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

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 1086021
Sex: M
Age: 75
State: MD

Vax Date: 01/08/2021
Onset Date: 02/06/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Possible Stroke; Unable to speak/Lack of pronunciations; Fatigue; A spontaneous report was received from a health care professional concerning 75-years old male patient who experienced stroke (Cerebrovascular accident), unable to speak/ lack of pronunciations (Speech disorder) and fatigue (Fatigue). The patient's medical history included heart attack. Concomitant medications included included Metoprolol, HCTZ, Irbesartan, and Aspirin. On 08 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (lot/batch: 012L201A) intramuscularly in the Anatomical location for prophylaxis of COVID-19 infection. On 05 Feb 2021, approximately four days prior to the events, the patient received their second of two planned doses of mRNA-1273 (lot/batch: 030L20A) intramuscularly in the Anatomical location for prophylaxis of COVID-19 infection. On 06 Feb 2021, the patient experienced fatigue. On 09 Feb 2021, the patient experienced the events stroke and unable to speak/ lack of pronunciations. The events resulted in hospitalisation as seriousness criteria. The patient was admitted to the hospital on 09 Feb 2021. The patient was moved to ICU for 24 hours, and was the patient was discharged from Hospital on 11 Feb 2021. Treatment for the event included Eliquis and 80 mg chewable aspirin. The patient received both scheduled doses of mRNA-1273 prior to the events, therefore, action taken with the drug in response to the events is not applicable. The events stroke, unable to speak/ lack of pronunciations and fatigue were considered as recovered/resolved.; Reporter's Comments: Based on the current available information, a temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Of note, the patient has a pre-existing history of heart attack which is a strong confounder for the reported CVA and speech disorder. Fatigue is consistent with the known safety profile of the vaccine.

Other Meds: METOPROLOL; HCTZ; IRBESARTAN; ASPIRIN [ACETYLSALICYLIC ACID]

Current Illness:

ID: 1086022
Sex: F
Age: 65
State: AZ

Vax Date: 02/18/2021
Onset Date: 02/20/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Chest cold; Bad sinus and chest cold; Sore from head to toe; A spontaneous report was received from a reporter(consumer) concerning a 65-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced chest cold/lower respiratory tract infection, bad sinus/sinusitis and sore from head to toe/pain. The patient's medical history was not provided. No concomitant product use was reported. On 18 Feb 2021, the patient received the first of two planned doses of mRNA-1273 (Lot number: not provided) in the left arm intramuscularly for prophylaxis of COVID-19 infection. On 20 Feb 2021, the reporter stated the patient had severe side effects. The patient had a bad sinus and chest cold and felt sore from head to their toes. No treatment information was provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the events, chest cold/lower respiratory tract infection, bad sinus/sinusitis and sore from head to toe/pain, were considered unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086023
Sex: F
Age: 79
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: UTI (Urinary Tract Infection); A spontaneous report was received from a 79-year-old female consumer who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced urinary tract infection (UTI). The patient's current history included fibromyalgia and lymphoma. No relevant concomitant medications were reported. On 30 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch No.007M20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On an unknown date (weeks after the vaccination), the patient experienced urinary tract infection after receiving first dose of vaccination. On an unspecified date, she also reported that she felt better. Action taken with mRNA-1273 in response to the event was unknown. The event, urinary tract infection, was considered resolving.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset date of the reported event, a causal relationship cannot be excluded. Elderly age, female gender and underlying lymphoma are considered risk factors.

Other Meds:

Current Illness: Lymphoma

ID: 1086024
Sex: M
Age: 55
State: NJ

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: bell's palsy or could of had a stroke; mouth drooping; speech was a little slurred; could not smile, could not open mouth to eat; right eye started tearing up and was watery; A spontaneous report was received from a consumer concerning a 55 years old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced Facial paralysis, Lacrimation increased, Dysarthria and Facial discomfort. The patient's medical history was not provided. Relevant concomitant medications were not reported. On 05-FEB-2021, prior to the onset of the events, the patient received their first dose of two planned dose of mRNA-1273 (lot/batch: 031L20A) intramuscularly for prophylaxis of COVID-19 infection. On 05-FEB-2021, the patient experienced Lacrimation increased. On 06-FEB-2021, the patient experienced Facial paralysis (mouth drooping), Facial discomfort. On 08-FEB-2021, the patient experienced Facial paralysis. The patient reported that he went to the doctor who said it could be bell's palsy or could had a stroke, and recommend he go to hospital to have it checked. The Patient reported that he has not gone to the hospital at the time of this report. No Laboratory details were provided. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was unknown. At the time of this report, the outcome of the event's Facial paralysis, Lacrimation increased, Dysarthria and Facial discomfort was considered as not resolved.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086025
Sex: F
Age: 91
State: WI

Vax Date: 01/30/2021
Onset Date: 02/09/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Losing eyesight in one eye; Has scratched cornea; She developed Bell's Palsy; She developed shingles; A spontaneous report was received from a relative concerning a 91-year old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and developed shingles, Bell's Palsy, losing eyesight in one eye, and scratched cornea. The patient's medical history included blind in one eye after laser surgery. Concomitant medications include vitamin d, equate arthritis medicine, losartan potassium, and eye vitamins. On 30 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: 007M20A) intramuscularly for prophylaxis of COVID-19 infection. On 09 Feb 2021, the patient developed shingles and Bell's Palsy. The patient was in the process of losing eyesight in one eye, on the side affected by the Bell's Palsy. The patient also has a scratched cornea. The patient went to the emergency room on 12 Feb 2021. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events was unknown.; Reporter's Comments: Based on the current available information, a temporal association between the use of the product and the start date of the event and excluding all other etiologies, a causal relationship with the events of shingles Bell's Palsy cannot be excluded. However, causality with scratched cornea and losing eyesight in one eye is unlikely. The scratch is most likely due to a trauma and can impair vision. No further information is expected and follow up consent was denied.

Other Meds: VITAMIN D [COLECALCIFEROL]; EQUATE 8HR ARTHRITIS PAIN RELIEF; LOSARTAN POTASSIUM; VITAMINS NOS

Current Illness: Blindness, one eye (Blindness in one eye after laser surgery)

ID: 1086026
Sex: F
Age: 58
State: MI

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Blood pressure was 180/101; numbness on whole left side of body; tingling; A spontaneous report was received from a consumer concerning a 68 years-old, female patient who received Modern's COVID-19 vaccine (mRNA-1273) and hospitalized for blood pressure that was 180/101 and experienced numbness on whole left side of body, and tingling. The patient's medical history included hypertension, allergies to penicillin, IV contrast (highly allergic, has to be pre-medicated if uses it 2-3 days before), and sulfa, and unspecified issues with sodium. Concomitant product use included blood pressure medication. On 24 Feb 2021 at 09:45 am, prior to the onset of the events, the patient received the first dose of two planned doses of mRNA-1273 (lot/batch: unknown) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 24 Feb 2021, approximately 2 hours after receiving the dose at 11:00 am, the patient's left side started going numb. The patient went home at 02:30 pm and took some Motrin, but still had numbness and tingling. At around 07:00 pm same day, the patient reported blood pressure was 180/101 beats per minute. Patient reported taking prescribed blood pressure medicine prior to getting the vaccine on 24 Feb 2021 and Motrin after the vaccination on 24 Feb 2021 in order to stop the numbness. In the morning of 25 Feb 2021, patient's blood pressure was very high until 04:00 am; therefore, patient went to the emergency room (ER). At the hospital, they were very concerned about patient's blood pressure because it remained high. The patient thought the numbness and tingling would stop but they didn't. Patient denied numbness in arms; but felt it in legs and all up left side. Due to prior "issues with sodium", patient had to be treated for sodium levels at the hospital. Patient was discharged out of the hospital on 26 Feb 2021. All tests came back normal. Numbness on side and tingling went away. The patient believed reaction was due to the vaccine even though it was temporary. Treatment information included Motrin. Action taken with mRNA-1273 in response to the events is not reported. The events blood pressure was 180/101, numbness on whole left side of body, and tingling were considered resolved.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events approximately 2 hours after receiving the dose, a causal relationship cannot be excluded. However, patient's hx of hypertension, allergies to penicillin, IV contrast and sulfa, and issues with sodium are confounding factors that may play a possible contributory role providing an alternative explanation.

Other Meds:

Current Illness: Allergy to intravenous contrast media (highly allergic, has to be pre-medicated 2 to 3 days before use); Drug allergy (Sulfa drugs); Hypertension (approximately 30 years); Penicillin allergy

ID: 1086027
Sex: F
Age: 79
State:

Vax Date: 02/19/2021
Onset Date: 02/01/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Passed out; Things were going downhill; Dizzy; Injection site was painful; Fatigued; Muscle pain; Joint pain; Nausea without vomiting; Low grade fever; A bit of an ache in injection arm; A spontaneous report was received from a consumer concerning a 79-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the following: things were going downhill, injection site was painful, fatigued, muscle pain, joint pain, nausea without vomiting, low grade fever, dizzy, passed out, and a bit of an ache in her injection arm. The patient's medical history was not provided. No concomitant medications were reported. On 19-Feb-2021, prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (lot/batch: 032L20a) intramuscularly for prophylaxis of COVID-19 infection. On 19-Feb-2021, the patient received the vaccine around noon and by the evening she could tell things were going downhill. She went to bed early, and throughout the night the injection site was painful, she was fatigued, she had muscle pain, joint pain, nausea without vomiting, and a low grade fever. The patient got up at night to go to the bathroom and got dizzy and passed out. She said she was passed our for barely a minute and when she came too she laid there for a bit before she went back to bed with her husband's help. All day on Saturday 20-Feb-2021 the patient was in bed but by that evening she was able to get up and walk out of the bedroom. On Sunday night 21-Feb-2021, she was able walk up stairs without huffing and puffing and felt much better. The patient states they have recovered from it all except sometimes when doing yoga, they can feel a bit of an ache in the injection arm. No treatment information was provided. The patient received both scheduled doses of mRNA-1273 prior to the event(s); therefore, action taken with the drug in response to the event(s) is not applicable. The outcome of the events things were going downhill, injection site was painful, fatigued, muscle pain, joint pain, nausea without vomiting, low grade fever, dizzy, and passed out, were considered recovered/resolved. The outcome of the event, ache in injection arm, was unknown.; Reporter's Comments: This case concerns a 79 Y/O F with a serious unexpected event of loss of consciousness along with NS unexpected dizziness, feeling abnormal, pain in extremity, and NS expected fever, fatigue, myalgia, arthralgia, nausea, vaccination site pain. Event onset the same day as second dose mRNA-1273. Events resolved except arm pain. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086028
Sex: M
Age: 96
State: CA

Vax Date: 02/03/2021
Onset Date: 02/24/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Cellulitis on chest; Swollen; Tender; Red; Chills; Fever; A spontaneous report was received from a consumer concerning a 96 Years-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced cellulitis, fever, chills and injection site swelling, tenderness, and redness. The patient's medical history included serving as an employee, episodes of days with fever, feeding tube, Pulmonary issues and cellulitis on arm.. Concomitant medication included triamcinolone acetonide cream 0.1%, Tessalon and Robitussin. On 03 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: 030M20A) in his left arm for prophylaxis of COVID-19 infection. On an undisclosed date, the patient experienced injection site swelling, tenderness, and redness. On 24 Feb 2021, the patient experienced chills. Vital signs included a temperature of 103.9 degrees Fahrenheit. Also, his sputum had some blood in it. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events was unknown.; Reporter's Comments: Based on the current available information, a temporal association between the use of the product and the start date of the event and excluding all other etiologies, a causal relationship with the events cannot be excluded. Fever, chills injection site swelling, tenderness and redness are consistent with the known safety profile of the mRNA-1273 vaccine.

Other Meds: TRIAMCINOLONE ACETONIDE; TESSALON; ROBITUSSIN 12 HOUR COUGH RELIEF

Current Illness: Cellulitis of arm; Feeding tube user; Fever (Days (never diagnosis)); Lung disorder NOS (Pulmonary issues (uses tessalon and robitussin))

ID: 1086029
Sex: M
Age: 77
State: IL

Vax Date: 12/29/2020
Onset Date: 02/01/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: UTI; Anemia; Colitis; A spontaneous report was received from a healthcare professional concerning a 77 years-old, male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and who developed anemia, colitis and Urinary Tract Infection (UTI). 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: 039k208) on 29 Dec 2020. On 26 Jan 2021, approximately 6 days prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 (Batch number: 019K20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 01 Feb 2021, the patient had a hospital visit for anemia and colitis for which patient was admitted and was discharged on 04 Feb 2021.The patient was again admitted to the hospital on 22 Feb 2021, for UTI and was at the hospital at the time of reporting. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the drug in response to the events is not applicable. The outcome of the events was not reported.; Reporter's Comments: Very limited information has been provided for this cases Although, a temporal association exist between the product use and the reported events of anemia and colitis, critical details such as the patient's medical history concomitant medication list lacking. Urinary tract infection is of an infective etiology as such a causal relationship is unlikely.

Other Meds:

Current Illness:

ID: 1086030
Sex: M
Age: 66
State: GA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Broken nose; Rib fracture; Body ache; everything turned cloudy; A report from was received from a 66 year old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced everything turned cloudy, and his car crashed, suffered a broken nose, rib fracture and body ache. Patient's medical history and concomitant medications were not reported. On 24-Feb-2021 the patient received his second dose of mRNA-1273 (Lot number: 012L20A) injection intramuscularly in his left arm for prophylaxis of COVID-19 infection. On 25-Feb-2021, the patient crashed into a fire truck while driving. The patient "totalled" his Feb-2021, the patient was home with body aching everywhere The events broken nose and rib fracture and were medically significant. Action taken with mRNA-1273 was not applicable. Patient was treated with Ultram (tramadol hcl) 50mg and Skelaxin (metaxalone) 800 mg. Outcome for the event of body ache was not recovered/not resolved and for all other events the outcome was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086031
Sex: F
Age: 73
State: FL

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Hearing loss; Virus in ear; Arm was sore; A spontaneous report was received from a consumer, concerning a 73-year-old, female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and developed arm sore, hearing loss and virus in my ear. The patient's medical history was not provided. Products known to have been used by the patient, within two weeks prior to the events included losartan, fluticasone, escitalopram, esomeprazole sodium, simvastatin, cetirizine hydrochloride, alpha lipoic acid, chromium, cinnamon oil, ascorbic acid, folic acid, nicotinic acid, pyridoxine hydrochloride, retinol, riboflavin, vitamin b1 nos, vitamin b12 nos, vitamin d nos, vitamin e nos, turmeric [curcuma longa rhizome], vitamin B complex, vitamin D3, levothyroxine;liothyronine, fish oil, probiotics nos, ascorbic acid, melatonin, calcium, ubidecarenone, vitamin e nos, magnesium and polycarbophil calcium. On 29 Jan 2021, approximately 1 day prior to the onset of symptoms, the patient received the first of two planned doses of mRNA-1273 (Batch number: 012M20A) intramuscularly in the right deltoid for prophylaxis of COVID-19 infection. On 30 Jan 2021, the next day, after the first dose of vaccine, the patient woke up with arm sore which had lasted for two days. On 25 Feb 2021, the patient experienced hearing loss which was from a virus in her ear. Treatment for the events included high dose of prednisone tablets. Action taken with mRNA-1273 in response to the events were unknown. The event of arm sore was considered resolved on 01 Feb 2021. The outcome for the events of hearing loss and virus in my ear were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: LOSARTAN; FLUTICASONE; ESCITALOPRAM; NEXIUM [ESOMEPRAZOLE SODIUM]; SIMVASTATIN; ZYRTEC ALLERGY; ALPHA LIPOIC ACID; CHROMIUM; CINNAMON OIL; MULTI VITAMIN [ASCORBIC ACID;FOLIC ACID;NICOTINIC ACID;PYRIDOXINE HYDROCHLORIDE;RETINOL;RIBOFLAVIN;V;

Current Illness:

ID: 1086032
Sex: M
Age:
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: cellulitis; A spontaneous report was received from a male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and developed cellulitis. The patient's medical history was not reported. Concomitant medications were not reported. On an unspecified date, the patient received his first of two planned doses of mRNA-1273 (lot/batch: unknown) for prophylaxis of COVID-19 infection. The patient reported that a few days after receiving the vaccine, he developed cellulitis. His physician prescribed antibiotics. Laboratory details were not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, cellulitis, was reported as resolving.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086033
Sex: F
Age: 67
State: OH

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Blood clots in arm; Arm was sore; A spontaneous report was received from a healthcare professional concerning a 67-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced sore arm/pain in arm and blood clot in her arm/thrombosis. The patient's medical history, as provided by the reporter included diabetes. Concomitant medications were not included. On 15 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 031M20A) in the left arm for prophylaxis of COVID-19 infection. On 15 Feb 2021, post vaccination the patient experienced sore arm and her condition got worse. She was then taken to emergency room with blood clots in her arm. Action taken with mRNA-1273 in response to the events were not reported. The outcome of the events, sore arm and blood clot in her arm, were not known.; Reporter's Comments: This case concerns a 67-year-old, female patient, who experienced thrombosis and pain in arm. 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. The patient's medical history of diabetes is a risk factor. Further information has been requested.

Other Meds:

Current Illness: Diabetes

ID: 1086034
Sex: F
Age:
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Cough with phlegm; Covid pneumonia; tested positive for Covid 19; Loss of smell; A spontaneous report was received from a consumer concerning a female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced loss of smell,covid-19,covid pneumonia and cough with phlegm. The patient's medical history was not reported. Concomitant medications was not reported. On 03 Feb 2021 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 09 Feb 2021,the patient experienced loss of smell.On 11 Feb 2021,she tested positive for covid pneumonia.On 16 Feb 2021,she had covid pneumonia.On 26 FEB 2021 she has cough with phlegm and slight loss of smell. This case is considered as a serious case as the event covid-19 pneumonia is medically significant. Lab details were not provided. Treatment for the events included Z pack,steroids and antibiotics. Action taken with mRNA-1273 in response to the events was not reported. At the time of the report,the events covid-19 pneumonia,anosmia,covid-19 and productive cough were unknown.; Reporter's Comments: Covid-19 pand Covid-19 pneumonia are unlikely to be related to Moderna Covid-19 vaccine. Based on the current available information and temporal association between the use of the product and the start date of the other events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086035
Sex: F
Age: 69
State: MN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Peripheral neuralgia; Left arm had numbness/belowboth knees to feet had numbness/Left hand fell asleep; Left arm had tingling /belowboth knees to feet had tingling; A spontaneous report was received from a consumer/patient concerning a 69-years-old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and developed peripheral neuralgia, left arm had numbness/below both knees to feet had numbness/Left hand fell asleep, Left arm had tingling /below both knees to feet had tingling. The patient's medical history was not provided. At the time of the event the patient had allergy to narcotics and steroids, rheumatoid arthritis. No relevant concomitant medications were reported. On 01-Mar-2021, the patient received their first of two planned doses of mRNA-1273 (Lot: 006M2(or 0)0A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 01-Mar-2021, the patient had tingling and numbness on her left arm in the waiting area. Then the patient's left hand fell asleep. The patient reported, the same night it developed into peripheral neuralgia on both hands and then from below both knees to feet she had tingling and numbness. No treatment information was provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the events of developed peripheral neuralgia, left arm had numbness/below both knees to feet had numbness/Left hand fell asleep, Left arm had tingling /below both knees to feet had tingling was resolving The reporter did not provide an assessment for the events peripheral neuralgia, left arm had numbness/below both knees to feet had numbness/Left hand fell asleep, Left arm had tingling /below both knees to feet had tingling.; Reporter's Comments: Based on the current available information, a strong temporal association between the use of the product and the start date of the events, a causal relationship with the events cannot be excluded.

Other Meds:

Current Illness: Drug allergy (Allergy to narcotics and steroids)

ID: 1086036
Sex: M
Age:
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Got moderna vaccine first, mistakenly got the Pfizer Covid vaccine second.; There were only 12 days between the 2 doses.; A spontaneous report was received from a pharmacist concerning a 74-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) mistakenly took Pfizer-Biontech Covid-19 vaccine for second dose and only twelve days of time span between the two doses. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (Batch Number: unknown) for prophylaxis of COVID-19 infection. Twelve days after the vaccination (Inappropriate schedule of vaccine administered), the patient mistakenly took the Pfizer-Biontech Covid-19 vaccine for the second dose (Interchange of vaccine products). Treatment information was not provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the events was recovered for both events.; Reporter's Comments: This report refers to a case of interchange of vaccine products (Pfizer) for mRNA-1273, lot # unknown with no associated AEs.

Other Meds:

Current Illness:

ID: 1086037
Sex: M
Age:
State: TX

Vax Date:
Onset Date: 02/26/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Passed out for a few minutes; Nausea; 24 hours of fever; A spontaneous report was received from a consumer concerning a male patient of unspecified age, who received Moderna's COVID-19 Vaccine (mRNA-1273). The patient's medical history included immunodeficiency, cancer and gall bladder removal (not specified). Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number not provided) on an unspecified date. On an unspecified date, prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) via an unknown route for prophylaxis of COVID-19 infection. The patient had fever for twenty-four hours. On 26 Feb 2021, while on outing with patient's friend's patient had 2 beers. Later patient reported nausea and passed out for few minutes. However, patient drove back to home. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the drug in response to the events is not applicable. The event, fever was considered recovered/resolved on an unspecified date, and the events passing out and nausea were considered recovered/resolved on 26 Feb 2021.; Reporter's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.

Other Meds:

Current Illness: Immunocompromised

ID: 1086038
Sex: F
Age: 91
State: AL

Vax Date: 01/20/2021
Onset Date: 02/28/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Drop on their sodium levels; A spontaneous report was received from a healthcare professional concerning, a 91-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and reported drop on sodium levels. The patient's medical history, as provided by the reporter, included bad fall the patient had a year ago. The concomitant medication included unspecified blood pressure and thyroid medications. On 20 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly in the right arm for prophylaxis of COVID-19 infection. The patient was past due date for the second dose of the vaccine. On 28 Feb 2021, the patient experienced drop in sodium levels and was hospitalized. According to the patient's relative this could be attributed to the hitting of head due to bad fall the patient had a year ago leading to hospitalization. Since then the patient had been instructed to monitor sodium and potassium levels. Treatment information was unknown. Action taken with mRNA-1273 was unknown. The outcome of the event, drop on sodium levels, was unknown. The consumer assessed the event, drop on sodium levels/hyponatremia, as related to fall.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086039
Sex: F
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vaccine administrator by accident dropped the vaccine on the floor.; Sore Arm; Headache; A spontaneous report received from a consumer concerning, 20-year-old age female patient who experienced vaccine administrator by accident dropped the vaccine on the floor, sore arm and headache. The patient's medical history was not included. Concomitant medications were not reported by reporter. On unknown date in 2021, the patient received their second dose of the two planned doses of mRNA-1273 in the right arm shoulder deltoid muscle (Batch number unknown) intramuscularly for prophylaxis of COVID-19 infection. Patient father stated that he took his daughter to the vaccination clinic to get her second dose of the Moderna COVID-19 vaccine. Patient father stated that when the provider brought the vaccine out to his daughter the vaccine administrator by accident dropped the vaccine on the floor. Patient had a sore arm and a headache. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event, vaccine administrator by accident dropped the vaccine on the floor, was considered resolved. The outcome of the events sore arm and headache were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1086040
Sex: M
Age: 75
State: IL

Vax Date: 01/27/2021
Onset Date:
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Breathing problems; Retaining a lot of fluids; A spontaneous report received from a Consumer, concerning 75-year-old male patient who received Moderna COVID-19 vaccine ((mRNA-1273) and experienced breathing problems and retaining a lot of fluids. The patient's medical history included breathing problem and retaining fluid. No relevant concomitant medications were reported. On 27-JAN-2021, the patient received his first of two planned doses of mRNA-1273 (Lot number: 038K20A) through an unknown route in an unknown arm for prophylaxis of COVID-19 infection. On an unspecified date, the patient had experienced breathing problems and was retaining a lot of fluids. The patient was hospitalized on 24-JAN-2021. The patient was placed on a ventilator (defibrillator). The patient was discharged from the hospital on 28-JAN-2021. The patient stated that this had happened to him prior to getting the first dose of the vaccine. Action taken with mRNA-1273 in response to the event was not reported. Outcome of the events of having breathing problems and retaining a lot of fluids was unknown.; Reporter's Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.

Other Meds:

Current Illness: Breathing difficult; Fluid retention

ID: 1086041
Sex: F
Age:
State: GA

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Very sensitive now to regular meds; lower back felt really heavy; pounding sensation up and down my torso; feeling of muscle heaviness that I almost felt paralyzed; extreme body ache; chills; I had a bad headache; stinging on both sides of my head and on hands and feet; was very lethargic; arm became real sore and was painful; This is a spontaneous report from a contactable consumer (patient). A 71-year-old female patient received their first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EL3249, expiry date not reported), via an unspecified route of administration on the left arm on 27Jan2021 10:30 at single dose for covid-19 immunisation. Medical history included mild lupus, post concussion syndrome (PPCs) and allergies: sulfur (very sensitive to large doses) from an unknown date and unknown if ongoing. Concomitant medication included esomeprazole magnesium (NEXIUM), tramadol, alprazolam and acetylsalicylic acid (ALKA SELTZER). The patient reported that after just a few hours on 27Jan2021, their arm became real sore and was painful to use until next morning, was sore for 2 days. Hurt after much normal use. Woke up on the morning of 28Jan2021 (3 am) with chills, extreme body ache and feeling of muscle heaviness that they almost felt paralyzed. They could still move. They had a bad headache and stinging on both sides of their head and on hands and feet. They took aspirin and went back to sleep. When they got up they felt some better, but did not feel well and was very lethargic. That night they took another aspirin before bed. On the morning of 29Jan2021 (second day ) they again woke up at 3 AM to extreme body ache, the same heavy paralyzing feeling, but this time their lower back felt really heavy and there was a pounding sensation up and down their torso. They repeated the aspirin dose and went back to bed but did not sleep anymore that day. They did feel some better but still very lethargic. Next day better, but took 5 days to feel some normal w/o fatigue. The patient is very sensitive now to regular meds. Therapeutic measures were taken which included aspirin. The patient was recovering from feeling of muscle heaviness that I almost felt paralyzed, extreme body ache, chills, headache, stinging on both sides of my head and on hands and feet, lethargy recovered from arm became real sore and was painful on an unspecified date, while the outcome of the other events was unknown. The patient was not diagnosed with COVID prior to vaccination and has not been tested for COVID since vaccination.

Other Meds: NEXIUM; TRAMADOL; ALPRAZOLAM; ALKA SELTZER

Current Illness:

ID: 1086042
Sex: M
Age:
State: NC

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: COVID-19; Fever; Pain; got sick; he did not feel well; This is a spontaneous report from a contactable consumer (patient's wife). This consumer reported 2 reports for herself and her husband. This is the 2nd of 2 reports and refers for her husband. A 74-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech) (lot# unclear, E or FU4176), via an unspecified route of administration, on 28Jan2021, at single dose, for COVID-19 immunisation. Medical history included blood pressure high and non-alcoholic fatty liver. Concomitant medications were not reported. The patient experienced COVID-19 (medically significant) on 05Feb2021 with outcome of unknown, fever (non-serious) on 05Feb2021 with outcome of unknown, pain (non-serious) on 05Feb2021 with outcome of unknown, got sick (non-serious) on 29Jan2021 with outcome of unknown, he did not feel well (non-serious) on 29Jan2021 with outcome of unknown. The patient got sick on the very next day and he did not feel well and each day he got worse and worse until his wife had to take him to the emergency room on 05Feb2021. The patient underwent lab tests and procedures which included COVID-19 virus test: positive on 05Feb2021. Therapeutic measures were taken as a result of the events and included treatment with Tylenol.

Other Meds:

Current Illness:

ID: 1086043
Sex: F
Age:
State: TX

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: all of a sudden it's 200 something 300 something and then the last couple days I'm battling 500 and something/the ingredients in the shot and it has sucrose; all of a sudden it's 200 something 300 something and then the last couple days I'm battling 500 and something/the ingredients in the shot and it has sucrose; This is a spontaneous report from a contactable consumer (patient). A 67-year-old female patient received her first dose of bnt162b2 (BNT162B2; lot number: EL3248; expiration date: unknown) at 67-year-old vaccination age at a single dose in the left arm for covid-19 immunization and sucrose at unknown dosing regimen for an unspecified indication, both via an unspecified route of administration on 30Jan2021. Medical history included diabetes. Concomitant medication included levothyroxine sodium (SYNTHROID) and insulin for diabetes. The patient reported that she received her first dose on 30Jan2021 with no problem at all but this past week her blood sugar levels have been climbing. She normally was 120-150 [unknown unit] then all of a sudden, it's 200 [unknown unit] something or 300 [unknown unit] something and then the last couple days (2021), she was battling 500 [unknown unit] and something. She was just wondered because she looked at the ingredients in the shot and it has sucrose, so she just wondered if that is why her sugar levels are rising. The patient has tried getting hold of her doctor to ask the same question, but her office is closed since last three days, so they didn't have their phones connected. She reported that she did not have issues with the shot, its fine didn't get sick or anything. She's just worrying if that's the reason her blood sugar levels are rising. The outcome of the events unknown.

Other Meds: SYNTHROID; INSULIN SUCROSE

Current Illness:

ID: 1086044
Sex: F
Age:
State: LA

Vax Date: 02/04/2021
Onset Date: 02/13/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: has not smell or taste a lot of the time; has not smell or taste a lot of the time; sight is not clear; flipped out; her blood pressure went up while she was in the Emergency room; panicked; Lightheadedness; Weakness; felt a little tired at that time; atrial fibrillation/started racing/Heartbeats irregular; anxiety; couldn't breathe/shortness of breath/hard time breathing; it was cold outside by her nephew's graveside, but she felt she had to fan herself like she was overheated; her heart rate was flying; scared; she said it was not a migraine headache like she is used to, but more of a mild headache; This is a spontaneous report from a contactable consumer (patient herself). A 77-year-old female patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine, Batch/lot number: EM9801), via an unspecified route of administration on the left arm, first dose on 04Feb2021 (Administered between 9:30-10:00AM) at single dose for COVID-19 immunisation. Medical history included chronic migraines all her life. She said her migraines have let up as she has gotten older. She also had an irregular heart rate before, saying her irregular heart rate started in her adult life. She said she considered herself more of a "carrier" for an irregular heart rate because her irregular heart rate doesn't happen enough for her to think about it. She said she doesn't have an irregular heart rate now. She said her father had a pacemaker & her 2 brothers had heart problems; her oldest brother passed away from his heart problems & her other brother has blood pressure issues. Patient also had mild asthma as an adult. She said she worked at (name) in a dusty environment, and lived near a landfill, where a lot of her neighbors have gotten sick. She said she needs an inhaler for her asthma. She said when she needs the inhaler, she takes 3-4 puffs at a time. She said she doesn't use the inhaler every day and also mentioned that her grandfather had died of a bad asthma attack. No previous immunization with the Pfizer vaccine considered as suspect. No vaccines administered on the same date of vaccine. No prior vaccinations within 4 weeks. There were no concomitant medications. On 13Feb2021, the patient experienced an atrial fibrillation in which she started racing and couldn't breathe. She mentioned that she recently attended a funeral but attributed the symptoms as side effects of the vaccine. She was taken to the Emergency room where she was given cortisone and resolved her symptoms. Patient also further reported she had side effects with the Pfizer COVID-19 Vaccine. She clarified she had her first COVID-19 Vaccine dose on 04Feb2021. She said her side effects happened less than 14 days after getting the COVID-19 Vaccine. Patient thought her side effects from the COVID-19 Vaccine may have been anxiety within. She said her nephew had died of COVID-19, and when she was at his funeral at the graveside, she flipped out while she was at her nephew's funeral, she was not doing good. She said she has a history of chronic migraines, and mild asthma. She said she had to lean against a gravestone because she couldn't breath. She said it was cold outside by her nephew's graveside, but she felt she had to fan herself like she was overheated. She said her heart rate was flying, and she had an irregular heart beat. She said she left her nephew's graveside and went to an urgent care. She said the doctor at the urgent care had done an EKG result abnormal, and told her she needed to go to the Emergency Room right away. She said the doctor had called the paramedics to transport her from the urgent care to the Emergency Room at (Institute name). She said she did not have any pain, but had a hard time breathing. She said she may have been scared because her grandfather had died of a bad asthma attack. She said she has chronic migraines, but what she had at the time was a mild headache, and not a migraine. She said she has not smell or taste a lot of the time. She clarified she has had no smell or taste for a while, saying she would not be able to tell if she got the COVID-19 Virus because of her loss of taste and smell. She said she was tested the Friday before her nephew's funeral and was negative for the COVID-19 Virus. She said she has had a total of four COVID-19 Virus tests before, and all her COVID-19 Virus tests have been negative. She clarified she did not have a COVID-19 Virus test while she was at the ER on Saturday, 13Feb2021. With her nephew's death, getting her COVID-19 Vaccine had left her mind. She said it didn't dawn on her until she settled down, and she thought her high heart rate and irregular heart beat were side effects of the COVID-19 Vaccine. She said she read the paperwork that was given to her at the time she got the COVID-19 Vaccine. She said the side effects listed for the COVID-19 Vaccine is what she had, a very fast heart beat, and it was very hard for her to breath. She said the Emergency Room doctor didn't think to ask her about the COVID-19 Vaccine. She said she panicked when she got to the hospital. She said she didn't even know that someone had drew blood from her. She said someone put a label on her, and told her the label was to show blood was drawn from her. She said when she looked down at the label, she saw an IV access was put in her arm. Additional treatment reported when she was in the Emergency Room, she was given an injection (clarified as IVPB on 13Feb2021) of Diltiazem 120mg at 12:13:50 PM, she said she was given another Diltiazem 5mg injection at the same time. She clarified she was diagnosed in the Emergency Room with Atrial Fibrillation. Patient stated that her blood pressure went up while she was in the Emergency room. She said she was kept in the Emergency Room so she could be monitored up until that evening. She said after the Diltiazem injections were given, her heart rate went down. She said the Emergency Room doctor gave her a prescription for Diltiazem 120mg white capsules, and told her to take the Diltiazem 120mg every day. She said the emergency room doctor told her she could go home, and that she needed to follow-up with her regular doctor. Reported she no longer has the shortness of breath, lightheadedness, or weakness. She said had felt a little tired at that time, as well. Patient also reported that on 22Feb2021 was her first day outside of her house since last Sunday (14Feb2021) and reported she has a slight headache, and her sight is not clear. She said she now feels she has "name" back, clarifying she has recovered completely. She has a follow up with her doctor on 24Feb2021. She is scheduled to take her 2nd dose on 04Mar2021 and is asking if she should take anything before the shot. Vaccination Facility Type was a pharmacy/drug store. Vaccine was not administered at Facility. The outcome of the events was recovered on an unspecified date.

Other Meds:

Current Illness:

ID: 1086045
Sex: M
Age:
State:

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 03/09/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: tested positive for COVID; fever; This is a spontaneous report from a non-contactable consumer or other non-healthcare professional. An 81-year-old male patient received BNT162B2 (Pfizer-BIONTECH Covid-19 Vaccine), via an unspecified route of administration on 20Feb2021 at single dose for covid-19 immunisation. The patient's medical history and concomitant medications were not reported. On 20Feb2021, the patient experienced fever, and was taken to hospital for a different issue and subsequently tested positive for COVID. The adverse event resulted in emergency room/department or urgent care and hospitalization. It was unknown if other vaccines received in four weeks. It was unknown that patient received treatment for adverse event. No covid prior vaccination. Covid was tested post vaccination in Feb2021. The outcome of events was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1086046
Sex: U
Age:
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Undefined allergic reaction; Initial information received on 01-Oct-2020 regarding an unsolicited valid non-serious case received from a non-healthcare professional (consumer). This case involves an patient of unknown age who experienced undefined allergic reaction (hypersensitivity), after receiving INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] . The patient's past medical history, concomitant disease or risk factor, medical treatment(s), vaccination(s), family history and concomitant medications were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA QUADRIVALENT RECOMBINANT VACCINE (batch number and expiration date were not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a non-serious undefined allergic reaction to a biological or med (hypersensitivity) (unknown latency) following the administration of INFLUENZA QUADRIVALENT RECOMBINANT VACCINE. No laboratory data was reported. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome was not reported for the event hypersensitivity. There will be no information on the batch number for this case.

Other Meds:

Current Illness:

ID: 1086050
Sex: M
Age: 90
State: IN

Vax Date: 09/10/2020
Onset Date: 09/12/2020
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None known

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Two days after injection pain started at site of injection. Pain increased daily for about 3 days. Five days after injection a reddish-pink area started up. Pain & red area persisted and after 3 weeks the left elbow developed a pain on a bone protruding . In December went to Doctor... He said the elbow pain would go away (and eventually it did). He diagnosed the pink area as the result of my scratching it and advised me to stop and put euricin cream on it which I continue to do today. I favor the arm somewhat to prevent pain and to keep from dropping things. The injection (and pain) site appears to me to be at the lower point of the deltoid muscle, well below the shoulder edge. I seldom scratch it as it does not itch. The doctor thought I was scratching it as every time I tried to show him where it was at he thought I was getting ready to scratch it. The pain continues today.

Other Meds: Isosorbide 15mg; Metaprolol 50mg; Tamsulosin 0.4mg; Atorvastatin 20mg; Amlidopine 5mg; Metformin 500mg.

Current Illness: None

ID: 1086051
Sex: F
Age: 51
State: IL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient has a history of fainting after vaccination. Patient told us prior to vaccination. Patient did not pass out but needed to lay down and put her legs on a chair. She was a give a ice pack for her forehead. She recovered after 5 to 10 minutes and reported back to work without any problems.

Other Meds: None

Current Illness: None known, patient has a history of fainting when she receives a vaccine,. This was reported prior to getting the Pfizer Covid Vaccine EUA today.

ID: 1086052
Sex: F
Age: 36
State: PA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Mold Penicillin Hydrocodine Wheat Dust mites Grass Cockroach Rabbit

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

Symptoms: A few hours after receiving the vaccine I started to feel fatigue and started getting shooting pains through my back, injection site was slightly sore. Second day my whole body felt stiff. Third day I started getting shortness of breath. Fourth day I woke up with swollen itchy eyes and ears as well as a sore throat. It started to become even harder to breath. I took allergy medicine, Allegra and zertex and felt some immediate relief.

Other Meds: Zertec

Current Illness: MS

ID: 1086053
Sex: F
Age: 57
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Reaction -aseptra - (a sulpha drug) - a long time ago

Symptom List: Nausea

Symptoms: Sore arm. Around 5 and 6 pm, I was feeling and chilled and then hot - my temp was going up until it got to about 102. I felt horrible. I started takin Tylenol and piggy backing it with ibuprofen 4 or 5 hours later. That took the fever down. I had shaking, chills, sore arm and my whole body hurt - felt like I had been working out - hips, legs, etc. I experienced these symptoms until the next day - still was running around 100 degree fever - so I was improved but still sore, fever, etc. The next day, on Friday, I was okay - 36 hours about. Shingles symptoms were still be experienced as well. The right side hurt with the reaction and left side hurt with Shingles. I returned to work on February 24th but I am still having - around the clavicle and where the blisters were that skin is still sensitive and sore. I have to scoop neck clothing. I can function with work duties.

Other Meds: Gabapentin

Current Illness: Shingles and adverse events of dose 1 vaccine

ID: 1086054
Sex: F
Age: 47
State: TX

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: 102 fever, joint pains, chills, headache, body aches, injection site very painfull.

Other Meds:

Current Illness:

ID: 1086055
Sex: F
Age: 70
State: OH

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

Vax Type:
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Lab Data:

Allergies:

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

Symptoms: Patient called and stated her throat swelled up however she had no trouble breathing. She took an antihistamine after contacting pharmacy. She complained of severe dizziness through the night and fever which persisted into the next day.

Other Meds:

Current Illness:

ID: 1086056
Sex: F
Age: 44
State: WA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 03/09/2021
Hospital:

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Lab Data:

Allergies: Soy, almonds, hazelnuts, sunflower seeds, borderline in pistachios, walnuts, shrimps

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

Symptoms: Within in 20 seconds, I stated to get flushed. I felt flushed, hot in my face, and felt dizzy and my tongue and the back of my throat started tingling. Then about 30 minutes my knee (below the knee), calves and feet started to feel tingling. My jaw and ears also started tingling. EMT then took my BP, lungs were clear. I was given Benadryl and Claritin as medication. I had no shortness of breath or difficulty swallowing. I talked to my immunologist who recommended not to get the second dose. However, I subsequently feel that I have a reaction and I am extra sensitive to alcohol and certain type of foods which I did not have before.

Other Meds: Atanolol 10mg OD, Eladrol cream of 1%, Antihistamine Xyzal 5mg OD, Vitamin D 9000 units, Vitamin C 1000mg, Vitamin B12, Vitamin B6, Iron supplements 325mg three times a week

Current Illness:

ID: 1086057
Sex: M
Age: 62
State: NM

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

Vax Type:
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Lot:
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Lab Data:

Allergies: No Known Allergies

Symptom List: Tremor

Symptoms: Approximately 10 minutes after vaccine patient had c/o flushing for approximately 15 minutes.

Other Meds: unknown

Current Illness: unknown

ID: 1086058
Sex: F
Age: 70
State: AZ

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
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Vax Site:

Lab Data:

Allergies: Bentyl, codeine, sulfa

Symptom List: Erythema, Pruritus

Symptoms: Heart pounding Earrings ringing High blood pressure

Other Meds: Levothyroxine .125mg Lisinopril 30mg Spironolactone 25mg Furosemide 20mg 2x day 1 baby aspirin 1x day Multivitamin

Current Illness:

ID: 1086059
Sex: F
Age: 92
State: CO

Vax Date: 02/21/2021
Onset Date: 02/25/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: None

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

Symptoms: DVT in right leg discovered after swollen foot on 2/25/2021 via ultrasound. Clot extends from mid thigh to mid calf. Placed on Xarelto 15 mg 2x/day until next imaging appointment on March 30, 2021. First incident of blood clot for mother.

Other Meds: Claritan, Astrovastatin, Flecanide Acetate, Baby aspirin, Amlodipine Besylate, Martazapine, Tylenol

Current Illness: Urinary in continuance - on cathather for 3 years, supplemental oxygen

ID: 1086060
Sex: F
Age: 37
State: NC

Vax Date: 02/27/2021
Onset Date: 03/08/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
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Lot:
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Lab Data:

Allergies: Shellfish, dairy, Flagyll

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

Symptoms: Severe swelling, hard knot, warm to the touch This occurred 10 days after the vaccine was administered. I have also had a tingling feeling in my arm and it painful! At the guidance of the nurse and pharmacist, I have put hydrocortisone on the site and taken Benedryl and Tylenol. I?ve also used a cold pack.

Other Meds: Benedryl Tylenol

Current Illness: N/A

ID: 1086061
Sex: F
Age: 62
State: NY

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt felt dizzy upon taking vitals pt stated she felt ok and wanted to go home vitals were normal

Other Meds:

Current Illness:

ID: 1086062
Sex: F
Age: 50
State: IA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies: NKA

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

Symptoms: Early this morning 0700 while cleaning an office building I felt sick to stomach high in my stomach, headache-heavy feeling, neck aches, chills, no fever. Temp is my regular 97.7?. I did not go to work my full job, pharmacy tech

Other Meds: BC, 5000 IU D3, 100MCQ K2, 1000MCG B12, 800 MCG FOLIC ACID, 10 mg Loratadine. 500 mg APAP, 800 mg IBU

Current Illness: None. Moderna Covid 2nd shot 1/27/2021

ID: 1086063
Sex: F
Age: 24
State: MN

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

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

Symptoms: Before going to bed at 10:30p with really bad chills that made it feel like I was freezing and was sweating profusely. I woke up super nauseous at 4:00am and quickly vomited afterwards. From there on I slept for 10-30 minutes in between vomiting for 3 hours. Afterwards the chills and extreme nauseous feeling didn't leave until the 3rd day after the shot.

Other Meds:

Current Illness:

ID: 1086064
Sex: F
Age: 51
State: MO

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: codeine, latex

Symptom List: Pain in extremity

Symptoms: first night had strange vivid dreams, extremely fatigued/sleepy, muscle aces all over, joint pains all over (arthritis is only in a few joints), runny nose, sore throat. 2nd day felt better but still very sleepy, fatigued, muscle cramping. 3rd day still extremely sleepy, muscle soreness, joint pain. 4th day fatigue, weakness, nausea.

Other Meds:

Current Illness: lingering "long haul" symptoms after (suspected false positive) covid in 11/2020--fatigue, weakness, brain fog, sleep problems; IBS, arthritis, autism, PTSD, OCD,ADHD, severe anxiety, sensory processing disorder

ID: 1086065
Sex: F
Age: 66
State: OH

Vax Date: 02/09/2021
Onset Date: 02/12/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies:

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

Symptoms: The patient reported that she had a red, itchy, and hard left arm that extended to her elbow after receiving her first moderna vaccine . The reaction appeared 3-4 days after her shot. It resolved after 2 weeks and she did not seek any medical treatment during that time.

Other Meds:

Current Illness:

ID: 1086066
Sex: F
Age: 68
State: MD

Vax Date: 02/26/2021
Onset Date: 03/09/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Red area around injection site, a little swollen, and warm. This occurred 11 days after the vaccination.

Other Meds: Metoprolol succinct, Losartan Tabs, Triamterene/Hctz, Fibercon, Centrum Silver, Tums, Pepcid, Acidophilus, Magnesium, Turmeric, Restasis

Current Illness:

ID: 1086067
Sex: F
Age: 35
State: MD

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Yes antibiotic, PCN

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

Symptoms: pt reports lip and tongue tingling. no chest tightness, SOB, or wheezing. Benadryl 25mg IM. pt feels improved no facial symptoms. reports now mild tingling in fingers. she would like to go home

Other Meds: Albuterol

Current Illness: no

ID: 1086068
Sex: F
Age: 70
State: MD

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Vax Site:

Lab Data:

Allergies: Penicillin, tetracycline, milk, molds

Symptom List: Vomiting

Symptoms: Exactly 8 hours after the vaccine was given, I felt very fatigued, felt cold, had a mild headache, and had sharp, but not debilitating, pain in both the right and left side of my lower abdomen whenever I moved. The symptoms lasted 24 hours except for the mild headache which is still continuing one week after the vaccine was given.

Other Meds: Levothyroxine, Meloxicam, Omeprazole, Red-Yeast Rice, UC-II, multi-vitamin

Current Illness: None

ID: 1086069
Sex: F
Age: 61
State: IN

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tiredness, fatigue, headache, nausea, chills, fever. Starting about 9:PM on 02/27/21 continuing all the next day 02/28/21. Still had a slight headache on 03/01/21.

Other Meds: Metformin,Atorvastatin, B12, Citalopram,Telmisartan, low dose aspirin

Current Illness: None

ID: 1086070
Sex: M
Age: 69
State: IN

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: sulphamethoxazole

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

Symptoms: Mild fever, chills night of the shot. Spent the next day in bed, lethargy. Sore arm for a couple of days.

Other Meds: Valsartan hctz 160-12.5 mg, Atorvastatin 10 mg, alpha lipoic 6+00 mg, CoQ10 300 m g, Fish oil 1200mg, multi-vitamin, baby aspirin, magnesium 500 mg, vitamin D3, 125 mcg

Current Illness:

ID: 1086071
Sex: F
Age: 0
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillins

Symptom List: Injection site swelling, Limb discomfort

Symptoms: According to patient 5 minutes after receiving the vaccine she felt like her throat was closing.

Other Meds: not sure

Current Illness: not sure

ID: 1086072
Sex: F
Age: 51
State: NC

Vax Date: 02/26/2021
Onset Date: 03/01/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: No known allergies.

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

Symptoms: Patient received the vaccine and reported back to the pharmacy that she was experiencing a side effect that concerned her. The pain went from the site of injection on the left arm to "a little bit past the collar bone". She experienced a slight bump/nodule in the collar bone area.

Other Meds: acetaminophen

Current Illness: No

ID: 1086073
Sex: M
Age: 32
State:

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 03/09/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

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

Symptoms: Member has persistent altered sense of taste and smell following vaccination. Started ~5 days after vaccination. Unchanged through clinic encounter today on 9 March 2021.

Other Meds:

Current Illness: Acute cholecystitis w/ cholecystectomy ~1 month prior to vaccination

Total 2021 VAERS Injuries: 704,237

Page last modified: 26 October 2021 2:21am