEONE COME SPEAK WITH HER DURING THE VACCINATION TO DISTRACT HER BECAUSE SHE DOES NOT LIKE IMMUNIZATIONS. I ASKED SOMEONE TO ACCOMPANY THE PATIENT WHILE I ADMINISTER VACCINE. UPON INJECTION, PATIENT JUMPED AND IMMEDIATELY NOTED SHORTNESS OF BREATH, VISUAL DISTURBANCES, AND HAND NUMBNESS/WEAKNESS. THERE WAS A SMALL DROP OF BLOOD THAT RAN DOWN HER ARM ABOUT 1/2 INCH BEFORE I STOPPED THE BLEEDING WITH A COTTON BALL AND COVERED IT WITH A BANDAGE. I INSTRUCTED HER TO BREATH DEEPLY, SLOWLY, AND EVENLY AND HER BREATHING SEEMED TO BE IMPROVING. SHE CONTINUED TO NOTE HAND NUMBNESS AND WEAKNESS. SHE THEN ACCEPTED OUR INVATIATION TO ESCORT HER TO THE EMERGENCY ROOM. PATIENT REMAIND ALERT AND TALKATIVE AS I ASKED HOW HER BREATHING WAS AND IF SHE HAS HAD ANY REACTION LIKE THIS TO ANY OTHER VACCINE, TO WHICH SHE REPLIED SHE HAD NOT; THAT SHE MAY HAVE REACTED TO THIS BECAUSE THIS IS A DIFFERENT MEDICINE THAN SHE'S HAD IN THE PAST. UPON LEAVING HER AT THE EMERGENCY ROOM, I ASKED HOW HER BREATHING WAS AND IT SEEMED TO HAVE IMPROVED BUT HER HAND WAS STILL NUMB. I ASKED EHR TO STOP BY THE PHARMACY BEFORE LEAVING THE BUILDING SO I KNEW HOW SHE WAS DOING. SHE STOPPED BY AT 10:48AM TO EXPLAIN THAT THE DR. IS HAVING HER MONITOR FOR ANY LOCAL REACTION AND ANAPHYLAXIS TYPE REACTION AND TO REPORT TO ER RIGHT AWAY IF SHE NOTICES ANY SWELLING OF THE MOUTH/THROAT. HER NUMBNESS SEEMED TO BE SUBSIDED AND LOCALIZED MORE TO THE UPPER ARM AREA ABOVE THE ELBOW. SHE WAS GRIPPING HER KEYS IN HER LEFT HAND WITH HER POINTER FINGER POKED THROUGH THE RING ALL THE WAY DOWN TO THE KNUCKLE. SHE WAS STILL INTERESTED IN THE SECOND SHOT BECAUSE SHE HAS FAMILY MEMBERS WHO HAVE HAD SHINGLES AND DOES NOT WANT THAT.

Other Meds: APAP, Symbicort, diclofenac, docusate, gabapentin, ipratropium-albuterol, famotidine

Current Illness: Pain of chest wall due to fall 2/2/21

ID: 1069018
Sex: F
Age: 44
State: IL

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

Lab Data: Taken to ED, evaluation/assessment/ fluid bolus; Solu-Medrol; Pepcid.

Allergies: Shrimp (specifically); Reglan

Symptoms: First felt itching on inner forearms; moved to neck and stomach; throat itching.

Other Meds: Vyvanse; BCP; Botox for migraines

Current Illness: None

ID: 1069019
Sex: M
Age: 30
State: AZ

Vax Date: 02/05/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: 3/1: URGENT CARE, ER VISIT, NEUROLOGICAL TESTS

Allergies: N/A

Symptoms: BELL'S PALSY, FACIAL PARALYSIS

Other Meds: AMLODIPINE 5MG

Current Illness: N/A

ID: 1069020
Sex: M
Age: 43
State: VA

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

Lab Data: n/a

Allergies: none known

Symptoms: Tingling and swelling to lips with progressive tingling and swelling to chin area and neck about 5-10 mins post injection. Given Benadryl 50mg PO and Epinepherine 0.3mg/0.3mL. EMS called. Pt declined transport to hopital, opted to have wife drive him.

Other Meds: none

Current Illness: n/a

ID: 1069021
Sex: F
Age: 72
State: MD

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: Patient presented to ED after her GI specialist referred her for an abnormal hgb level. Patient reported fatigue for past several days but denied any abdominal symptoms or symptoms of bleeding. In the ED, patient's hgb was found to be 5.2. Pt received blood transfusion and was treated with protonix. She underwent an endoscopy and a colonoscopy. Pt was discharged to follow up with GI and PCP

Other Meds:

Current Illness:

ID: 1069022
Sex: F
Age: 70
State: CO

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

Lab Data: None

Allergies: Tylenol, Brie cheese, tree pollens

Symptoms: Increased swelling and pain at the site to size of egg with redness extending down left arm nearly to elbow over 5 days following injection. Did not subside for approximately 10 days and has left continued sore spot at injection site. Also, accompanied by temp 101.4 times 24 hours followed by gen. malaise day 2 till evening.

Other Meds: Tramadol, Aleve, fish oil, L-carnitine, alpha lipoic acid, DMAE, Kelp, Lutein, Zeaxanthin, Biotin, fermented mushroom complex.

Current Illness:

ID: 1069023
Sex: F
Age: 68
State: MI

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

Lab Data: None

Allergies: None

Symptoms: Extreme painful flare of psoriasis on legs, still present, using triamcinolone acetonide to treat.

Other Meds: Losartan Amlodipine Hydrochlorothiazide Prilosec

Current Illness: None

ID: 1069024
Sex: M
Age: 25
State: AZ

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

Lab Data:

Allergies: None

Symptoms: Fatigue and very painful headache, took ibuprofen and a sleep aid, headache resided after about 8 hours and no further fatigue experienced after a good night's rest (9.5 hours of sleep)

Other Meds: Advair 250/50 and Zyrtec

Current Illness: None

ID: 1069025
Sex: M
Age: 70
State: FL

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

Lab Data: Dr drained eye fluid to relief pressure and referred to a retina institute for more teste and checkout. Have been referred to D.o to checkup including blood work.

Allergies: none

Symptoms: Had a eye stroke to the left eye/retinal artery occlusion

Other Meds: ocuvite,multi vitamin and zyrtec

Current Illness: none

Date Died: 02/26/2021

ID: 1069026
Sex: M
Age: 73
State:

Vax Date: 02/05/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Patient admitted with severe COVID on 2/12. Prolonged hospital course requiring intubation. Treated with mechanical ventilation, proning therapy, as well as medical therapy to no avail. Other "significant conditions contributing to death" but not resulting in the underlying cause given in PART I: HTN, T2DM, ESRD, CAD

Allergies:

Symptoms: Death Narrative: Family was able to be present at bedside shortly after patient was extubated. Fentanyl bolus given 10-15 minutes prior. Patient passed away soon after endotracheal tube removed. Time of death 10:14am.

Other Meds:

Current Illness:

ID: 1069034
Sex: U
Age:
State: MD

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: improperly stored vaccine administered; This spontaneous report as received from an administrator refers to a patient of unknown age and gender. The patient's medical history, concurrent conditions and concomitant medications were not reported. On 22-JAN-2021, the patient was vaccinated with an improperly stored dose of measles, mumps, rubella and varicella (oka-merck) virus vaccine live (rHA)(PROQUAD) 0.5 ml, lot # S027460, expiration date: 02-MAR-2021 for prophylaxis (route of administration and anatomical location were not reported). Administered dose of vaccine underwent the temperature excursion of 6 to 14 degrees Fahrenheit (F) (9.3F) for 15 minutes and 6F to 14F (9.1F) for 15 minutes. Digital data logger was involved. There were no previous excursions reported.

Other Meds:

Current Illness:

ID: 1069035
Sex: M
Age: 0
State: OH

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: no side effects; Medical assistant called to report an administered expired ROT ATEQ vaccine, vaccine expired 30-JAN-2021; This spontaneous report was received from a physician and a practice coordinator who worked at the providers office referring to a 6-month-old male patient. No information was provided regarding the patient's medical history, concurrent conditions, drug reactions or allergies and concomitant medication. On 10-FEB-2021, the patient was accidentally vaccinated with a single expired dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ), this was the third dose of the scheme, lot number S012931 and expiration date of 30-JAN-2021, orally for prophylaxis, the patient tolerated the inmmunization well. No side effects. On the same date, the patient was vaccinated with the third dose of: diphtheria toxoid, hepatitis b virus vaccine rhbsag (yeast), pertussis acellular 3-component vaccine, poliovirus vaccine inactivated (vero), tetanus toxoid(PEDIARIX) lot number AZ472 expiration date of 28-NOV-2022 intramuscularly at the right vastus lateralis, hib conj vaccine (tet toxoid)(HIBERIX) lot number TF4EB expiration date of 26-SEP-2021 intramuscularly at the right vastus lateralis, pneumococcal 4 6b 9v 14 18c 19f 23f conj vaccine (crm197)(PREVNAR) lot number DP5137 expiration date of 01-JAN-2023 intramuscularly at the left vastus lateralis and influenza virus split virion 3v vaccine inactivated(AFLURIA) lot number P100244052 expiration date of 30-JUN-2021.

Other Meds:

Current Illness:

ID: 1069036
Sex: F
Age:
State: NM

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

Lab Data:

Allergies:

Symptoms: she "has high-risk HPV; This spontaneous report as received from a physician assistant via company representative refers to a female patient of unknown age. There was no information about the patient's medical history, concurrent conditions or concomitant medication. On an unknown date, reported as years ago, the patient was vaccinated with a dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) or quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) ,0 .5 milliliter, intramuscular for prophylaxis (dose number, and expiration date were not reported), unidentified Merck hpv vaccine administered (name and lot number not provided)". The administration dates of vaccinations were unknown. It was reported that recently, on an unspecified date, the patient received results (test unspecified) stating that she "has high-risk HPV" (papilloma viral infection). The outcome of papilloma viral infection was reported as not recovered. The causal relationship between the aforementioned event hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) or quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) was not reported.

Other Meds:

Current Illness:

ID: 1069037
Sex: M
Age:
State: WA

Vax Date: 08/26/2020
Onset Date: 08/26/2020
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: faint/syncopal episode; faint and flushed; This spontaneous report as received from a finance an business economic reported an adverse event reported to him by medical assistant at health care professional office refers to a 16-year-old male patient. There was no information about the patient's medical history, concurrent conditions or concomitant medication. Approximately on 26-AUG-2020, reported as 6 months ago, the patient was vaccinated with a dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9), intramuscular for prophylaxis (dose, lot number and expiration date were not reported). Approximately on 26-AUG-2020, reported as 6 months ago, the patient became "faint and flushed", after adminsitration of the vaccine. The patient was leaned back on table and symptoms resolved, approximately on the same date, on 26-AUG-2020 . The causal relationship between the events and therapy with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) were not reported. Upon internal review the events faint was considered to be medically significant.

Other Meds:

Current Illness:

ID: 1069038
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: feverish; Felt fatigued; mild body aches; headache; This case was reported by a consumer and described the occurrence of fever in a female patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2020-2021 season) for prophylaxis. In January 2021, the patient received Shingles vaccine and Influenza vaccine Quadrivalent 2020-2021 season. In January 2021, less than a week after receiving Shingles vaccine and Influenza vaccine Quadrivalent 2020-2021 season, the patient experienced fever, fatigue, general body pain and headache. On an unknown date, the outcome of the fever, fatigue, general body pain and headache were unknown. The reporter considered the fever, fatigue, general body pain and headache to be possibly related to Shingles vaccine. It was unknown if the reporter considered the fever, fatigue, general body pain and headache to be related to Influenza vaccine Quadrivalent 2020-2021 season. Additional details were provided as follows: The age at vaccination was not reported. The patient was administered Shingrix at the same time as the flu vaccine. The patient was feverish with mild body aches and a headache. The patient felt fatigued when took the shingles vaccine, which had similar side effects. The patient stated that a third of people who take the shingles shot have flu-like feelings. But it was definitely better than getting shingles.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR001249:Same reporter

Other Meds:

Current Illness:

ID: 1069039
Sex: M
Age:
State: FL

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

Lab Data:

Allergies:

Symptoms: sore arm for a couple days/ more so than with a flu shot; This case was reported by a consumer via call center representative and described the occurrence of pain in arm in a adult male patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season. On an unknown date, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was unknown. It was unknown if the reporter considered the pain in arm to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were reported as follows: The age at vaccination was not reported. The patient had sore arm with a flu shot. This case had been linked with US2021AMR025675, US2021025175 and US2021025187 reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021025175:same reporter US-GLAXOSMITHKLINE-US2021AMR025675:same reporter US-GLAXOSMITHKLINE-US2021025187:same reporter

Other Meds:

Current Illness:

ID: 1069040
Sex: F
Age:
State: PA

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

Lab Data:

Allergies:

Symptoms: sore arm for a day; This case was reported by a consumer and described the occurrence of pain in arm in a 77-year-old female patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis, Hepatitis A vaccine for prophylaxis, Hepatitis B vaccine for prophylaxis and PNEUMOCOCCAL VACCINE for prophylaxis. Concurrent medical conditions included sulfonamide allergy. On an unknown date, the patient received Shingles vaccine, Influenza vaccine Quadrivalent unspecified season, Hepatitis A vaccine, Hepatitis B vaccine and PNEUMOCOCCAL VACCINE. On an unknown date, unknown after receiving Shingles vaccine, Influenza vaccine Quadrivalent unspecified season, Hepatitis A vaccine and Hepatitis B vaccine, 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 Shingles vaccine, Influenza vaccine Quadrivalent unspecified season, Hepatitis A vaccine and Hepatitis B vaccine. Additional information was provided as follows: The age at vaccination was not reported. The patient was a traveler and had all kinds of vaccines. The patient was reported as a very healthy person with no diabetes and overweight. The patient had Shingles shot, pneumonia shot, Flu vaccines, Hepatitis A and Hepatitis B vaccine. Post vaccination the patient had a sore arm for a day. The patient never had fever, headache or nausea. On 21st January 2021, the patient had a COVID 19 vaccine from Pfizer and had skin rash which was recovering at the time of reporting. The reporter consented to follow up.

Other Meds:

Current Illness: Sulfonamide allergy

ID: 1069041
Sex: U
Age:
State: WA

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

Lab Data: Test Name: MRI Test; Result Unstructured Data: (Test Result:brain cerebral glucose deregulated with micro-blee,Unit:unknown,Normal Low:,Normal High:)

Allergies:

Symptoms: Development of cerebral amyloid angiopathy / full active case; Broken brain with a path of more micro-bleeds; broken brain; brain cerebral glucose deregulated; This case was reported by a consumer via interactive digital media and described the occurrence of cerebral amyloid angiopathy in a 56-year-old patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Concurrent medical conditions included blood pressure high. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced cerebral amyloid angiopathy (serious criteria GSK medically significant), cerebral microhemorrhage (serious criteria GSK medically significant), brain injury (serious criteria GSK medically significant) and glucose abnormal. On an unknown date, the outcome of the cerebral amyloid angiopathy, cerebral microhemorrhage, brain injury and glucose abnormal were unknown. It was unknown if the reporter considered the cerebral amyloid angiopathy, cerebral microhemorrhage, brain injury and glucose abnormal to be related to Shingles vaccine. Additional details were reported as follows: 56 years old patient went to hospital with high blood pressure. The patient received unknown shingles vaccine. The patient was at the time brain cerebral glucose deregulated with micro-bleeds to show (M.R.I.) The development of cerebral amyloid angiopathy in play to encapsulate this Zoster pathogen gave to patient a further broken brain with a path of more micro-bleeds now in a full active case of cerebral amyloid angiopathy of someone 88 plus years old at only 56 plus. The patient stated that, this report was from his or her neurologist. The patient was retired at 60. A struggle since 57 years old. No fluff here just facts.

Other Meds:

Current Illness: Blood pressure high

ID: 1069042
Sex: F
Age: 58
State: VA

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

Lab Data:

Allergies:

Symptoms: rash across the middle of her back and under the breasts in the middle area like a triangle; muscle aches in her back that presented yesterday; redness at the injection site/The red area is 3" x 2" in size; tenderness at the injection site; muscle aches in her back / back ache; This case was reported by a consumer and described the occurrence of injection site erythema in a 58-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. The patient's past medical history included rash (had rash like this presented in that area under the breasts in the past), allergic reaction (had an allergic reaction to another medication) and back pain (sometimes had a back ache). On 6th January 2021, the patient received the 1st dose of Shingrix. On 7th January 2021, 1 days after receiving Shingrix, the patient experienced injection site erythema, injection site tenderness and muscle pain. On 8th January 2021, the patient experienced rash. In January 2021, the patient experienced back pain. On an unknown date, the outcome of the injection site erythema, injection site tenderness, rash and muscle pain were not recovered/not resolved and the outcome of the back pain was unknown. It was unknown if the reporter considered the injection site erythema, injection site tenderness, rash, muscle pain and back pain to be related to Shingrix. Additional details were provided as follows: The patient received Shingrix 2 days ago and experienced tenderness and redness at the injection site. The red area was 3 x 2 in size. The patient noticed a rash across the middle of back and under the breasts in the middle area like a triangle. The patient said a rash like this presented in that area under the breasts in the past when she had an allergic reaction to another medication. The patient had muscle aches in her back and although sometimes had a backache so was not sure if that was caused by the vaccine. The reporter did not consent to follow up.

Other Meds:

Current Illness:

ID: 1069043
Sex: F
Age: 67
State: MS

Vax Date: 10/09/2020
Onset Date: 10/01/2020
Rec V Date: 03/03/2021
Hospital:

Lab Data: Test Date: 202010; Test Name: Biopsy; Result Unstructured Data: (Test Result:Allergic reaction,Unit:unknown,Normal Low:,Normal High:)

Allergies:

Symptoms: diagnosed an allergic reaction; rash presented on her right wrist and lower arm area / upper extremities, truck area from under the breasts down to the groin, back; This case was reported by a nurse and described the occurrence of allergic reaction in a 67-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. On 9th October 2020, the patient received the 1st dose of Shingrix and Influenza vaccine Quadrivalent unspecified season. In October 2020, 2 weeks after receiving Shingrix and Influenza vaccine Quadrivalent unspecified season, the patient experienced allergic reaction and rash. The patient was treated with triamcinolone (Kenalog). On an unknown date, the outcome of the allergic reaction and rash were not recovered/not resolved. It was unknown if the reporter considered the allergic reaction and rash to be related to Shingrix. The reporter considered the allergic reaction and rash to be unrelated to Influenza vaccine Quadrivalent unspecified season. Additional details were reported as follows: This case was reported by patient herself. The reporter stated that two weeks later a rash presented on her right wrist and lower arm area. It slowly progressed to both upper extremities, truck area from under the breasts down to the groin, back and a little on the lower extremities as well but not as severe as upper extremities. A biopsy diagnosed an allergic reaction. She had two shots of kenalog that had not helped. She also had a flu shot at the time but was not contributing that to her symptoms. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1069044
Sex: F
Age:
State: CA

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

Lab Data:

Allergies:

Symptoms: Awakened past midnight / sweating / continued every night / and is unresolved; This case was reported by a consumer via call center representative and described the occurrence of night sweat in a 71-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Concomitant products included Herpes zoster (Shingrix). On 1st February 2021, the patient received the 2nd dose of Shingrix. In February 2021, less than a day after receiving Shingrix, the patient experienced night sweat. On an unknown date, the outcome of the night sweat was not recovered/not resolved. It was unknown if the reporter considered the night sweat to be related to Shingrix. Additional information was provided as follows: The patient received 1st dose of Shingrix vaccine about 2 months before reporting and there were no reports of any events associated with it. Later the evening of receiving 2nd Shingrix vaccine, while the patient was sleeping, she was awakened past midnight and was sweating. The sweating continued every night since the 2nd injection and was unresolved at time of report. Formulation of Shignrix was not known for both injections. The reporter did not consent to follow up. Discrepancy: As per narrative time to onset was considered as less than a day and not 1 day as per provided onset date.

Other Meds: Shingrix

Current Illness:

ID: 1069045
Sex: F
Age:
State: TX

Vax Date: 11/30/2020
Onset Date: 12/01/2020
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Soreness and Swelling at the injection site; Rash at the injection site; Swelling at the injection site; low grade Fever; Chills; Fatigue; This case was reported by a consumer via call center representative and described the occurrence of injection site pain in a adult female patient who received Herpes zoster (Shingrix) for prophylaxis. On 30th November 2020, the patient received the 1st dose of Shingrix (intramuscular). On 1st December 2020, 1 days after receiving Shingrix, the patient experienced injection site pain, injection site rash, injection site swelling, fever, chills and fatigue. On 3rd December 2020, the outcome of the fever was recovered/resolved. On an unknown date, the outcome of the injection site pain, injection site rash, injection site swelling, chills and fatigue were recovered/resolved. The reporter considered the injection site pain, injection site rash, injection site swelling, fever, chills and fatigue to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported. The patient received Shingrix and had fatigue, Chills, low grade Fever, soreness and swelling at the injection site, and rash at the injection site. The reactions lasted between three to five days. The reporter consented to follow up. All information was not available.

Other Meds:

Current Illness:

ID: 1069046
Sex: M
Age:
State: GA

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Muscle pain; Weakness; Headache; Shivering; Nausea; This case was reported by a consumer via call center representative and described the occurrence of muscle pain in a male patient who received Herpes zoster (Shingrix) for prophylaxis. On 4th February 2021, the patient received the 1st dose of Shingrix. On 5th February 2021, 1 days after receiving Shingrix, the patient experienced muscle pain, weakness, headache, shivering and nausea. On an unknown date, the outcome of the muscle pain, weakness, headache, shivering and nausea were not recovered/not resolved. It was unknown if the reporter considered the muscle pain, weakness, headache, shivering and nausea to be related to Shingrix. Additional information was provided as follows: The age at vaccination was not reported. The patient got his first shingrix shot a day before reporting and experienced muscle pain, weakness, headache, shivering, and nausea on the day of reporting. The reporter did not consent to follow up.

Other Meds:

Current Illness:

ID: 1069047
Sex: F
Age: 85
State: MA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Test Date: 2021; Test Name: MRI; Result Unstructured Data: (Test Result:small kidney stones,Unit:unknown,Normal Low:,Normal High:); Test Date: 2021; Test Name: X-Ray; Result Unstructured Data: (Test Result:small kidney stones,Unit:unknown,Normal Low:,Normal High:)

Allergies:

Symptoms: had some burning before; showed small kidney stones; maybe had a UTI going on; lower back pain; was not able to get up from the bed or the chair; maybe back kidney pain; This case was reported by a consumer via call center representative and described the occurrence of renal stone in a 85-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Concomitant products included tamsulosin hydrochloride (Tamsulosin), lidocaine hydrochloride (Lidocaine), tramadol and diclofenac (Diclofenac Topical Gel). On 14th January 2021, the patient received the 1st dose of Shingrix. On 15th January 2021, 1 days after receiving Shingrix, the patient experienced renal stone (serious criteria GSK medically significant), urinary tract infection, low back pain, mobility decreased and renal pain. On an unknown date, the patient experienced burning sensation. On an unknown date, the outcome of the renal stone, urinary tract infection, low back pain, mobility decreased, renal pain and burning sensation were not recovered/not resolved. It was unknown if the reporter considered the renal stone, urinary tract infection, low back pain, mobility decreased, renal pain and burning sensation to be related to Shingrix. Additional details were reported as follows: The reporter was patient's daughter. The patient next day of vaccination started to be had lower back pain. The patient was not able to get up from the bed or the chair. The reporter stated that the patient might be had a UTI (urinary tract infection) going on that we were not aware of or might be back kidney pain and the patient had some burning before, but it was not confirmed. X-Ray or MRI (magnetic resonance imaging) showed small kidney stones. The reporter stated that events had still not resolved. The reporter did not consent to follow up with him/her via email as well as with healthcare professional.

Other Meds: Tamsulosin; Lidocaine; TRAMADOL; DICLOFENAC TOPICAL GEL

Current Illness:

ID: 1069048
Sex: F
Age:
State:

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

Lab Data:

Allergies:

Symptoms: Disk injury; shingles on my left leg; pulled leg; Back pain; A spontaneous report was received from a consumer who was also a female patient of unknown age who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced pulled the leg, back pain from disk injury, and shingles on left leg. The patient's medical history was not provided. Concomitant product use was not provided. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. The patient reported she was hospitalized with pulled leg and back pain from disk injury and shingles on left leg. Treatment information was not provided. Action taken with mRNA-1273 in response to the events were not provided. The outcome of the events were unknown.; Reporter's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1069049
Sex: M
Age: 65
State: NY

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

Lab Data:

Allergies:

Symptoms: Covid-19; A spontaneous report was received from a 65-year old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced COVID-19. The patient's medical history was not provided. No relevant concomitant medications were reported. On 19 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 032L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 16 Feb 2021, the patient reported he was admitted to the hospital a week ago because he was positive for COVID-19. No adverse event was reported by the patient after being given the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event, COVID-19 was not provided.; Reporter's Comments: This case concerns a 65-year-old male who was hospitalized with a serious unexpected event of COVID-19. The event occurred with unknown latency after the first dose of mRNA-1273. Treatment was not reported. Event outcome unknown. Based on 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. Further information has been requested.

Other Meds:

Current Illness:

ID: 1069050
Sex: F
Age: 79
State: OH

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

Lab Data:

Allergies:

Symptoms: passed out; almost delirious; couldn't lift leg; pain went all the way down left side of body; sweating; chills; felt heavy weight on chest; left leg hurting so bad like a charley horse; weak all over; allergic reaction; pain in left arm at injection site; felt extremely tired; A spontaneous report was received from a consumer, via notification from another manufacturer, concerning a 79 year-old female patient who experienced an allergic reaction (hypersensitivity); passed out (loss of consciousness); almost delirious (delirium); couldn't lift leg (femoral nerve injury); pain radiating down leg (pain); sweating (hyperhidrosis); chills; heavy weight on chest (chest discomfort); leg hurting like Charlie horse (muscle spasms); weak all over (asthenia); pain in left arm where she got the shot (injection site pain); felt extremely tired (fatigue). The patient's medical history included sinus issues and drug allergies to glycopyrrolate, sulfa, meloxicam, erythromycin and azithromycin. The patient stated that she had a long list of names and ingredients of things she is allergic to. Products known to have been used by the patient, within two weeks prior to the event, included Amiodipine. On 28 Jan 2021, approximately 12 hours prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: 028120A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient reported that she received the vaccine dose around 12:00 or 12:30 pm. The patient reported that she woke up with extreme pain in the left side and in the left arm where she got the shot. The pain went all the way down her body and she reported it as severe pain. She reported that the pain would not go away. The patient reported that she started sweating, had chills, and she felt heavy like a weight on her chest, but she was breathing okay. Her leg on the left side started hurting so bad that it was like a big Charley horse that would not go away. She got out of the bed and tried to see if she could stand on it, but she could not. She tried to rub it, but it did not help. She tried to walk on it, but by that time she was almost delirious. She was sweating so bad and she was weak all over. She had become extremely tired and she ended up laying on the floor because she could not get her leg to lift in order to get back in the bed so she just laid on the floor. By that point, she did not know if she had passed out or fallen asleep, but she does not think she fell asleep because it was too much pain to sleep. When she woke up and came to, the pain in her leg was gone. However, she was still sweating. She could not get back in the bed. The following morning, she was extremely weak and tired. She still felt heavy on her chest like something had been pushed on her. She was hurting, weak, and tired, but the pain was not extreme like it had been that night. She clarified the time of onset for this event was around midnight, but she could not look at the clock to confirm the exact time. She reported the event either started the night of 28 Jan 2021 or early in the morning hours of 29 Jan 2021. She called her doctor, Moderna, and the pharmacist to ask about the ingredients of the vaccine. Treatment information was unknown. Action taken with mRNA-1273 in response to the events was withdrawn. The events, passed out and pain in left leg, was considered resolved the following day. The events of sweating, weakness, tiredness, and heavy chest was improved the following day. The outcome of the events, allergic reaction, delirious, pain in left arm, pain in left side of body, chills, couldn't lift leg, was 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: AMLODIPINE

Current Illness: Allergy to antibiotic (erythromycin); Allergy to antibiotic (azithromycin); Blood pressure high; Drug allergy (allergic reaction to Mobic caused extreme reaction requiring hospitalization); Drug allergy (allergic reaction to anesthesia Robinul while undergoing D&C; caused cardiac arrest.); Sulfonamide allergy

ID: 1069051
Sex: F
Age: 82
State: PA

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

Lab Data: Test Date: 20210129; Test Name: sinus rhythm; Result Unstructured Data: Normal

Allergies:

Symptoms: So tired; No energy, very weak; Same night went into afib; A spontaneous report was received from a 82 years old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) experienced atrial fibrillation, so tired and no energy, very weak. Patient's medical history included atrial fibrillation. Relevant concomitant medications included prednisone and benadryl. On 28 JAN 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: not provided) intramuscularly for prophylaxis of COVID-19 infection. On the same day, patient experienced atrial fibrillation. On 29 JAN 2021, she was so tired and had no energy and was very weak which lasted for 6 days. She thought that this was due to prednisone and Benadryl prophylactically. On the same day, her sinus rhythm was found to be back to normal. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events atrial fibrillation was considered resolved on 29 JAN 2021 and the events so tired and no energy, very weak were considered resolved on 04 FEB 2021.; Reporter's Comments: This case concerns an 82 year old female patient, with medical history of paroxysmal atrial fibrillation (2016), who experienced a serious unexpected event of atrial fibrillation, among other non-serious events, after receiving first dose mRNA- 1273 (Lot# unknown). 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. Further information has been requested.

Other Meds: BABY ASPIRIN

Current Illness:

ID: 1069052
Sex: F
Age: 90
State: FL

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: sepsis; UTI; shingles; severe headaches; A spontaneous report was received from a 90-year old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced UTI, sepsis, shingles, and headaches. The patient's medical history was not provided. No relevant concomitant medications were reported. On 04 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. On 05 Feb 2021, the patient began experiencing severe headaches. On 11 Feb 2021, the patient developed a severe urinary tract infection and had to be hospitalized. The patient broke out with shingles and now has sepsis. The patient is reported as being conscious, but not responding. No treatment information was provided. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcomes of the events, UTI, sepsis, shingles, and headaches, were not provided.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1069053
Sex: F
Age: 78
State: NJ

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

Lab Data: Test Date: 20210212; Test Name: Blood pressure; Result Unstructured Data: High; Test Date: 20210212; Test Name: Chest X-ray; Result Unstructured Data: Normal; Test Date: 20210212; Test Name: EKG; Result Unstructured Data: Normal; Test Date: 20210213; Test Name: Heart nuclear scan; Result Unstructured Data: It was nuclear scan of heart.

Allergies:

Symptoms: Pain in the chest; High Blood Pressure; Acid Reflux; Weak On and Off; A spontaneous report was received from a consumer concerning a 78-year-old, female patient who received a second dose of Moderna's COVID-19 vaccine experienced chest pain, high blood pressure, acid reflux, weak on and off. The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly on an unknown date in Jan-2021. On 11-Feb-2021, patient received their second of two planned doses of mRNA-1273 (Lot number: 013L20A) intramuscularly in left arm for prophylaxis of COVID-19 infection. On 12-Feb-2021, in the morning patient had chest pain which lasted all day. She went to emergency room. Procedures performed at emergency room were blood pressure measurement which was high, electrocardiogram and chest X-ray with normal results. Patient stayed overnight at the hospital for observation. The next morning on 13-Feb-2021, nuclear scan of heart was performed, and it came out normal. Patient got discharged on same day. Sunday morning on 14-Feb-2021 she was weak but in the afternoon she felt better. The weakness has been on and off. Monday morning on 15-Feb-2021 weak again and in the afternoon, she was fine again. Patient was concerned if her symptoms were normal after second dose of vaccine. Acid reflux medication was provided at the hospital. Consent for safety Follow up given. The patient received both scheduled dose of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the events, experienced chest pain, high blood pressure, acid reflux, weak on and off were considered unknown.; Reporter's Comments: Based on the information provide which includes a temporal association, a causal association between the reported events and the administration of the mRNA-1273 cannot be excluded

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm