VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1030213
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Gave vaccine to 17 year olds; A spontaneous report was received from a healthcare professional concerning a 17-year-old, male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and resulting in the event of inappropriate age of dose of administration. The patient's medical history was not provided. Concomitant medications were not reported. On an unspecified date, the patient received their first of two planned doses of mRNA-1273 (Batch number: unknown) for the prophylaxis of COVID-19 infection. On an unspecified date, the patient received the vaccine resulting in the event of inappropriate age of dose of administration. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, inappropriate age of dose of administration, was considered resolved.; Reporter's Comments: This report refers to a case of product administration error for mRNA-1273 (Batch number: unknown), where the product was administered to inappropriate age. There were no associated AEs.

Other Meds:

Current Illness:

ID: 1030214
Sex: F
Age:
State: IN

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: woke with swollen tongue, throat, and all mucosal linings; woke with swollen tongue, throat, and all mucosal linings; woke with swollen tongue, throat, and all mucosal linings; Mallampati score 4, not my baseline; Moderate fatigue rest of the day; Sore arm was experienced within 5 hours of administration; This is a spontaneous report from a contactable Nurse reporting for herself. A 42-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL1284), via an unspecified route of administration at Left arm on 29Dec2020 17:15 at single dose for covid-19 immunization. The COVID-19 vaccine was administered at Hospital. Medical history included hypertension (HTN), ablation corrected Wolff-Parkinson-White syndrome, pre-eclampsia. The patient was not pregnant. Concomitant medication included hydrochlorothiazide, triamterene (MAXZIDE), ibuprofen, naproxen sodium (ALEVE) and Women's multivitamin. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient previously took trolamine polypeptide oleate-condensate (CERUMENEX) and experienced allergy. The patient's sore arm was experienced within 5 hours of administration on 29Dec2020. Next morning 15 hours post, woke with swollen tongue, throat, and all mucosal linings. Mallampati score 4, not her baseline. Moderate fatigue rest of the day. Finally took Benadryl at 23-hours post vaccine, had to repeat Benadryl every 8 hours for 2 more days and monitor symptoms, events onset date was 30Dec2020 08:30. Adverse events result in: Doctor or other healthcare professional office/clinic visit. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was not been tested for COVID-19. The outcome of the events was recovered on an unknown date.; Sender's Comments: Considering the temporal association, a causal association between administration of BNT162B2 and the onset of Swollen tongue, Throat edema, Oral mucosa swollen, and Physical examination abnormal cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds: MAXZIDE; IBUPROFEN; ALEVE

Current Illness:

ID: 1030215
Sex: F
Age:
State: MA

Vax Date: 12/22/2020
Onset Date: 12/26/2020
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: neuropathy; Day 4 after injection, heat sensitivity in hands and feet; tingling in hands/feet; sharp burning needles sensation up arms and legs; Tips of fingers and toes were numb and felt swollen; Tips of fingers and toes were numb and felt swollen; Hands then started peeling, palms became thickened and rough; This is a spontaneous report from a contactable healthcare professional, the patient. A 65-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) solution for injection intramuscular in the right arm on 22Dec2020 at 08:30 (at the age of 65-years-old) as a single dose for COVID-19 vaccination. The patient was not pregnant at the time of vaccination. Medical history included A-fib (atrial fibrillation), GERD (gastroesophageal reflux disease) and osteoporosis. Concomitant medications included atenolol, calcium, acetylsalicylic acid (ASPIRIN), famotidine (PEPCID) and omeprazole. Past drug history included known allergies: fexofenadine (ALLEGRA) and codeine. The patient did not receive any other vaccine within 4 weeks prior to the vaccine. Prior to the vaccination, the patient was not diagnosed with COVID-19. On 26Dec2020, day 4 after injection, the patient experienced heat sensitivity in hands and feet, followed by tingling in hands > feet, with sharp burning needles sensation up arms and legs. Heat sensitivity continued. Tips of fingers and toes were numb and felt swollen for several days, while neuropathy continued. Hands then started peeling, palms became thickened and rough. For the events neuropathy, heat sensitivity in hands and feet, tingling in hands/feet, burning needles sensation, tips of fingers and toes were numb and felt swollen, and hands then started peeling an emergency room visit and physician office visit was required. Unspecified treatment was provided for the events neuropathy, heat sensitivity in hands and feet, tingling in hands/feet, burning needles sensation, tips of fingers and toes were numb and felt swollen, and hands then started peeling. The outcome of the events neuropathy, heat sensitivity in hands and feet, tingling in hands/feet, burning needles sensation, tips of fingers and toes were numb and felt swollen, and hands then started peeling was recovering. Since the vaccination, the patient has been tested for COVID-19. Nasal Swab on 13Jan2021 was negative and on 19Jan2021 was negative. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender's Comments: The information is limited and does not allow a full medical assessment. Considering temporal relationship, a possible contribution role of vaccination with BNT162B2 to the onset of neuropath, cannot be excluded. The case will be reassessed should additional information become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds: ATENOLOL; CALCIUM; ASPIRIN [ACETYLSALICYLIC ACID]; PEPCID [FAMOTIDINE]; OMEPRAZOLE

Current Illness:

ID: 1030216
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: immediate pain in my upper arm; pain in my upper arm it is accompanied by numbness on and off in my are to my fingers tips.; Initial information received on 28-Jan-2021 regarding an unsolicited valid non-serious case received from a consumer/non-hcp. This case involves an adult patient who experienced immediate pain in my upper arm (pain in extremity) and pain in my upper arm it is accompanied by numbness on and off in my are to my fingers tips (hypoaesthesia), while he/she received vaccine INFLUENZA VACCINE. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer, lot number and expiry date not reported) via unknown route in unknown administration site for prophylactic vaccination. The patient developed a non-serious immediate pain in my upper arm (pain in extremity) and pain in my upper arm it is accompanied by numbness on and off in my are to my fingers tips (hypoaesthesia) (unknown latency) following the administration of INFLUENZA VACCINE. It was not reported if the patient received a corrective treatment. The outcome for both the events were unknown at the time of reporting. Information on batch number will not be available.

Other Meds:

Current Illness:

ID: 1030217
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: sore muscles all over; Initial information received on 12-Nov-2020 regarding an unsolicited valid non-serious case received from a consumer via social media. This case involves patient (unknown demographics) who experienced sore muscles all over (myalgia), while he/she received vaccine INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor. Medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date: not reported) via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious sore muscles all over (myalgia) (unknown latency) following the administration of INFLUENZA VACCINE. It was also reported that patient got really sore muscles all over for about a week when got mine. Patient was really under the weather. Hope it affects you differently. It is unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was reported as unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030218
Sex: U
Age:
State:

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: little fever; Initial information received on 19-Jan-2021 regarding an unsolicited valid non-serious case received from a consumer. This case involves patient (unknown demographics) who experienced little fever (pyrexia), while he/she received vaccine INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor. Medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date: not reported) via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious little fever (pyrexia) (next day) following the administration of INFLUENZA VACCINE It was also reported that patient had shot had little fever next day been 7 days no side effects. They need to talk to someone who knows It is unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was reported as unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030219
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: flu; Initial information was received on 01-Feb-2021 regarding an unsolicited valid non-serious case from a consumer/non-health care professional via social media. This case involves a patient (demographics unknown) who had flu (influenza), after received INFLUENZA VACCINE. The patient's past vaccination(s) included influenza vaccine for prophylactic vaccination. The previous vaccinations had always made the patient not feel good for a couple of days. The patient had no medical history, concomitant disease or risk factor. Medical treatment(s) and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer lot number not reported via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious flu (influenza) about two weeks later following the administration of INFLUENZA VACCINE. It was unknown if the patient experienced any additional symptoms/events There were no lab data/results available. It was not reported if the patient received any corrective treatment. At the time of report, the outcome of event was unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030220
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Every time patient got one patient got sick; Initial information received on 02-Feb-2021 regarding an unsolicited valid non-serious case received from a consumer (patient). This case involved a patient of unknown age who got one and got sick (illness), while patient received vaccines INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, it was reported that every time patient got one patient got sick (illness), (latency: unknown) following the administration of suspect vaccine. No laboratory data was reported. It was not reported if the patient received a corrective treatment. Outcome of the event was unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 1030221
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: patient got sick every time patient got one; Initial information received on 02-Feb-2021 regarding an unsolicited valid non-serious case received from a consumer (patient). This case involved a patient of unknown age who got one and got sick (illness), while patient received vaccines INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, it was reported that every time patient got one patient got sick (illness), (latency: unknown) following the administration of suspect vaccine. No laboratory was reported. It was not reported if the patient received a corrective treatment. Outcome of the event was unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 1030222
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: flu; Initial information received on 19-Jan-2021 regarding an unsolicited valid non-serious case received from a consumer. This case involves patient (unknown demographics) who experienced flu (influenza), while he/she received vaccine INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor. Medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date: not reported) via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious flu (influenza) (unknown latency) following the administration of INFLUENZA VACCINE. It was also reported that patient only get the flu when patient have been around people that had the flu vaccine It can slough for up to 2 weeks after injection. But hey, your body, your choice. It is unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was reported as unknown. There will be no information available on the batch number for this case

Other Meds:

Current Illness:

ID: 1030223
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: flu; sick; Initial information received on 02-Dec-2020 regarding an unsolicited valid non-serious case received from a consumer via social media. This case involves patient (unknown demographics) who experienced flu (influenza) and sick (illness), while he/she received vaccine INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor. Medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date: not reported) via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious flu (influenza) and sick (illness) (unknown latency) following the administration of INFLUENZA VACCINE. It was also reported that Social media case, Product name: product name was not provided. Since this is a public post on flu shot campaign. They are assuming the consumer is referring to the flu vaccine. Reported adverse Event Information: patient skipped the flu shot one year when patient thought that patient could not afford it. Well patient got the flu and it cost 500 dollars Plus patient was sick as hell Think about it comment id: 382901882934023. Medication Details and reason for taking the medicine: Indication, dose and frequency: unknown. It is unknown if patient physician provided consent to be contacted It is unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was reported as unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030224
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: told them it would give me flu and it did; Initial information was received on 02-Dec-2020 regarding an unsolicited valid non-serious social media case from the patient. This case involved an adult patient (age and gender were not reported) who had flu (influenza), after he/she received INFLUENZA VACCINE. The patient had no medical history, concomitant disease or risk factor and the patient's past medical treatment(s), vaccination(s), family history and concomitant medication were not reported. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer, batch number and other dosing details were not reported) for prophylactic vaccination. On an unknown date, the patient developed non-serious flu (influenza), (unknown latency) following the administration of INFLUENZA VACCINE. It was unknown if the patient experienced any additional symptoms/events. The patient reported that as his/her experience was just the opposite. Parents forced him/her to get flu shot, even though he/she told them it would give flu. And it did. They had both survived the 1918 pandemic as children, so maybe they were paranoid. Ten years earlier, the patients entire family, except the patient, got flu in that pandemic, & they were lucky that the patient did not, because they were out of groceries. The patient walked to the store through waist-deep snow in a blizzard & came back with 2 of those big brown grocery sacks. Couldn't even see over the top of the bags, the patient followed his/her own trail back home. Since that one flu shot, they had no vaccine & no flu. Not starting at the time of reporting & no coronavirus vaccine either. It was the patients personal experience and he/she knew, but that was what the patient go with. The patient trusts his/her immune system. Details of laboratory data were not reported. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome was unknown. It was unknown if patients physician provided consent to be contacted. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030225
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: flu; Initial information was received on 18-Dec-2020 regarding an unsolicited valid non-serious case from a consumer/non-healthcare professional (patient). This case involves a patient (unknown demographics) who had flu (influenza) and received INFLUENZA VACCINE. The patient's medical history included flu (Influenza) and past vaccination(s) included Influenza Vaccine for 20 years. The patient had no concomitant disease or risk factor. Past medical treatment (s), concomitant medications and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer) (lot number and expiry date not reported) via an unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious flu (influenza) (unknown latency)and administered INFLUENZA VACCINE. The patient had flu every time (for 4 years) but after receiving flu shot no flu occurred. There were no lab data/results available. It was not reported if the patient received a corrective treatment. On an unknown date, the patient recovered from the event. There will be no information available on batch number for this case.

Other Meds:

Current Illness:

ID: 1030226
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: make patient and thousands of others deathly ill; Initial information received on 11-Oct-2020 regarding an unsolicited valid non-serious case received from a consumer (patient) via social media. This case involved a patient of unknown age who and thousands of others deathly ill (illness), after patient received INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, patient and thousands of others deathly ill (illness), (latency: unknown) following the administration of suspect vaccine. No laboratory data was reported. It was not reported if the patient received a corrective treatment. Outcome of the event was unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 1030227
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: got the Flu and almost died the this time; Initial information was received on 05-Feb-2021 regarding an unsolicited valid non-serious case from a consumer or non-health care professional via social media. This case involves a patient (age and gender unspecified) who got the flu and this time almost died (influenza), after patient received INFLUENZA VACCINE. The patient had past vaccination with flu vaccine [INFLUENZA VACCINE] and had flu [influenza]. Past medical treatment, family history and concomitant medication were not reported. The patient had no other medical history, concomitant disease or risk factor. On an unknown date, the patient received a second dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer) [lot number, expiry date and other doing details were not reported] for prophylactic vaccination. On an unknown date, the patient got the flu and this time almost died (influenza), (unknown latency) following the administration of INFLUENZA VACCINE. There were no laboratory data/results available. It was reported, product name was not provided and it was a public post on the Sanofi flu shot campaign and the Race to 200 M hence reporter assumed that the consumer was referring to the Sanofi flu vaccine. It was not reported if the patient received any corrective treatment. At the time of reporting, event outcome was not reported for influenza. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1030228
Sex: U
Age:
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: flu shot, patient wear masks & follow the guidelines & yet right now patient ws sick with the flu; Initial information received on 07-Feb-2021 regarding an unsolicited valid non-serious case received from a consumer (patient) via social media. This case involved a patient of unknown age who got flu shot, patient wear masks & follow the guidelines & yet right now patient was sick with the flu (influenza), while patient received vaccines INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, patient got flu shot, patient wear masks & follow the guidelines & yet right now patient was sick with the flu (influenza), (latency: unknown) following the administration of suspect vaccine. Relevant laboratory test results included: COVID-19 - On an unknown date: Negative [tested for Covid & it was negative]. It was not reported if the patient received a corrective treatment. Outcome of the event was unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 1030233
Sex: F
Age: 67
State: OH

Vax Date: 02/07/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None known

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Slight pain at injection site for a couple days. Then at day 7, itchy round rash developed at injection site. Raised red area about 3 inches across, feels warm, and itches.

Other Meds: Rosuvastatin, Levothyroxine, multi vitamin

Current Illness: None

ID: 1030234
Sex: M
Age: 48
State: NY

Vax Date: 02/14/2021
Onset Date: 02/15/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: soreness on the arm where I got the shot, body aches & tiredness

Other Meds: none

Current Illness: none

ID: 1030235
Sex: F
Age: 55
State: GU

Vax Date: 02/04/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Redness, hardness, and warmth in the area of the vaccination (upper left arm)

Other Meds: Jardiance,Fenofibrate,Glimeperide, Anastrozole, Omega 3, Vit C

Current Illness: None

ID: 1030236
Sex: F
Age: 29
State: PA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: amoxicillin

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: 31 weeks + 3 pregnant. estimated due date 4/12/21. Low grade fever of 100 degrees F, body aches, chills, headache. Lasted until 2/12/21 at 8:00am.

Other Meds: Prenatal vitamin, ferrex 150mg and levothyroxine

Current Illness: none

ID: 1030237
Sex: F
Age: 46
State: IN

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Levaquin, pork, tramadol

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Rash to sore rash to upper chest , and bloating and diarrhea, swollen eyes where vision was like looking through a glass of water.

Other Meds: Benadryl 1 hour before

Current Illness: None

ID: 1030238
Sex: F
Age: 26
State: VA

Vax Date: 01/25/2021
Onset Date: 02/03/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Soy products

Symptom List: Unevaluable event

Symptoms: Stiff arm( 5 days after injection) Then red rash on arm (2.5 inch diameter) (7 days after injection) Then swollen lymph nodes in armpit of injection arm (2 weeks after injection) Then (3 weeks after vaccine) - full body rash/hives, itchy

Other Meds:

Current Illness:

ID: 1030239
Sex: F
Age: 71
State: MI

Vax Date: 02/06/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Large hot, red rash about 2 inches under injection site

Other Meds: Losartan

Current Illness: none

ID: 1030240
Sex: F
Age: 72
State: MI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Covid Arm - 8 days after injection I woke up with a oval shaped red area around the injection site. It was very puffed up, a bit hard, sore and itchy. I had no previous side effects except a slight sore arm for a day or two after the injection. Since I was a bit concerned, I looked up the effect online and found that this is a less common reaction, but does exist. I plan to keep an eye on it and call my doctor if it hasn't resolved in a couple of days

Other Meds: daily multi vitamin & probiotic

Current Illness: Diverticulitis attack

ID: 1030241
Sex: F
Age: 62
State: NJ

Vax Date: 01/27/2021
Onset Date: 01/30/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: history of rashes-seen by Dermatologist and Allergist-can not determine cause...Allergist saying environmentally related, Will be going back to Allergist to discuss reaction. Moderna vaccine #2 administered on 1/27/21 on 1/30/21 developed lower lip swelling and progressed to swelling down chin to L cheek, went to ED IV steroids given, no chest pain or shortness of breath. Observed x 4 hrs then released. Discharged on prednsoine

Symptom List: Injection site pain, Menorrhagia

Symptoms: 1/30/21 at 1pm developed lower lip swelling, progressed down chin to L cheek, no shortness of breath or chest pain Following day extremely tired Started on prednisone x 5 days with Pepcid. Symptoms totally resolved after 2 days

Other Meds: benacar 5mg, Premarin cream, Vitamin D3, B complex, fish oil, elderberry gummies, advil

Current Illness: none

ID: 1030242
Sex: F
Age: 39
State: ME

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Shaking chills, nausea, dizziness, fatigue

Other Meds: Multivitamin, Calcium/Vit D

Current Illness: none

ID: 1030243
Sex: F
Age: 56
State: MI

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Codeine,Bactrim, ivp dye

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I went from couch watching a movie to my husband helping me walk to the bedroom. My body was locked i could barely move. I went into a cold hypothermia chill, I could get warm. ( teeth chattering) My husband said I burning up hot on my body . I didn't think to take my temperature. I was so scared. I've never had the flu ,or anything like this before in my entire life. I called into work the next day , because my job is physical.

Other Meds: Hctz 12.5mg

Current Illness: Hypertension

ID: 1030244
Sex: F
Age: 61
State: MN

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN injection as a child (leg reaction/swelling)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 2nd COVID-19 vaccination on 02-11-2021. NO symptoms with 1st vaccination. I woke up to a fever of 99.8 on 02-12-2021, which gradually escalated to 102 within 2 hours. It remained at 102 for most of day. Finally came down to 101.1 by around 6:00PM. My normal body temperature is low- around 97.6. I also had an odd sensation at the back of my throat- cannot really describe it- sometimes hurt to swallow- but not consistently. Only felt that symptom the day of 02-12-2021. The next morning, my temperature was 99.2. Eventually returning to normal around 3:00 PM that afternoon. I did not take any OTC medications during the course of recovery.

Other Meds: Vitamin D. L-Lysine

Current Illness: None, other than a fall on the ice causing muscle aches/pains

ID: 1030245
Sex: M
Age: 49
State: ME

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: peanut allergies

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: chills sweats, throwing up headaches body aches

Other Meds: cosenytx

Current Illness: rheumatoid psoriatic arthritis

ID: 1030246
Sex: F
Age: 28
State: GA

Vax Date: 02/07/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Red itchy bumps all over my body; starting on lower extremities, and moving to arms and neck. Large (over quarter size) very swollen lump under skin appeared on right shin- it is firm to touch. Other details: I did not consume any foods out of my ordinary diet. I did have 1 gin and tonic the night before (first alcohol since getting the vaccine) I have not been bitten by any bugs to my knowledge, and have not spent any significant time outside. Benadryl cream on bumps soothsayer for a short time, but itchiness remains. The more I scratch the more they appear.

Other Meds: None

Current Illness: None

ID: 1030247
Sex: M
Age: 50
State: IL

Vax Date: 01/27/2021
Onset Date: 02/10/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Started with itching on back and arms on Wednesday 2-10-21. By Friday evening I had a rash all over my back and hives on my back and right arm. Some hive are also apparent on my left hand and wrist. I contacted my doctor Sunday 2-14-21 as the rash and itching were not being controlled by benadryl and hydroctorisone cream. My doctor gave me Prednisone to take 60mg daily for 5 days. I am now on day 2 of therapy and the rash on my back has gone down some, the rash on my right wrist and hand are still severe.

Other Meds: Zinc 25mg Vitamin C 500mg Osteo-bi-flex tripple strength d-amphetamine salt combo 10mg Aspirin EC 81mg Vitamin D3 5,000 units

Current Illness:

ID: 1030249
Sex: F
Age: 44
State: VA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 100.8?F fever began 12 hours after receiving dose and persisted for 18 hours. Fatigue; hip pain throughout these hours. Mild headache began 24 hours after dose, but lasted only a few hours. Fever did not subside with 1000mg of acetaminophen taken every 4-5 hours.

Other Meds: None

Current Illness: None

ID: 1030250
Sex: F
Age:
State: KY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: 1st Vaccine 1/14/21; 2nd Dose Vaccine 2/2/21; developed nausea, elevated temp, chills, body aches, and severe headache 2/3/21.

Other Meds:

Current Illness:

ID: 1030251
Sex: F
Age: 38
State: KY

Vax Date: 02/05/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Na

Symptom List: Tremor

Symptoms: Immediate swelling/raised and red area with some itching. Day 9 increased itching/irritation, hot to the touch and still swollen and red raised area.

Other Meds: Na

Current Illness: Na

ID: 1030252
Sex: F
Age: 68
State: WI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pcn,apples,peanuts,mold,tomato,grass,birch,corn

Symptom List: Erythema, Pruritus

Symptoms: Pain in arm, full body muscle and joint aches, fever several dats later, immediate rash now spreading across body,severe chills

Other Meds: Palmitoylethanolamide

Current Illness: None

ID: 1030253
Sex: F
Age: 70
State: AZ

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Intermittent pain in arm several inches away from injection site which has continued for 10 days.

Other Meds: Atorvastatin, Levothyroxin, Multi-Vitamin

Current Illness:

ID: 1030254
Sex: F
Age: 52
State: NH

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bee sting

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Swelling and red rash on arm at site of injection which is still present, body ache and headache, general malaise the day following the injection resolving within 24 hours

Other Meds: Levothyroxine, rosuvastatin, D3, B complex, vitamin C, multivitamin

Current Illness:

ID: 1030256
Sex: F
Age: 74
State: CT

Vax Date: 02/08/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Allergic reaction six days after receiving vaccine...red blotch at vaccine site, itchy...this is second day and still the same. Have photo if needed.

Other Meds: Quinapril 20 mg 1 x day vitamins - took 1 time after vaccination

Current Illness: none

ID: 1030257
Sex: F
Age: 35
State: OH

Vax Date: 02/06/2021
Onset Date: 02/14/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Red swelling and itching around injection site that didn't appear until a week after the 1st dose of the vaccine. Swollen spot is about the size of the palm of my hand.

Other Meds: None

Current Illness: None

ID: 1030258
Sex: F
Age: 51
State: NJ

Vax Date: 01/21/2021
Onset Date: 01/29/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: After 8 days post vaccine, a red raised rash appeared at injection site. Rash was circular and 5 inches in diameter. There was pain in elbow area (lymph nodes?) as well. No other symptoms. There was no rash or redness after the vaccine, only appeared 8 days later.

Other Meds: none

Current Illness: none

ID: 1030259
Sex: M
Age: 65
State: AZ

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Painful, reddened big toe on left foot within 24 hours of injection. Pain and redness disappeared after 24 hours. Itchy, reddened rash at injection site on left arm which is still present as of 2/15/21.

Other Meds: Simvastatin Multi vitamin Tamsulosin Tumeric CoQ10 Vit D3

Current Illness: None

ID: 1030260
Sex: M
Age: 78
State: CT

Vax Date: 02/09/2021
Onset Date: 02/12/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Initially, focal pain in left shoulder, subscapular. In susequent days more diffuse in location and more intense. Distribution shoulders and upper back, greater on left. Exacerbated by motion and pressure. Relieved by acetominophen.

Other Meds: None

Current Illness: None

ID: 1030261
Sex: F
Age: 72
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Pt. reported itching on back and bilateral arms. Pt. did not complain of shortness of breath, GI upset, difficulty breathing; redness to bilateral upper arms and scapular region. Pt. stated she does have an allergy to penicillin but does not carry emergency medication for treatment. Pt. declined EpiPen and shared with pt and husband, the driver, that it was protocol to call EMS at this time due to reaction. Pt and husband upset and concerned about cost of EMS ride. Driver (husband) stated he would take pt to ED if emergency care was needed. Called 911 to have EMS dispatched and while on line with dispatcher, husband stated he was leaving and proceeded to exit the vaccination site.

Other Meds:

Current Illness:

ID: 1030262
Sex: F
Age: 70
State: WV

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: began to feel foggy headed which came and went on day 2. On day 3 the foggy head also came with nausea. Persisted off and on all day. When I went to bed around 11:30 pm that day I began to feel like I was inside a closed up box. This persisted and disappeared around 3 am on the 4th morning and hasn't returned

Other Meds: levothyroxine, Vit B12, Multi vitamin

Current Illness: none

ID: 1030267
Sex: U
Age:
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: other zoster-related conditions; shingles; Information has been received from a lawyer, regarding a case in litigation, and refers to a patient (pt) of unknown age and gender. No information about the pt's medical history, concurrent conditions or concomitant medications was provided. On an unknown date in 2014, the pt was inoculated with zoster vaccine live (ZOSTAVAX) (dose, route of administration, anatomical location, lot # and expiration date were not provided) by a pharmacist at a pharmacy for the long-term prevention of shingles and zoster-related conditions. On unknown dates, subsequently to the pt's zoster vaccine live (ZOSTAVAX) inoculation, the pt was treated by a physician for shingles and other zoster-related conditions. As a direct and proximate result of the pt's use of zoster vaccine live (ZOSTAVAX), the pt had and would continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and would continue to suffer such losses, and damages in the future. The outcome of the events was considered not recovered/not resolved (reported as would continue suffer ongoing injuries). The reporter considered the events to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1030269
Sex: U
Age:
State: NC

Vax Date: 08/11/2016
Onset Date:
Rec V Date: 02/15/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: other zoster related conditions; shingles; Information has been received from a lawyer and refers to a patient of unknown age and gender. The patients concurrent conditions and historical conditions were not reported. On or about 11-AUG-2016, the patient was inoculated with zoster vaccine live (ZOSTAVAX) (dose, route of administration, lot # and expiration date were not reported), as prescribed and/or administered by a pharmacist at pharmacy for the long-term prevention of shingles and zoster-related conditions. Subsequent to patient's zoster vaccine live (ZOSTAVAX) inoculation, the patient was treated by a physician for shingles and other zosterrelated conditions.As a direct and proximate result of patient's use of the zoster vaccine live (ZOSTAVAX) vaccine, the patient has and will continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and will continue to suffer such losses, and damages in the future. The outcome of the events was not reported. The evenst were considered to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

Date Died:

ID: 1030270
Sex: M
Age:
State: AZ

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: died from heart problems; suspected vaccination failure; shingles; pain; This case was reported by a consumer via interactive digital media and described the occurrence of heart disorder in a elderly male patient who received Herpes zoster (Shingles vaccine) for prophylaxis. The patient's past medical history included shingles (had shingles when he was 8 years.). On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced heart disorder (serious criteria death), vaccination failure (serious criteria GSK medically significant), shingles and pain. On an unknown date, the outcome of the heart disorder was fatal and the outcome of the vaccination failure, shingles and pain were unknown. The reported cause of death was heart disorder. It was unknown if the reporter considered the heart disorder, vaccination failure, shingles and pain to be related to Shingles vaccine. Additional details were reported as follows: The patient received shingrix in his early 80s and he ended up with shingles. The patient had bad pain until he died from heart problems.; Reported Cause(s) of Death: Heart disorder

Other Meds:

Current Illness:

ID: 1030272
Sex: F
Age: 34
State: MD

Vax Date: 01/05/2021
Onset Date:
Rec V Date: 02/15/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Skin necrosis; Severe dermatitis; Left side macerated with stuff all over it; Bilateral axillary pain that got worse and worse; Left side-patient reported that it was draining; Bilateral axillary swelling that got worse and worse; A spontaneous report was received from a physician concerning a 34-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced severe dermatitis, skin necrosis, bilateral axillary pain that got worse and worse, bilateral axillary swelling that got worse and worse, left side macerated with stuff all over it and left side-patient reported that it was draining. The patient's medical history was not provided. No relevant concomitant medications were reported. On 05 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the left arm for prophylaxis of COVID-19 infection. On unknown date, the patient developed systemic reactions for a couple days with bilateral axillary swelling and pain that got worse and worse. She developed severe dermatitis with skin necrosis. On 10 Jan 2021, the patient went to urgent care and was given methylprednisolone 50 mg for four days. Her left side especially was swelling and was macerated with stuff all over it. The patient reported that it was draining also. A computerized axial tomography (CAT) scan did not show any abscess; it showed several lymph nodes on left axilla with the largest being 1.5 centimeters (CM), nothing impressive and nothing that explains skin necrosis. Her white blood cell count (WBC) was 18 (units and reference ranges were not provided) and vital signs were stable with no fever. On exam, the only thing the doctor found was a small lymph node in the right axillary area, and the left axillary area was significantly more swollen. The injection site on the left arm has nothing. On unknown date, the patient was at the hospital and given antibiotics and methylprednisolone. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events, severe dermatitis, skin necrosis, bilateral axillary pain that got worse and worse, bilateral axillary swelling that got worse and worse, left side macerated with stuff all over it and left side-patient reported that it was draining, were not reported.; Reporter's Comments: This case concerns a 34-year-old, female patient, who experienced a serious unexpected event of skin necrosis, non-serious unexpected event of dermatitis, skin maceration, axillary pain, wound secretion, and non-serious expected event of lymphadenopathy. The events occurred on an unspecified date after first dose of mRNA-1273, lot # unknown. Laboratory tests revealed WBC 18 and a CT scan showed several lymph nodes on left axilla with no abscess. Treatment included antibiotics and Medrol. Very limited information regarding these events has been provided at this time. Based on the current available information and temporal association between the use of the product and onset of the event a causal relationship cannot be excluded.

Other Meds:

Current Illness:

Date Died: 12/30/2020

ID: 1030273
Sex: U
Age:
State:

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Death; A spontaneous report was received from a reporter concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and passed away. 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 on 28 Dec 2020 intramuscularly for prophylaxis of COVID-19 infection. On 30 Dec 2020, 2am the patient passed away. Administrator marked as natural causes. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event was fatal. The patient died on 30 Dec 2020. The cause of death was reported as unknown. The reporter did not provide an assessment for the event, passed away.; Reporter's Comments: This case concerns a patient of unknown age and gender. The medical history and concomitant medication is not provided. The patient experienced Death. The event occurred approximately one day after receiving their first of two planned doses of mRNA-1273 (Lot unknown). Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. The benefit-risk relationship of Moderna's COVID-19 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death

Other Meds:

Current Illness:

ID: 1030274
Sex: U
Age:
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Angioedema; A spontaneous report was received from a physician concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced angioedema. The patient's medical history was not provided. No relevant concomitant medications were reported. On 12 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly for prophylaxis of COVID-19 infection. On 12 Jan 2021, after vaccine administration, the patient experienced a severe allergic event. The event was angioedema which required multiple epinephrine injections. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, angioedema, was unknown.; Reporter's Comments: This case concerns a patient, who experienced event of angioedema. The event occurred the same day after the first and last dose of mRNA-1273 vaccine administration. Based on the current limited available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded and the event is assessed as possibly related.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm