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: 1031461
Sex: F
Age: 60
State: CA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Numbness of face, tongue, throat; Tingling of face, tongue, throat; A spontaneous report was received from a health care professional concerning a 60-year old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced numbness and tingling of face, tongue and throat. The patient's medical history was Rheumatoid arthritis, hypertension and possible allergy to diphenhydramine and meperidine. No relevant concomitant medications were reported. On 13 Jan 2021 at 10:11 A.M., prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 041L20A) intramuscularly in the right arm for prophylaxis of COVID-19 infection. On 13 Jan 2021 at 10:15 A.M., after receiving the vaccine, patient started to experience numbness and tingling of face, tongue and throat. Initial examination included lungs angiogram, which indicated regular tachycardia. Findings included swelling of lips and tongue, and uvula midplane, not deviated. The patient was moved on an observation area. Emergency medical services (EMS) were notified. Intramuscular (IM) epinephrine was administered at 10:23 A.M. At 10:25 A.M. the patient's vital signs included blood pressure 185/87, heart rate 128, respiratory rate 20, and oxygen saturation 100%. A second IM epinephrine treatment was given at 10:26 A.M. At 10:29 A.M. the patient's vital signs included blood pressure 185.87, heart rate 134, and oxygen saturation 100%. At 10:29 A.M. treatment included oral diphenhydramine. Next dose of IM epinephrine failed; a fourth dose was given at 10:35 A.M. At 10:45 A.M., EMS arrived, and the patient was taken to the emergency room. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the events, numbness and tingling of face, tongue and throat was unknown.; Reporter's Comments: This case concerns a 60 year-old, female patient, who experienced events of numbness and tingling of face, tongue and throat. The events occurred within minutes after the first and last dose of mRNA-1273 vaccine administration. 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 and the events are assessed as possibly related.

Other Meds:

Current Illness:

ID: 1031462
Sex: F
Age: 56
State: CA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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: Periorbital swelling; Generalized facial edema; Oropharyngeal edema; Felt faint; Tingling lip; Facial redness; Appears pale; A spontaneous report was received from a healthcare professional concerning a 56-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced lower lip tingling, pale in color, periorbital and generalized facial edema and facial redness. The patient's medical history was not provided. No concomitant product use was reported. On 13 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 041L20A) in the left arm intramuscularly for prophylaxis of COVID-19 infection. On 13 Jan 2021, at 0845, 7 minutes after receiving the Moderna COVID-19 vaccine, the patient arrived for observation at urgent care. The patient stated she felt faint and her lip was starting to "feel swollen" and tingling. Initial vital signs were: blood pressure ? 147/79, heart rate ? 69, respirations ? 20 and oxygen saturation ? 99 percent. A nurse practitioner and doctor evaluated the patient and noted patient had oropharyngeal edema and lungs were clear to auscultation (CTA). At 0851, diphenhydramine 25 milligrams orally was given with no effect. Facial redness and edema worsened. At 0855, epinephrine 3 milligrams was given with improvement, but after 5 minutes, facial redness and lower lip worsened. At 0902, a second dose of epinephrine was given. At 0903, vital signs were: blood pressure ? 162/87, heart rate ? 104, respirations ? 20 and oxygen saturation ? 100 percent on 4 liters of oxygen. Facial redness and edema improved but still had swelling and tingling of lower lip. At 0909, emergency medical services (EMS) were called and patient was transported to emergency room/department. Treatment for the event included diphenhydramine, epinephrine and oxygen. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, lower lip tingling, pale in color, periorbital and generalized facial edema and facial redness, were considered unknown.; Reporter's Comments: This case concerns a 56-year-old, female patient. The patient's medical history was not provided. The patient experienced serious, unexpected event of periorbital swelling, facial swelling, oropharyngeal edema and unexpected events of Paraesthesia oral, erythema, pallor and dizziness. The events occurred 8 minutes after the first dose of mRNA-1273 (Lot number: 041L20A) administration. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1031463
Sex: F
Age: 24
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: Anaphylactic reaction; A spontaneous report was received from a healthcare professional concerning a 24-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced Anaphylactic reaction. The patient's medical history included allergy to milk. No concomitant medications were reported. On 12 Jan 2021, 5 ? 10 minutes prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly in an unknown arm for prophylaxis of COVID-19 infection. The patient experienced chest tightness and tachycardia symptoms following which she was transported via gurney to the observation area. The patient looked sleepy and had trouble arousing her. The blood pressure was at 140/80 mmHg, heart rate was in the 90s to 100s heartbeats per minute. The patient's breath sound decreased bilaterally. It was also noted that her throat felt uncomfortable. The reporter stated that anaphylaxis reaction was suspected due to the rapid decline in status. Following an increasing heart rate and complaints of chest discomfort the patient was treated with a dose one of epinephrine pen. It was noted after a minute or two the patient's chest felt better. Her blood pressure was stable at 140/80's mmHg, the heart rate initially increased to 110 and then back down to 100 about 5 minutes after the first dose. At about 8 minutes from dose one of epinephrine pen, the patient's heart rate increased to 160 and developed additional symptoms of chest tightness again so a second dose of Epinephrine pen was administered. The patient was somnolent but protecting airway. Oxygen was added 2 liters after second dose of epinephrine pen. The patient's oxygen saturation dropped right around second dose of epinephrine pen to 94% but about 2-3 minutes later it was back at 98%. The paramedics arrived 5 minutes after second dose of epinephrine pen and care was transferred to them. The patient was transported in a stable condition. Action taken with mRNA-1273 in response to the events was not provided. The outcome for the Anaphylactic reaction was unknown.; Reporter's Comments: This case concerns a 24 year old, female patient, who experienced serious unexpected event of Anaphylactic reaction. The event occurred 1 day (5-10 min) after mRNA-1273 (Lot# Unknown). Treatment included EpiPen (2 doses). 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 events, a causal relationship cannot be excluded. Additional information has been requested.

Other Meds:

Current Illness: Allergy to cow's milk

ID: 1031464
Sex: F
Age: 31
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Anaphylaxis; Hives; A spontaneous report was received from a healthcare professional concerning a 31-years-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced anaphylaxis and hives. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021 at 4:50 pm, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the arm for prophylaxis of COVID-19 infection. On 11 Jan 2021 at 4:50 pm, after receiving the vaccine, the patient experienced anaphylaxis and hives. She was given epinephrine and 50 mg of diphenhydramine. Emergency Medical Services (EMS) and the fire department were called. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events, anaphylaxis and hives, were unknown.; Reporter's Comments: This case concerns a 31 year old, female patient, who experienced serious unexpected event of Anaphylactic reaction, a non-serious unexpected event of urticaria. The event occurred 1 day (few min) after mRNA-1273 (Lot# Unknown). Treatment included EpiPen. 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 events, a causal relationship cannot be excluded. Additional information has been requested.

Other Meds:

Current Illness:

ID: 1031465
Sex: F
Age:
State:

Vax Date:
Onset Date: 01/29/2021
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:

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

Symptoms: seizure; signs of confusion; Fever; shoulder pain; A spontaneous report was received from a husband, concerning a 26-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced shoulder pain, fever, signs of confusion and a seizure. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received the first of two planned doses of mRNA-1273 intramuscularly (lot number: unknown). On 29 Jan 2021, the patient received the second of two planned doses of mRNA-1273 intramuscularly (lot number: unknown) for prophylaxis of COVID-19 infection. On 29 Jan 2021, the patient's husband reported that patient experienced shoulder pain, 10-12 hours later the patient started to have a fever. On 30 Jan 2021, the patient had signs of confusion and then suffered a seizure and was taken to the hospital. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome for the events, shoulder pain, fever, signs of confusion and a seizure, were unknown.; Reporter's Comments: This case concerns a 26-year-old, female patient, who experienced a serious unexpected event of Seizure, non-serious unexpected event of Confusional state, and non-serious expected events of Pyrexia and Arthralgia. The events of Pyrexia and Arthralgia occurred on the same day after second of two planned doses of mRNA-1273, lot # unknown. The events of Seizure and Confusional state occurred approximately 2 days after second of two planned doses of mRNA-1273, lot # unknown. Treatment information is not provided. 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:

ID: 1031466
Sex: F
Age: 72
State: CA

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

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: Minor stroke; Weak muscles; Terible pain in neck and lower back; Terible pain in neck and lower back; Nerve pain; Achy; Injection site reaction; A spontaneous report was received from a consumer who was also a female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced C, injection site reaction, and achy. The patient's medical history was not provided. Concomitant medications were not reported. On 21 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 043L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 21 Jan 2021, after vaccine administration, the patient experienced injection site reaction. On 22 Jan 2021, she was feeling achy. On 23 Jan 2021, she had nerve pain that felt like cutting on the back, legs, and arms. On 24 Jan 2021, the patient's muscles were weak and were not working or responsive on both sides. On 25 Jan 2021, the patient could not control her left hand and weakness was more predominant on left side. The patient went to the doctor and was hospitalized with minor stroke for 24 hours. The patient stated that she was still experiencing terrible pain in neck and lower back. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of events, minor stroke, weak muscles, nerve pain, injection site reaction, and achy, was unknown. The outcome of event, terrible pain in neck and lower back, was considered not resolved.; Reporter's Comments: Based on the current available information and evidence of a temporal association between mRNA-1273 use and the onset of injection site reaction and achy, a causal relationship cannot be excluded. There is limited information to asses causality for the events of injection site reaction, and achy. Additional information has been requested.

Other Meds:

Current Illness:

ID: 1031467
Sex: F
Age: 16
State: VA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 17 year old vaccinated with the Moderna COVID 19 vaccine; A spontaneous report was received from a dentist concerning a 17 years-old, female patient who was received the Moderna COVID 19 vaccine and product administered to patient of inappropriate age. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Lot # not provided) (route of administration and injection site not provided) on 05 Jan 2021 for prophylaxis of COVID-19 infection. On 05 Jan 2021, a 17 years-old patient was vaccinated with the Moderna COVID-19 vaccine. The patient's father (dentist) was asking for guidance as both of his daughters were vaccinated but only one of them received the second dose as the local health department did not allow one to get the second dose. Reporter also inquired about time of appearance of the side effects. Action taken with mRNA-1273 in response to the event was unknown. The outcome of event 17 year old vaccinated with the Moderna COVID 19 vaccine was unknown.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 1031468
Sex: M
Age: 16
State: NJ

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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: Pharyngeal swelling

Symptoms: spontaneous report was received from a consumer concerning a , White male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced first dose of the Moderna COVID-19 vaccine at 16 years of age / Product administered to patient of inappropriate age. The patient's medical history was not provided. No relevant concomitant medications were reported. On 06 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 026220A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 06 Jan 2021, the 16-year-old patient received the Moderna vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, first dose of the Moderna COVID-19 vaccine / Product administered to patient of inappropriate age, was resolved on 06 Jan 2021.; Reporter's Comments: This report refers to a case of product administration error for mRNA-1273 (Lot number: 026220A). There were no Associated AEs with this product administered to inappropriate age,

Other Meds:

Current Illness:

ID: 1031469
Sex: M
Age:
State: SC

Vax Date: 02/01/2021
Onset Date: 02/02/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: A spontaneous report was received from a consumer concerning a 19-year-old-male of unknown race and ethnicity patient who felt very sick, headache, nose is stuffy, body chills, severe body ache, trembling, fever of 102F, rust colored spots on hands and fingers after receiving the Moderna's mRNA-1273 vaccine by accident. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. Additional suspected products included Pfizer vaccine. On 01 Feb 2021, approximately 1 day prior to the onset of the symptoms, the patient received 1 dose of mRNA-1273 (Batch number not provided) intramuscularly in the for prophylaxis of COVID-19 infection. Caller received the mRNA vaccine by accident. The first vaccine dose received by the patient was Pfizer. The patient went to Walgreens and was offered the 2nd dose, he didn't know that he would be receiving the Moderna's mRNA-1273 vaccine. The patient received the Moderna mRNA-1273 vaccine on 01 Feb 2021 at 4pm, the next day, 02 Feb 2021 he felt very sick, headache, nose is stuffy, body chills, severe body ache, trembling, fever of 102F, rust colored spots on hands and fingers. LOT # of the vaccine was not listed in the vaccine card. Agreed to follow up call. Treatment for the event included baby aspirin. The outcome of events he felt very sick, headache, nose is stuffy, body chills, severe body ache, trembling, fever of 102F, rust colored spots on hands and fingers were unknown. The outcome of event wrong vaccine administered was considered recovered.; Reporter's Comments: This report refers to a case of Wrong product administered for mRNA-1273 with lot number not provided and several adverse events. 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: 1031470
Sex: M
Age: 74
State: CO

Vax Date: 01/07/2021
Onset Date: 02/03/2021
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: vaccine liquid dripped on his arm; needle wasn't connected very well to the plastic part of the syringe; A spontaneous report was received from a 74 year old male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and the needle wasn't connect well, so the liquid dripped on his arm. There were no medical history or concomitant medications reported. The patient received their first of two planned doses of mRNA-1273 (Batch number: 025L20A) on 07 Jan 2021. On 03 Feb 2021 the patient received their second of two planned doses of mRNA-1273 (Batch number: 010M20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. After receiving the vaccine, the patient reported that the needle wasn't connect very well to the plastic part of the syringe so the liquid dripped on his arm. According to the nurse, nothing was administered so she went ahead and administered a newfull dose. No treatment information was provided. Action taken with study drug was not applicable as the subject had already received both scheduled doses. The outcomes of the events vaccine liquid dripped on his arm and needle wasn't connected very well to the plastic part of the syringe were considered resolved on 03 Feb 2021.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their second of two planned doses of mRNA-1273 (Lot unknown), reporting Device connection issue and Exposure via skin contact without any associated adverse events.

Other Meds:

Current Illness:

ID: 1031471
Sex: M
Age:
State:

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 02/15/2021
Hospital: Y

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: Tested positive for COVID-19; Feels very ill; Feeling tired; A spontaneous report was received from a consumer concerning a male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced feeling tired, feeling very ill, and tested positive for COVID-19. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 07 Jan 2021, approximately 1 day prior to the onset of the symptoms, the patient received their first dose of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 08 Jan 2021, the patient felt tired and sick. On 13 Jan 2021, the patient was admitted to the hospital where he tested positive for COVID-19. He felt very ill. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the events was not reported.; Reporter's Comments: This spontaneous report concerns a male patient who experienced feeling tired, feeling very ill, and tested positive for COVID-19. The events of feeling tired, feeling very ill started one day after the administration of mRNA-1273 vaccine (Lot number: unknown, expiration date: unknown) and 6 days after the vaccine administration, the patient tested positive for COVID-19. Based on the information provided, the known etiology of the disease and the timing from vaccine administration to COVID diagnosis, a causal association between the reported events and mRNA-1273 vaccine administration is unlikely.

Other Meds:

Current Illness:

ID: 1031472
Sex: U
Age:
State: NH

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

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Was vaccinated with less than half of the dose; Situation with a syringe in which the patient was vaccinated with less than half of the dose; A spontaneous report was received from a health care professional concerning a patient, unknown age, who was vaccinated with less than half of the dose of Moderna's COVID-19 Vaccine (mRNA-1273). The patient's medical history was not provided. No relevant concomitant medications were reported. On 03 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 028L20A) intramuscularly for prophylaxis of COVID-19 infection. The health care professional reported there was a situation with a syringe in which the patient was vaccinated with less than half of the dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the events vaccinated with less than half of the dose and situation with a syringe in which the patient was vaccinated with less than half of the dose, was considered resolved on 03 Feb 2021.; Reporter's Comments: This report refers to a case of underdose and device connection issue for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 1031473
Sex: F
Age:
State:

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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:

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

Symptoms: Did not receive full dose of first vaccine; A spontaneous report was received from a consumer concerning a female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and did not receive a full dose of her first Vaccine. The patient's medical history was not provided. Concomitant product use was not provided. On 22 Jan 2021, the patient received their first of two planned doses of mRNA-1273, (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. On 22 Jan 2021, the patient reported that she did not received full dose. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The event was considered resolved on 22 Jan 2021.; Reporter's Comments: This report refers to a case of Incorrect dose administered for mRNA-1273 with no associated AEs.

Other Meds:

Current Illness:

ID: 1031474
Sex: F
Age:
State: ME

Vax Date: 02/02/2021
Onset Date: 02/02/2021
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: 17 year old received vaccine; A spontaneous report was received from a nurse concerning a 17-year-old female who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, 17-year old received vaccine. The patient's medical history was not provided. No relevant concomitant medications were reported. On 02 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 007M20A) intramuscularly for prophylaxis of COVID-19 infection. On 02 Feb 2021, the Moderna COVID vaccine was given to a 17- year- old. 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 event was not reported. The outcome of the event, 17-year old received vaccine, was considered resolved on 02 Feb 2021.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 1031475
Sex: M
Age: 57
State: MN

Vax Date: 01/14/2021
Onset Date: 02/04/2021
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:

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

Symptoms: Received dose 7 days prior to the indicated second dose date; A spontaneous report was received from a healthcare professional concerning a 57-year-old, male patient who received a second dose of Moderna's COVID-19 vaccine administered seven days prior to the indicated second dose date. 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:032H20A) unknown route of administration on 14 Jan 2021. On 04 Feb 2021, patient received their second of two planned doses of mRNA-1273 (Lot number: 043L20A) unknown route of administration for prophylaxis of COVID-19 infection. The patient got the first dose of mRNA-1273 vaccine on 14 Jan 2021 and second dose should have been in on 11 Feb 2021 but got it on 04 Feb 2021 at 15:42, seven days prior to the indicated second dose date. No treatment information was provided. The patient received both scheduled dose of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event is not applicable. The event, vaccine administered seven days prior to the indicated second dose was considered resolved on 04 Feb 2021.; Reporter's Comments: This report refers to a case of Incorrect schedule of product administered for mRNA-1273 (Lot number: 043L20A) with no associated AEs.

Other Meds:

Current Illness:

ID: 1031476
Sex: M
Age: 16
State: MA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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:

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

Symptoms: Dizziness; Headache; patient is 16- years old; A spontaneous report was received from a non-health professional concerning a 16-year-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the events dizziness, headache, and vaccine given to a 16-year old. The patient's medical history was not provided. No relevant concomitant medications were reported. On 05 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 028L20A) intramuscularly in their arm for prophylaxis of COVID-19 infection. On 06 Feb 2021, a father called stating his son was given the Moderna COVID vaccine. His son is 16-years old and had a headache and dizziness after the shot. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of events dizziness and headache were not provided. The outcome of the event, patient is 16- years old, was considered resolved on 05 Feb 2021.; Reporter's Comments: This report refers to a case of Product administered to patient of inappropriate age for mRNA-1273, lot # 028L20A. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded

Other Meds:

Current Illness:

ID: 1031477
Sex: U
Age:
State: MD

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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:

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

Symptoms: When nurse was administering dose in patient arm the connection between needle spilled out; Syringe connection issue; A spontaneous report was received from a pharmacist concerning a patient (age and gender not provided) who received Moderna's COVID-19 vaccine (mRNA-1273) and when nurse was administering dose in patient arm the connection between needle spilled out. The patient's medical history was not provided. Concomitant product use was not provided. On 05 Feb 2021 the patient was set to receive their second of two planned doses of mRNA-1273 (Lot #: 013L20a) intramuscularly for prophylaxis of COVID-19 infection. When the nurse was administering the dose in the patient's arm, the connection between the needle spilled out. The nurse's assessment was that she didn't think the patient received the dose or maybe little of the dose. Action taken with mRNA-1273 in response to the event was unknown. The event, when nurse was administering dose in patient arm the connection between needle spilled out, was considered resolved.; Reporter's Comments: This report refers to a case of Incorrect dose administered for mRNA-1273, lot # 013L20a with no associated AEs.

Other Meds:

Current Illness:

ID: 1031478
Sex: U
Age:
State: VT

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Received second dose of Moderna vaccine and should have received second dose of Pfizer vaccine; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) but the patient received second dose of Moderna vaccine and should have received second dose of Pfizer vaccine. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On an unknown date, the patient received their first of two planned doses of Pfizer COVID-19 vaccine for prophylaxis of COVID-19 infection. On 12 Jan 2021, the patient received their second of two planned doses of COVID-19 vaccine, but was administered Moderna's mRNA-1273 vaccine instead of Pfizer's. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The event, patient received second dose of Moderna vaccine and should have received second dose of Pfizer vaccine, was considered resolved on 12 Jan 2021.; Reporter's Comments: This report refers to a case of Wrong product administered for mRNA-1273, lot #

Other Meds:

Current Illness:

ID: 1031479
Sex: U
Age:
State: NC

Vax Date:
Onset Date:
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: syringe that was found to be leaking during administration, may not have received full dose; received the second dose from a syringe that was found to be leaking during administration; A spontaneous report was received from a pharmacist concerning a patient, unknown age, who received the Moderna's COVID-19 vaccine (mRNA-1273) from a syringe that was found to be leaking during administration, patient may not have received the full 0.5ml dose. The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received their second of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. On 09 Feb 2021, a pharmacist reported a patient received the second dose of the Moderna COVID-19 vaccine from a syringe that was found to be leaking during administration and the patient may not have received the full 0.5ml dose. No adverse event was reported by the patient after being given the vaccine. 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 were considered resolved.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their second of two planned doses of mRNA-1273 (Lot unknown), reporting Device connection issue and Underdose without any associated adverse events.

Other Meds:

Current Illness:

ID: 1031480
Sex: U
Age:
State: NC

Vax Date:
Onset Date:
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:

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

Symptoms: Received the first dose of the Moderna COVID-19 vaccine on day one, and then received the second dose of the Moderna COVID-19 vaccine only 5 days later; A spontaneous report (United States) was received from a pharmacist concerning a patient, unknown age, who received the first dose Moderna's COVID-19 vaccine (mRNA-1273) and then received the second dose only 5 days later. 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 (Batch number not provided). 5 days later, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. On 09 Feb 2021, a pharmacist reported a patient received the first dose of the Moderna COVID-19 vaccine on day one, and then received the second dose of the vaccine only 5 days later. No adverse event was reported by the patient after being given the vaccine. 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 outcome of the event, Received the first dose of the Moderna COVID-19 vaccine on day one, and then received the second dose of the Moderna COVID-19 vaccine only 5 days later, was considered resolved.; Reporter's Comments: This report refers to a case of inappropriate schedule of product administration for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 1031481
Sex: M
Age: 16
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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:

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

Symptoms: first dose administered to a 17 year old; A spontaneous report was received from a consumer's guardian concerning a 17 year old female patient who was administered a COVID vaccine at an inappropriate age. The reporter requested to enroll their 17 year old child into the pediatric clinical trial. The reporter wants to know what to do about the second dose. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number :041L20A) on 12 Jan 2021 for prophylaxis of COVID-19 infection. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event administered a COVID vaccine at an inappropriate age was considered as resolved.; Reporter's Comments: This report refers to a case of 17 year old female patient administered vaccine ( inappropriate age at vaccine administration) for mRNA-1273, lot #041L20A). There was no associated AEs with the event of inappropriate age at vaccine administration.

Other Meds:

Current Illness:

ID: 1031482
Sex: F
Age: 34
State: NY

Vax Date: 01/17/2021
Onset Date: 01/18/2021
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:

Symptom List: Unevaluable event

Symptoms: Patient fainted; Migraine; Shortness of breath; Felt very tired; Fever; A spontaneous report was received from a consumer who was also a 34-year old female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and who experienced fainting (syncope), migraine, shortness of breath (dyspnoea), fever (pyrexia), and felt very tired (fatigue). The patient's medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included fexofenadine hydrochloride and birth control. On 17 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 026L20A) intramuscularly in right arm for prophylaxis of COVID-19 infection. On 18 Jan 2021, the patient fainted. She felt very tired, had migraine, fever, and shortness of breath. The symptoms continued on and off. Treatment for the event included paracetamol. Action taken with mRNA-1273 in response to the events was not provided. The outcomes of the events fainted, migraine, shortness of breath, fever, and felt very tired, was not reported.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset of the reported events, a causal relationship cannot be excluded. Fever and fatigue are consistent with the known safety profile of the vaccine.

Other Meds: ALLEGRA

Current Illness:

ID: 1031483
Sex: F
Age:
State: TN

Vax Date: 01/30/2021
Onset Date: 01/31/2021
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:

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

Symptoms: body is very sore; severe chill rigors; couldn't get out of the bed because the rigors were so intense that legs would not support her; a slight fever; This is a spontaneous report from a contactable consumer reported for herself. A 75-years-old female patient (not pregnant) received 2nd dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration at left arm on 30Jan2021 11:30 at single dose for covid-19 immunization. The patient medical history was not reported. Concomitant medication included venlafaxine, levothyroxine, diclofenac, gabapentin. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The historical vaccine included the 1st dose of BNT162B2 on 09Jan2021 11:30 AM for covid-19 immunization. Initially the patient noticed a slight fever 11 hours after vaccine on 31Jan2021. Then about 12 hours after her vaccine on 31Jan2021, she had severe chill rigors for about 2.5 hours. She couldn't get out of the bed because the rigors were so intense that her legs would not support her. On 31Jan2021 12:00 AM, (12 hours after the rigors), her entire body was very sore, feeling as if she had been run over by a truck. No treatment received for the adverse events. The events outcome was recovering. No COVID prior vaccination, since the vaccination the patient hadn't been tested for COVID-19. It was not reported as serious. Information on the Lot/Batch number has been requested.

Other Meds: VENLAFAXINE; LEVOTHYROXINE; DICLOFENAC; GABAPENTIN

Current Illness:

ID: 1031484
Sex: F
Age:
State: UT

Vax Date: 01/30/2021
Onset Date: 01/30/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Dizziness with very high blood pressure 193/94; Major Headache; Dizziness with very high blood pressure 193/94; shakiness; This is a spontaneous report from a contactable consumer (patient) reported for that a 73-years-old female patient (no pregnant) received the first dose bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number EL8982) , via an unspecified route of administration on 30Jan2021 14:30 at single dose at right arm for covid-19 immunisation. Medical history included blood pressure. Concomitant medication included pantoprazole, metoprolol, atorvastatin, metformin. The patient previously took Cefdinir and experienced allergy. The patient experienced dizziness with very high blood pressure 193/94, also shakiness, major headache on 30Jan2021 16:30. Adverse event result doctor or other healthcare professional office/clinic visit. The patient had EKG. Therapeutic measures were taken as a result of events included unspecified medication. The outcome of events was recovered with sequelae. No other vaccine in four weeks; No covid prior vaccination; No covid tested post vaccination.

Other Meds: PANTOPRAZOLE; METOPROLOL; ATORVASTATIN; METFORMIN

Current Illness:

ID: 1031485
Sex: F
Age:
State: FL

Vax Date: 01/29/2021
Onset Date: 01/31/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: right side of face drooping, diagnosis Bells Palsy; This is a spontaneous report from a contactable consumer (patient). A 68-year-old female patient received 2nd dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot: El8982), via an unspecified route of administration on 29Jan2021 09:00 at single dose on right arm for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Historical vaccine included 1st dose of BNT162B2 (lot: El3246) received on 08Jan2021 at 03:00 pm on left arm for COVID-19 immunization. The patient experienced right side of face drooping, diagnosis as bell's palsy on 31Jan2021 06:00 with outcome of not recovered. Treatment received for the event included prescriptions. This event resulted in emergency room/department or urgent care. Patient was not diagnosed with COVID-19 prior to vaccination. Patient had not been tested for COVID-19 since the vaccination.

Other Meds:

Current Illness:

ID: 1031486
Sex: F
Age:
State: NY

Vax Date: 01/29/2021
Onset Date: 01/30/2021
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:

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

Symptoms: passing out; vomiting; tingling; severe pain shoulders; tingling/severe pain shoulders and all of back/torso, legs ached; tingling/severe pain shoulders and all of back/torso, legs ached; pain all over/torso; slight head ache; chills/cold; chills/cold; turned to temp 99.9; very warm/uncomfortable; fatigue; This is a spontaneous report from a non-contactable nurse (patient). This 45-year-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) (Lot# EL3249), via an unspecified route of administration on 29Jan2021 09:30 at single dose in the left arm for COVID-19 immunization. The patient's medical history was none. No known allergies. The patient's concomitant medications included naproxen (occasional) in two weeks. The patient previously took first dose of bnt162b2 (Lot number: EK9231), on 07Jan2021 at left arm for COVID-19 immunization. Facility type vaccine was hospital. No other vaccine received in four weeks. Patient got vaccine at 9:30am. Woke up morning (30Jan2021) after the vaccine about 9:30am with tingling/severe pain shoulders and all of back/torso, legs ached. During shower at that time, very close to vomiting/passing out. Took NSAID and slept. Then paracetamol (TYLENOL) mid day. That evening had fatigue and pain all over, slight head ache, chills/cold and then turned to temp 99.9, very warm/uncomfortable. Paracetamol again that night before bed. Woke on Sunday better just fatigue and achy. No treatment received. No COVID prior vaccination. No COVID tested post vaccination. Outcome of the events was recovered in 2021. No follow-up attempts are possible. No further information is expected.

Other Meds: NAPROXEN

Current Illness:

ID: 1031487
Sex: M
Age:
State: PA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 02/15/2021
Hospital: Y

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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: spiked a fever of 101.3; spiked a fever of 101.3 which cause a 20 minute seizure; spiked a fever of 101.3 which cause a 20 minute seizure; headache; This is a spontaneous report from a contactable consumer reported for himself. A 33-years-old male patient received the 2nd dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL3302), via an unspecified route of administration at right arm on 25Jan2021 11:00 at single dose for COVID-19 immunization. Medical history included seizure disorder and other neurological issues, allergy to latex. Concomitant medication included levothyroxine sodium (SYNTHROID), fluoxetine hydrochloride (PROZAC), omeprazole, lacosamide (VIMPAT), lamotrigine (LAMOTRIGINE). The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Historical vaccine included 1st dose of BNT162B2 (lot number: EK9231) on 04Jan2021 12:00 PM at left arm for COVID-19 immunization when he was 32-years-old. The patient had a headache throughout the following day and evening on 26Jan2021. On 27Jan2021 spiked a fever of 101.3 which cause a 20 minute seizure. He was hospitalized for 2 days. Events resulted in emergency room/department or urgent care, hospitalization. Treatment was received for the adverse event in hospital. The events outcome was recovering. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, it was unknown if the patient had been tested for COVID-19. The report was reported as serious with seriousness criteria-caused hospitalization.

Other Meds: SYNTHROID; PROZAC; OMEPRAZOLE; VIMPAT; LAMOTRIGINE

Current Illness:

ID: 1031488
Sex: M
Age:
State: NC

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 02/15/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: very sick/high fever/get weaker/diagnosed with double pneumonia; This is a spontaneous report from a contactable consumer (patient wife). A 72-year-old male patient received first dose of BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE) Lot # EL3247, intramuscular in left arm on 15Jan2021 (at 1500 or 1600) at single dose to prevent covid. There were no relevant medical history or concomitant medications. There were no additional vaccines administered on same date of the BNT162B2. There was no prior Vaccinations (within 4 weeks). The reporter stated on 16Jan2021 the patient got very very sick. He started running a fever, a high fever a high temperature all day on 16Jan2021 through 17Jan2021. On 17Jan2021 night the reporter took him to the emergency room and they said it was from the covid shot. The patient began to get weaker on 17Jan2021 (not resolved) and still with a fever (resolved in Jan2021) and they said it was the shot. They went to a walk in clinic where they did a covid test on 17Jan2021 which was negative and they gave him medicine for possible pneumonia. But he didn't get any better. They went to another clinic where he had 3 more tests on 17Jan2021, "a covid test, a throat culture/ strep test and a flu test that all came back negative". On 18Jan2021 his family doctor advised him to go the hospital and he was diagnosed with double pneumonia which was resolving. The reporter stated that the event required a visit to Emergency Room and Physician Office. The reporter wanted to know if he will be able to get the second shot and asking if the first dose of the covid vaccine give him pneumonia. The medicine they gave him did not seem to be doing a lot of good, he was admitted for 3 days last week (since Jan2021 to Jan2021) and he received iv antibiotics. The medicine that was not doing good she clarified was oral pills of azithromycin (Lot: KJ9712, Expiration: Jan2022. NDC: 0781808926)that was to be taken at home. The outcome of the event was not resolved.

Other Meds:

Current Illness:

ID: 1031489
Sex: F
Age:
State: WA

Vax Date: 01/26/2021
Onset Date: 01/28/2021
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:

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

Symptoms: serious all-over body aches; This is a spontaneous report from a non-contactable consumer (patient). A 69-year-old female consumer received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 26Jan2021 13:15 at single dose in left arm for COVID-19 immunization. Medical history included Hypertension, allergies to Mango. Concomitant medication included lisinopril and colecalciferol (VITAMIN D). The patient had no other vaccine in four weeks. The patient had no covid prior vaccination. The patient had no covid tested post vaccination. The patient had no immediate discomfort. No sore arm at all. But 2 days after the shot on 28Jan2021 18:00 she experienced serious all-over body aches. They were painful, and lasted about 30 hours. No treatment was received for the event. The outcome of the event was resolved. No follow-up attempts are possible. Information about Lot/Batch number cannot be obtained.

Other Meds: LISINOPRIL; VITAMIN D [COLECALCIFEROL]

Current Illness:

ID: 1031490
Sex: M
Age:
State: FL

Vax Date: 01/15/2021
Onset Date: 01/18/2021
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:

Symptom List: Nausea

Symptoms: Erectile dysfunction - trouble maintaining an erection; This is a spontaneous report from a contactable consumer (patient). A 44-year-old male patient received the first of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL1283), via an unspecified route of administration on 15Jan2021 13:30 at single dose in left arm for COVID-19 immunization. Medical history included Churg Strauss and vasculitis. The patient had no covid prior vaccination and did not had covid tested post vaccination. The patient had no known allergies. No other vaccine in four weeks. Concomitant medications included other medications in two weeks yes, but no changes to medication within months. The patient experienced erectile dysfunction - trouble maintaining an erection on 18Jan2021. No treatment was received. The outcome of the event was recovering.

Other Meds:

Current Illness:

ID: 1031491
Sex: F
Age:
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
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: experienced bleeding from her eyes and red blood circles around her eyes; bleeding internally; head breaking out in lumps and pustules and itching; head breaking out in lumps and pustules and itching; head breaking out in lumps and pustules and itching; she experienced a strange headache in the frontal area; she almost vomited; noticed a strong taste of chemicals; This is a spontaneous report from a contactable consumer (patient). A female patient of unknown age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 25Jan2021 at single dose for COVID-19 immunization. Medical history included poisoned with chemicals, sensitive to chemicals, thoracic aortic aneurysm and was taking the blood thinner for that reason. Concomitant medications included 14 prescription drugs including a blood thinner. The patient received the first dose of the Pfizer-Biontech Covid-19 vaccine on Thursday, 25Jan2021. About 20 minutes after the injection, she experienced a strange headache in the frontal area. While walking out of the clinic, she almost vomited and noticed a strong taste of chemicals. On Friday night, 26Jan2021, she experienced her head breaking out in lumps and pustules and itching. On Friday and Saturday, she experienced bleeding from her eyes and red blood circles around her eyes. The consumer thought she was bleeding internally. The outcome of all events was unknown. Information on Lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1031492
Sex: F
Age:
State: OH

Vax Date: 01/28/2021
Onset Date: 01/29/2021
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:

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

Symptoms: unconscious; no heart rate/heart was not beating; all of the sudden she stopped breathing and her heart stopped beating; COVID 19 test positive; act funny, kind of quiet and not talking which was unusual for her; pressure was 60 over 4; This is a spontaneous report from a contactable consumer (patient husband). A 78-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EN5318), via an unspecified route of administration on 28Jan2021 16:00 at single dose at left arm for covid-19 immunization. Medical history included kidney ablation (ablation on the kidney cancer 5 years ago), kidney cancer, blood pressure, neuropathy, pain, had a urinary tract infection 19Dec2020 and they saw the cancer came back, radiologist read the CAT Scan and said the size of the tumor 1.5 to 2.4. Concomitant medications included acebutolol for blood pressure taking for years, diclofenac for neuropathy using for 10 years, oxycodone for pain taking 19 years; all ongoing, and oxycodone hydrochloride (OXYCONTIN) for pain. Patient didn't receive any other vaccines within 4 weeks prior to the COVID vaccine. Family Medical History was none. The caller stated that he was not sure if the Pfizer COVID-19 vaccine could have given patient (his wife) COVID-19 or not. He also stated that when they received their vaccines the facility was very crowded as was the hospital when the wife was getting her blood work done so he was not sure when or where she contracted COVID-19. On 29Jan2021, patient was very busy running several errands including going to the hospital for bloodwork and a nuclear medicine injection as part of a work up for kidney ablation that the patient was supposed to have completed, patient was in the process of getting ready to have an ablation on her kidney and had the nuclear scan for her kidneys and then went to get a COVID test. After they got home, patient sat down at the computer and she started to act funny, kind of quiet and not talking which was unusual for her. So at about 1700PM the husband went in to ask her what kind of music she would like and he found her unconscious in the chair. He took her blood pressure and it was 60 over 4; with no heart rate; she was just barely breathing, he could tell by the way her mouth moved. He tried to breath for her, all of the sudden she stopped breathing and her heart stopped beating. He called (phone number provided) and they rushed her to the hospital, and the paramedics verified her heart was not beating and they started to do resuscitation. Then they finally pulled her out of the chair and put her on the floor and she started to breath. When they took her to the ambulance she was still not quite coherent; she didn't know what was happening. She was taken to the hospital emergency room and stayed there for 12 hours and they monitored her with an EKG and only saw one spike for 6 seconds. They discharged her on 30Jan2021 afternoon and she has been totally normal 100 percent since then. Since she had been home she had been doing well and has had no other events. Added patient had never had a heart problem before. Caller stated that he was not sure if this event was related to her receiving the vaccine or not. Now they had to stay in quarantine 10 days until 08Feb2021 since the COVID test given at the hospital on 29Jan2021 night when she went in was positive. Patient was scheduled to received the second shot 18Feb2021. Outcome of events unconscious, no heart rate, pressure was 60 over 4 was recovered on 29Jan2021, events started to act funny and stopped breathing was recovered on 30Jan2021, outcome of other events was unknown. The adverse events resulted in emergency room/department or urgent care, patient was taken to the ER and monitored for 12 hours but no admission. No history of all previous immunization with the Pfizer vaccine considered as suspect. No additional vaccines administered on same date of the Pfizer suspect.

Other Meds: ACEBUTOLOL; DICLOFENAC; OXYCODONE; OXYCONTIN

Current Illness:

ID: 1031493
Sex: M
Age:
State: OR

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 02/15/2021
Hospital: Y

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: appendicitis; This is a spontaneous report from a contactable consumer reported for self. This 42-Year-old male received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 08Jan2021 at single dose for covid-19 immunisation. No Covid prior vaccination. No known allergies. No other vaccine in four weeks. Facility type Vaccine: Hospital. He developed appendicitis after the vaccine on 11Jan2021. First symptoms appeared three days after first dose. Checked into hospital for an appendectomy the following day. Treatment was appendectomy. Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization for 2 days. Lab data included Nasal Swab on 15Jan2021: Negative. Outcome of the event was recovering. Information on Lot/batch number has been requested.

Other Meds:

Current Illness:

Date Died: 12/20/2020

ID: 1031494
Sex: F
Age:
State: IA

Vax Date:
Onset Date: 12/20/2020
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: Tremor

Symptoms: Spouse awoke 20Dec and found spouse dead; This is a spontaneous report from a Pfizer sponsored report Corporate (Pfizer) Social Media Platforms. A non-contactable consumer (patient's husband) reported that a female patient of an unspecified age (Age: 89, Units: Unknown) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot number: EH9899, Expiry date: unknown), intramuscular on an unspecified date at a single dose for COVID-19 immunisation. The patient's medical history and concomitant medications were not reported. It was reported that spouse awoke and found spouse dead on 20Dec2020. Patient was not transferred to hospital. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Spouse awoke 20Dec and found spouse dead

Other Meds:

Current Illness:

ID: 1031495
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: Erythema, Pruritus

Symptoms: sore arm about 3 days; Initial information was received on 28-Jan-2021regarding an unsolicited valid non-serious case from a consumer/non-health care professional via social media. This case involves a patient (age and gender unspecified) who had sore arm about 3 days (pain in extremity), when received vaccine INFLUENZA VACCINE.. Medical history, medical treatment(s), vaccination(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 unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient was sore arm about 3 days (pain in extremity), (unknown latency, non-serious event) following the administration of INFLUENZA VACCINE.. it was, sore arm about 3 days, currently all gone, having his/her second shot 2/17 put an ice pack on for 15 minutes It was unknown if the patient experienced any additional symptoms/events. No laboratory data was provided. The patient received ice pack on for 15 minutes as a corrective treatment. At the time of report, the patient was recovered form event. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 1031496
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: Almost killed me never again; Initial information was received on 01-Feb-2021 regarding an unsolicited non-valid non-serious case from a consumer/non-health care professional via social media. This is a non valid case as event is unevaluable. This case involves a patient (unspecified age and gender) who had almost killed me never again(unevaluable event), while he/she received vaccine INFLUENZA VACCINE. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing Diabetes mellitus, Cardiac disorder and Chronic obstructive pulmonary disease. 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. On an unknown date, the patient developed a non-serious almost killed me never again (unevaluable event) unknown latency following the administration of INFLUENZA VACCINE. No laboratory data was provided. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness: COPD; Diabetes; Heart disease, unspecified

ID: 1031497
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: patient still got covid; Initial information received on 19-Jan-2021 regarding an unsolicited valid serious case from non-healthcare professional. This case involves patient (unknown demographics) who had covid (covid-19), after receiving INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s), concomitant medication(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 an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed covid (covid-19) (serious ) (Unknown latency), following the administration of INFLUENZA VACCINE. Covid-19 was assessed as medically significant. No laboratory data reported. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome is unknown for the event. Information regarding the batch/lot number should be requested.; Sender's Comments: This case involves patient of unknown age who presented with covid-19, after vaccination with INFLUENZA VACCINE .Time to onset is unknown. Moreover, concomitant medication, family history, patient's medical condition at the time of vaccination and lab tests were not reported. Based upon the reported information, the role of vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1031498
Sex: F
Age: 67
State: CA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Sore left arm from elbow to shoulder lasted 24 hours. Could not lift my left arm straight up above my head. Difficult time carryiing any weight in my left arm.

Other Meds: Yes.

Current Illness: Elevated blood pressure. Elevated sugar levels.

ID: 1031499
Sex: F
Age: 89
State: PA

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: 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: patient says at insertion of syringe into arm she experienced what she says is an electrical current in her arm. The injection hurt immediately and thereafter. that afternoon and night 48 hrs patient could not lift her arm above her waist and was in significant pain in her shoulder. Patient has had previous bursitis in both shoulders. Patient claims that injection site location may have caused her bursitis to flare up. patient used cold compresses for 48 hrs and then switched to warm. as of 48 hrs patient still in pain and cannot lift arm above waist. Arm was also sore at injection site. Patient did not feel it was neceassary to go to dr but would monitor symptoms over next couple days.

Other Meds: none

Current Illness: spinal cord injury

ID: 1031500
Sex: F
Age: 43
State: OH

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was at vaccine clinic today for her 2nd dose. She reported to the vaccinator she had a mild reaction with the first dose. Verified with pharmacist we would observe her for an additional 30 minutes as a precaution. She received her vaccination and was sitting in a chair talking with another associate. Associate when she reported she began to feel dizzy, lightheaded, nausea and felt like she might pass out. Patient at this point laid on the floor and put her feet up, a cart was brought to the room and patient was able to get up and climb onto the cart with no difficulty. VSS, respirs easy and non labored. Patient laid on cart supine for approximately 10-15 minutes and then the HOB was elevated aprox 30-40 degrees, she was sitting up on the cart talking with another associate/friend drinking small water bottle provided and eating a bag of chips. She finished the water and stated she felt sick to her stomach, she was offered crackers. She did not appear to be in any respiratory distress at this time. She remained sitting up on the cart resting when she stated she was beginning to feel like she "does when she has a tree nut reaction" she then asked if she could get an "epi shot", we advised she was breathing easy and her oxygen saturation was WNL and did not meet criteria to receive an epi shot. Pt became upset and voiced "this is how I get when I have a reaction and I can breathe fine until I can't". Associate was advised if she felt she might need an epinephrine injection, she should consider being evaluated in the emergency department. She agreed to be transported to the emergency department to be evaluated for a possible reaction to the vaccine. Emergency department was notified of patient, patient was transported by cart to the ED accompanied by RN. report given to ED staff. ED Visit to Hospital Emergency dept: : ED Visit at hospital resulted in patient receiving 2 doses of Epinephrine, solu-medrol and Benadryl.

Other Meds:

Current Illness:

ID: 1031501
Sex: F
Age: 65
State: GA

Vax Date: 01/21/2021
Onset Date: 01/29/2021
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: NKDA

Symptom List: Pain in extremity

Symptoms: Large erythematous, itchy, round spot at the injection site.

Other Meds: Liothyronine, levothyroxine, Ambien, valtrex, vivelle-dot,micronized progesterone

Current Illness:

ID: 1031502
Sex: F
Age: 72
State: TN

Vax Date: 01/28/2021
Onset Date: 01/28/2021
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: Sulfa, Bactrim

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

Symptoms: That afternoon I walked, but cut it off at just over 2 miles as I was getting tired. Around 6 I had bad chills, a low fever 99.9, Around 8 nauseous and headache, 9:30 I started throwing up with urination at the same time.. This happened maybe 4 times until around 3 am.. I was really weak. Over temp around 101. On 29th: Took 2 Advil and kept the water down. Slept all day and weak, Hurt all over especially the entire left arm and hips. Temp 102.6 overnight.. On 30th, Temp stayed just over 100, took Advil, ate soup and slept most of day. Around 4 pm temp down to 99. On 31th, Sunday, I will could do much, but did sit up much of day and ate light meal. Fever broke in the afternoon. I did not call a doctor as I always thought I would be better soon. On Monday, Feb 1, I went for my previously scheduled Mammograms. The next day I received a call that I needed to come back. When I went in on the 8th for more mammogram views and ultrasounds, they found 3 places of concern. I am scheduled for a needle biopsy on this Thursday.. I told them that I had received my Covid19 vaccinations and they mentioned that they have seen differences in tissue after the shots. I did not see a doctor on the first and not sure if the breast tissue or mass is a consequence or not.

Other Meds: amlodipine Besylate 10 mg, simvastatin 10 mg, fluticasone (as needed), 80 mg aspirin, Zyrtec, Vitamin d, Caltrate +, multivitamin women's 50+

Current Illness:

ID: 1031503
Sex: F
Age: 78
State: OH

Vax Date: 01/25/2021
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: none

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

Symptoms: BELL'S PALSY. PATIENT WENT TO ER ON 2/13/21 AND WAS DIAGNOSED. FOLLOWED UP WITH PRIMARY CARE DOCTOR 2/15/2021. 2/13/21 PREDNISONE 10MG TAPER: 50MGX4DAY, 40MGX2 DAY, 30MGX2DAY, 20MGX2DAY, 10MGX2DAY 2/15/21 ACYCLOVIR 800MG 1 FIVE TIMES A DAY FOR 7 DAYS, BACITRACIN OPTHAMIC OINT AT BEDTIME.

Other Meds: ASA 81mg

Current Illness: unknown

ID: 1031504
Sex: F
Age: 50
State: WA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
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:

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

Symptoms: 103 temperature Body Aches Chills fatigue Nausea injection site swelling joint pain

Other Meds:

Current Illness:

ID: 1031506
Sex: F
Age: 50
State: NY

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

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

Lab Data:

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: Within 3-5 seconds R ear felt blocked Within 5 minutes tongue felt itchy and swollen and difficulty swallowing - eased after 5 minutes after 20 minutes - felt a constriction in throat and required effort to swallow

Other Meds: Zyrtec

Current Illness: None

ID: 1031507
Sex: M
Age: 78
State:

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Injection site developed numbness and tingling of left arm that began 45-60 minutes after reciving the vaccine on 2/8/2021. Resolved within an hour or so, then no strength between thumb and index finger. Symptoms resolved that night. On 2/10/2021 patient had difficulty picking up things and had less strength than usual. Patient stated he felt clumsy.

Other Meds:

Current Illness:

ID: 1031508
Sex: F
Age: 77
State: CA

Vax Date: 02/04/2021
Onset Date: 02/11/2021
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: Avocado, lactose intolerant Codeine, Hydrocodone, Steroids, Contrast dye

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

Symptoms: Current: COVID arm- small patch around injection site became red on day 8, Feb.11. It is not Feb.15, and the red itchy patch has grown to 2 1/2 " by 2 1/2". For the first 2-3 days, I had headaches, chills, extreme fatigue and had difficulty breathing. I had chest pressure the first day.

Other Meds: Premarin, Amlodipine Besylate, Spironolactone, Levothyroxine, Lorazepam/Belsomra as needed, Vitamins

Current Illness: None.

ID: 1031509
Sex: M
Age: 73
State:

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: injection pain

Other Meds:

Current Illness:

ID: 1031510
Sex: F
Age: 77
State: MI

Vax Date: 01/20/2021
Onset Date: 02/04/2021
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: n/a

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

Symptoms: itching in middle of back

Other Meds: metoprolol 25mg, simvastatin 10mg, Eliquis 5mg, flecainide acetate 100mg, alendronate sodium 70 mg, Claritin, losartan 1/2 25mg

Current Illness: n/a

ID: 1031511
Sex: M
Age: 70
State: DC

Vax Date: 02/03/2021
Onset Date: 02/07/2021
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: none

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

Symptoms: Scabs on hands looks like scars, Bumps on forehead and head. Used Cortizone on scars and forehead, as well as head. This has been going on since the 02/07/2021.

Other Meds: Aspirin EC 81mg Tablet, Clopidogrel 75mg, Triamterene 37.5-25mg Tablet,Cyclobenzaprene 10mg Tablet,Tramadol HCL 50 mg Tablet

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm