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: 1041204
Sex: F
Age: 66
State: CA

Vax Date: 02/09/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: sulfa

Symptom List: Dysphagia, Epiglottitis

Symptoms: My arm was sore and itching and I noticed this big red spot on my arm at the injection site.

Other Meds: losartan potassium Lipitor Zoloft bousperone proscar multivitamin

Current Illness: None

ID: 1041206
Sex: F
Age: 55
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
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: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: 55 ur old female was in observation area after receiving her first dose of the Covid 19 vaccine (moderna) when she stated feeling her palpitations. Pt felt warm and light headed. Pt was moved to medical room via wheel chair and sat in the chair to relax. Pt vs were taken and bp 152/94 hr 112, resp 18., spo2 was 98% ra. Pt was given a drink of water and relaxed for 15 min. In wheel chair. Vs were taken every 5 min and pt felt much better. Final vs were bp 134/87, hr was 82, resp 16, spo2 was 98% ra. Pt was released back to observation area by providers and pt checked out.

Other Meds: Hctz amd lorazapam

Current Illness: No illness at the time of the vaccination

ID: 1041207
Sex: F
Age: 47
State: DC

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: no known allergies

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

Symptoms: 2/18/2021 Patient received her 2nd dose of Moderna vaccine at 1230pm in the medical clinic examination room. At 1245pm, patient complained of dizziness 15 minutes after her injection. I advised her to sit and continue observation for another 15 minutes. At the same time, VS was taken in the examination room. She walked with steady gaits, conversing with me, and denied shortness of breath. After taking her VS, she was directed back to sit in the medical clinic for further observation. Patient was talking and drank some water from the water bottle. After 10 minutes, patient stated that she felt better and ready to go back to work. When she was about to leave the medical clinic area around 1255pm, she developed a nosebleed on her right nostril. I assisted patient in the bathroom to apply pressure on the right side of the nostril to stop the bleeding. Patient and I stayed in the clinic for approximately another 15 minutes to stop the nosebleed. Her nose bleed subsided, and she was ready to return to work. I explained to patient that she may feel sore and body ache after her 2nd dose of the vaccine. Patient had no further questions and left the medical clinic area around 115pm. 2/19/2021 Patient came to work this morning and mentioned to (name) who was in line for screening that she woke up with pain and swollen of her left side of her face. (name) reported patient complaint to (name) , Director of Nursing. (name) advised (name) to report the issue to the GMO on call. Doctor directed patient to seek medical attention from her primary care doctor. (name) notified patient and her supervisor - (name) . Patient came up to the administration area and she told (name) and (name) that she wanted her brother to take her to the hospital. She left the Hospital and went to UMC accompanied by her brother around 930am. UMC called (name) at the request of patient that she is in the emergency room and getting a full workup.

Other Meds: not known

Current Illness: Not known

ID: 1041208
Sex: F
Age: 38
State: IN

Vax Date: 02/11/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Redness at site of vaccine with an area about one inch radius of point of insertion. Itchiness at site of vaccine. No treatment sought.

Other Meds: Sertraline 100 mg, daily

Current Illness: None

ID: 1041209
Sex: M
Age: 81
State: MD

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 10:45 pt reported not feeling well; He complained of feeling nauseas and weak. Assisted pt to lie down on cot; Nursing assessment done, vital signs taken, pt offered water, history taken from pt and wife; mental status assesed; 911 called;RN stayed with pt until EMS took pt to hospital via ambulance for further evaluation.

Other Meds: Pantoprazole Atorvastatin Losartan potassium Amiodarone Abilify Cymbalta Inspra aspirin Coreg Metolazone

Current Illness: CHF pulmonary hypotension bipolar disorder reflux-recent hx of aspirating fluids and solids Dementia wife reported pt was in the hospital last week bc he" couldnt breathe", b/p was unstable acc to wife

ID: 1041210
Sex: F
Age: 60
State: MA

Vax Date: 02/09/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: penicillin and sulfa drugs

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

Symptoms: rash on thighs, torso and arms

Other Meds: atorvastatin, vitamin D3, humalog, Lantus

Current Illness: none

ID: 1041211
Sex: M
Age: 63
State: MO

Vax Date: 12/31/2020
Onset Date: 01/22/2021
Rec V Date: 02/19/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient is meeting diagnostic criteria for multisystem inflammatory syndrome post-vaccination. He received his 1st Moderna COVID vaccination on 12/31/2020 (037K20A) and his second COVID vaccination on 2/5/21 (029L20A). He began developing high grade fevers on 1/22/21 and was admitted to our facility on 2/8/21 due to "fever of unknown etiology" associated with hepatitis and coagulopathy on laboratory studies. He underwent an extensive evaluation which failed to reveal any other infectious, rheumatologic, or hematologic explanation for his clinical syndrome. He was ultimately discharged to outpatient care with ongoing supportive care for his fevers. His liver associated enzymes were improving at discharge.

Other Meds: Aspirin, amlodipine, multivitamin, lisinopril, Crestor.

Current Illness: None

ID: 1041212
Sex: F
Age: 70
State: MO

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: penicillin; sulfur drugs

Symptom List: Pharyngeal swelling

Symptoms: Itchy rash on chest and hives on chest. No treatment other than topical anti itch cream. Itching stopped after 24 hours. Still have spots today, but no more itching.

Other Meds: Losartan; Pravastatin; Metoprolol; Raloxifene; Boniva; Rhopressa; multi-vitamin; calcium; vitamin C; 81. mg. aspirin; cyanocobalamin; ibandronate sodium

Current Illness: none

ID: 1041213
Sex: M
Age: 59
State: VA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pfizer given as second dose. Moderna given as first dose

Other Meds: None known

Current Illness: None known

ID: 1041214
Sex: F
Age: 21
State: MO

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 02/19/2021
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: 2nd dose given 16 days after 1st dose

Other Meds:

Current Illness:

ID: 1041215
Sex: F
Age: 29
State: MA

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: Dairy, grass, pets

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

Symptoms: Dizziness, headache, body aches, chills, nausea, Low grade fever.

Other Meds: Levothyroxine, metformin, Claritin, multivitamin

Current Illness: None

ID: 1041216
Sex: M
Age: 72
State: MI

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: Inspra and Xarelto

Symptom List: Rash, Urticaria

Symptoms: Slight Headache, chills, sore right arm, low fever and tired

Other Meds: Coreg 6.25mg (2), Losartan 50mg(1), Pradaxa 150mg(2), Crestor 10mg(every other day), Aspirin 81mg (1), Flomax 0.4mg (1), Protonix 40mg (2), Folic Acid 800mcg (1), Co Q-10 100mg (every other day), Vitamin D-3 (1), Lexapro 10mg (1). All da

Current Illness: Recovery from fall.

ID: 1041217
Sex: M
Age: 67
State: GA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: Tamiflu, Vicodin

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

Symptoms: Headache, chills, muscle aches/pains, weakness. Fatigue

Other Meds: Klor-con M20 ER 20 MEQ every day Lasix 40mg every day Entresto 24-26mg BID Zoloft 50mg AM Eliquis 5mg AM Depakote 500mg BID Atorvastatin 80mg HS Sotalol HCL fr80mg BID Synthroid 75mcg Metformin 500mg Montelukast 10mg Antivert 25mg PRN Aspi

Current Illness: Hypothyroidism Diabetes Sleep Apnea 4 Heart Stents 12/2017 Defibrillator Pacemaker 4/2018 Degenerative Bone Disease Grand Mal /Partial Complex Seizures Gout Decreased Kidney Function

ID: 1041218
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
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: Patient c/o generalized itching starting on day 1 after covid 19 vaccination- Moderna

Other Meds:

Current Illness:

ID: 1041219
Sex: F
Age: 82
State: MN

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/19/2021
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: No

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

Symptoms: A body rash began after a week and continues to spread. She has had the rash for 10 days and it continues to spread. She has been told to watch for other symptoms and sent home.

Other Meds: Lipitor

Current Illness: None

ID: 1041220
Sex: M
Age: 66
State: NY

Vax Date: 02/17/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Moderna COVID-19 Vaccine EAU A line of red spots along part of my arm where the shot was given. Started about 15 minutes after shot and is not going away.

Other Meds: Vitamin C, Biotin, One a day, Calcium with Vitamin D, Bayer low dose , Atorvastatin, Tamsulosin

Current Illness: None

ID: 1041221
Sex: F
Age: 38
State: TN

Vax Date: 01/18/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
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: Received second dose of vaccine on 1/18/21. Had contact with +COVID family member. Asymptomatic but COVID tested on 2/13/21 and was negative. 2/16/21 came to ED with fever that had developed. COVID tested again with + result

Other Meds:

Current Illness:

ID: 1041222
Sex: F
Age: 71
State: TN

Vax Date: 02/04/2020
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
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: red rash at injection site and bruise , itching

Other Meds: levothyroxine

Current Illness:

ID: 1041223
Sex: F
Age: 69
State: MI

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/19/2021
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: AFTER RECEIVING THE VACCINE SHE STARTED COMPLAINING OF DIZZINESS AND LIGHTHEADINESS. ON SITE EMS RESPONDED. VITALS ARE BELOW. SHE WAS TREATED AND RELEASED TO HOME

Other Meds:

Current Illness:

ID: 1041224
Sex: F
Age: 25
State: MN

Vax Date: 02/11/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: Starting Thursday night (2/18/2021) my arm became extremely itchy. When I woke up this morning (2/19/2021) my arm was swollen, red and stilly itchy at the injection site. This is a week after the shot was given.

Other Meds:

Current Illness:

ID: 1041225
Sex: F
Age: 78
State: MI

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: NONE

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

Symptoms: patient indicated she noticed swelling in entire left side of face and neck no redness or rash swelling including lips not tongue

Other Meds: VITAMIN C 500 ONCE DAILY METOPROLOL 50MGS TWICE DAILY PLAVIX 75 ONCE DAILY LIPITOR 20 ONCE DAILY FUROSEMIDE 20 ONCE DAILY IMDUR 30 ONCE DAILY FISH OIL 500MGS ONCE DAILY ALDACTONE 25 ONCE DAILY APRESOLINE 50MGS TWICE DAILY CALCIUM+VIT D 1200

Current Illness: NASAL DRAINAGE THAT IS CONSISENT IN WINTER

ID: 1041227
Sex: F
Age: 85
State: CA

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/19/2021
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: Pt called this morning stating that she has had a high fever all night, chills, nausea with vomiting and not being able to get out of bed.

Other Meds:

Current Illness:

ID: 1041228
Sex: M
Age:
State: VA

Vax Date: 01/01/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
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: No

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

Symptoms: Accumulation of fluid in tissues.

Other Meds: ,Norvasc Catapres. Aricept. Proscar hydralazine. Potassium chloride sa. Desyrel. Kenalog topically

Current Illness:

ID: 1041229
Sex: F
Age: 70
State: WI

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 02/19/2021
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: Client noticed pain in her neck, left axillary and left shoulder. Had a CT scan two weeks ago that revealed enlarged lymph nodes. Still having pain with enlarged lymph nodes today on 2/19/21. Also stated that she had a metallic taste in her mouth when receiving the first dose of the Pfizer vaccine.

Other Meds:

Current Illness:

Date Died: 01/26/2021

ID: 1041230
Sex: M
Age: 75
State: SC

Vax Date: 01/22/2021
Onset Date: 01/26/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received first dose of covid vaccine on 1/22/2021. Patient had no immediate reaction. Patient presented to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction. Patient was treated and transferred to a cath lab where he died. Patient had significant coronary artery disease.

Other Meds: unknown

Current Illness: n/a

ID: 1041231
Sex: F
Age: 55
State: AZ

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/19/2021
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: IV contrast = itching

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

Symptoms: Itching and tingling began ten minutes after administration, stated itching to body and lips

Other Meds:

Current Illness: none reported, dialysis patient

ID: 1041232
Sex: F
Age: 42
State:

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/19/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Migraines, Fever of 100.7 for 5th day, Severe body pain The day following (unable to walk without assistance) nausea, Light Headed, Unable to focus

Other Meds:

Current Illness:

ID: 1041233
Sex: F
Age: 29
State: PA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Spider web like red mark all over lower back

Other Meds: Sleep aid, anxiety medication

Current Illness: N/a

ID: 1041234
Sex: F
Age: 32
State: KY

Vax Date: 02/12/2021
Onset Date: 02/16/2021
Rec V Date: 02/19/2021
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: Gold, Cephelosporins

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

Symptoms: COVID-19 Vaccine EUA. I have had a swollen, sore lymph node in my left armpit since Tuesday. I understand this is one of the possible side effects so I have not yet sought out medical treatment. If it is still swollen and sore in a few days, I will check up on it.

Other Meds: N/A

Current Illness: None

ID: 1041235
Sex: M
Age: 77
State: MI

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Nausea

Symptoms: Patient reports at least two falls following COVID vaccine. Requiring assistance to stand up. Legs reported as "giving out" resulting in falls. Reports being shaking within 24 hours following vaccination. Reports extreme weakness and needing to be lowered to the floor at least twice. This is new for him. Did not report feeling dizzy; blood sugar was reported as normal during the time. No confusion or feeling out of it reported at the time. Ended up with abrasions. Patient has been having bilateral leg weakness since Friday evening, patient had Covid-19 vaccine on Thursday. Wife called Sunday at 0130 after 2nd episode of leg weakness and fall (see previous note). His first fall was Friday evening around 2030. Saturday his wife reports that he was walking on his own without his walker but did have complaints of fatigue and decreased appetite, which she attributed to his Covid-19 vaccine. Sunday morning at 0130 was his second fall, an ambulance was called and patient refused ED after being assisted by EMS. Patient did not have any dizziness or syncope, just states that his legs were too weak and gave out. Wife states that patient has improved today, is using his walker and walking without difficulty. Yesterday she states that she pushed food and fluids due to decreased urine output. Urine output has returned to normal last night and today, appetite and fatigue have also improved. Assessment 1. Fall from standing, initial encounter 2. Multiple abrasions 3. Adverse effect of vaccine, initial encounter 4. Generalized weakness PT EVAL AND TREAT 5. Decreased strength, endurance, and mobility PT EVAL AND TREAT I suspect his falls and weakness are due to Covid-19 vaccine reaction. I think he has more baseline weakness than he realizes- recommended PHYSICAL THERAPY for strengthening and he agrees- already planning to see them for shoulder pain. Feeling better overall today. Recommended getting up every 2 hours to walk around, use walker for now. Call if more falls or continued extreme weakness.

Other Meds: aspirin, atorvastatin, carvedilol, ciclopirox, empagliflozin, fenofibrate, hydrocortisone cream, Novolin 70/30 insulin, ketoconazole cream, lisinopril

Current Illness: left shoulder pain consistent with impingement syndrome; diabetes mellitus (Chronic)

ID: 1041236
Sex: U
Age: 29
State: MO

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: Had knot the size of grape on arm till 15th or 16 it went away till the 19th it came back. On the 16th i started to have swelling in my arm pit. Treated by pcp the 19th resolved by the 22nd. The month of january.

Other Meds: N/A

Current Illness: N/A

ID: 1041245
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
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: lupus; rheumatoid arthritis; cervical cancer requiring hysterectomy by the age of 24; severe (also reported as several) autoimmune diseases; raynauds; POTS; inappropriate sinus tachycardia; high blood pressure; intractable migraines; food intolerances to red meat and dairy; food intolerances to red meat and dairy; IBS; health continues to deteriorate; This spontaneous report was received via social media monitoring from a lawyer, regarding an on-line article authored by the lawyer that involved a lawsuit (case in litigation), and refers to a 17-year-old female patient (pt) whose age at vaccination with the suspect vaccine was not provided. The pt's pertinent medical history, concomitant medications or drug reactions/allergies were not not provided. On an unknown date, the pt consented and was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (also referred to as "Gardasil human papillomavirus (HPV) vaccine") (strength, dose, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. On an unknown date, the patient reacted to the suspect vaccine developing severe (also reported as several) autoimmune diseases, lupus, rheumatoid arthritis, Raynauds, postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia, high blood pressure, intractable migraines, food intolerances to red meat and dairy, irritable bowel syndrome (IBS), cervical cancer requiring hysterectomy by the age of 24, and the pt's health continued to deteriorate. The pt inquired a physician about how to have her blood tested for the presence of the HPV-16 L1 fragment and any costs associated with that testing. The pt stated she had been unable to find treatment or recovery as her health continued to deteriorate. The outcome of the events was not recovered/not resolved (provided as present status: not recovered). The reporter considered the events to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (provided as reacted to the suspect vaccine developing the reported events). Upon internal review, the events of autoimmune disorder, cervix carcinoma, rheumatoid arthritis, and systemic lupus erythematosus were determined to be medically significant. This is one of several reports received from the same reporter.; Sender's Comments: US-009507513-2101USA011807:

Other Meds:

Current Illness:

ID: 1041255
Sex: F
Age: 30
State: TX

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: As the vaccine provider removed the syringe, a drop of clear liquid on arm; As the vaccine provider removed the syringe, a drop of clear liquid on arm; A spontaneous report was received from a consumer, concerning a 30-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and as the vaccine provider removed the syringe, a drop of clear liquid was on her arm. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 04 Feb 2021, the patient received their first of two planned doses of mRNA-1273 and as the vaccine provider removed the syringe, a drop of clear liquid was on her arm. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not provided. The events, as the vaccine provider removed the syringe a drop of clear liquid was on her arm, was considered resolved on 04 Feb 2021.; Reporter's Comments: This case concerns a 30-year-old female who experienced a NS unexpected event of Incomplete dose administered after a drop from the syringe dripped onto her arm. The event occurred with the first dose of mRNA-1273. No associated adverse events were reported. Event considered resolved. This report refers to a case of PT Incorrect dose administered for mRNA-1273 (lot # unknown) with no associated adverse events.

Other Meds:

Current Illness:

ID: 1041256
Sex: F
Age: 64
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/19/2021
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: Inflamed; lethargic; a little light headed; tired; when the shot was done, dripping of the vaccine liquid leaked from the arm; warm and red area about 3 centimeters around injection site; warm and red area about 3 centimeters around injection site; swelling on arm; A spontaneous report was received from a consumer concerning a 64 year old, female patient who experienced injection site warmth, injection site erythema, injection site swelling, injection site inflammation, fatigue, lethargy, dizziness and incorrect dose given. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 12-JAN-2021, approximately one day prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: 041L20A) intramuscularly in the arm for prophylaxis of COVID-19 infection. Treatment information was not provided. Action taken with mRNA-1273 in response to the event(s) was not provided/unknown. The outcome of the events, injection site warmth, injection site erythema, injection site swelling, injection site inflammation, fatigue, lethargy, were not reported. The outcome of the event, incorrect dose given, was resolved on 12 Jan 2021.; Reporter's Comments: This case concerns a 64-year-old female who had NS unexpected lethargy, dizziness, injection site warmth, injection site inflammation, and incorrect dose administered (liquid leaked from arm), and NS expected injection site redness, injection site swelling, and fatigue. The events occurred the same day as first dose mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1041257
Sex: F
Age: 37
State: OR

Vax Date: 01/13/2021
Onset Date: 02/03/2021
Rec V Date: 02/19/2021
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: 2nd dose 1 week early; A spontaneous report was received from a health care professional concerning a 38 year old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and received a second dose 1 week early (inappropriate scheduling of vaccine administered). 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: 025J20-2A) on 13-JAN-2021. On 03-FEB-2021, approximately the patient received their second of two planned doses of mRNA-1273 (Batch number: 025J20-2A) intramuscularly for prophylaxis of COVID-19 infection. The patient received the second dose 1 week early from 28 day recommendation. Treatment information was not provided/unknown. 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 event, second dose 1 week early, was considered resolved/recovered.; Reporter's Comments: This report refers to a case of inappropriate scheduling of vaccine administered for mRNA-1273 (Batch number: 025J20-2A) with no associated AEs.

Other Meds:

Current Illness:

ID: 1041258
Sex: M
Age:
State:

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

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: Cannot walk; Cannot move arms; Still ill with gas; Initial information received on 14-Dec-2020 regarding an unsolicited valid serious case received from a consumer or non-healthcare professional (reference number: US-SA-SAC20210202000763). This case involves a 69-year-old male patient who experienced cannot walk (gait disturbance), cannot move arms (mobility decreased) and still ill with gas (flatulence), while he received INFLUENZA VACCINE. Medical history, past medical treatment, past vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose (double) of suspect INFLUENZA VACCINE (produced by unknown manufacturer) [lot number, expiry date not reported] via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed serious cannot walk (gait disturbance), cannot move arms (mobility decreased) and still ill with gas (flatulence) (unknown latency) following the administration of INFLUENZA VACCINE. The patient was hospitalized for these events for 90 days (in hospital 3 months). It is also reported, the patient was rest home over a month. Details of laboratory data not reported. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome reported as unknown for cannot walk and cannot move arms and not recovered for still ill with gas (going on 5 months now). Information on the batch number was requested.; Sender's Comments: This case concerns 69-year-old male patient who experienced gait disturbance, mobility decreased and flatulence after vaccination with INFLUENZA VACCINE. The time to onset is unknown. Additional information regarding patient's medical history, condition at the time of vaccination, lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1041259
Sex: F
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 02/19/2021
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: severe anaphylaxis; Initial information received on 09-Feb-2021 regarding an unsolicited valid serious case received from a physician. This case involves female patient who experienced anaphylaxis (anaphylactic reaction), while she received vaccine RABIES VACCINE. The patient's medical history, past medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect RABIES VACCINE (produced by unknown manufacturer) lot number not reported via an unknown route at an unknown administration site for prophylactic vaccination. The patient developed a serious severe anaphylaxis (anaphylactic reaction) (unknown latency) following the administration of RABIES VACCINE. This event was assessed as medically significant. The reaction happened in the mid-90's (patient believes it may have been 1996 but is unsure the exact year), and now presented to see if we could determine the component of the vaccine that may have caused the reaction. Patient had contacted multiple people at the university and involved with Rabies Vaccination program, and they are unsure which rabies vaccine would have been given. Patient feels, it was likely Imovax, but this is not certain. If she able to determine which vaccine the patient received, only can test the relevant components. This is particularly relevant for her now as she is interested in COVID vaccination, and want to confirm that the rabies vaccine she received in the past did not contain polyethylene glycol (PEG)/polysorbates [what are thought to be the allergenic components in the messenger ribonucleic acid (mRNA) COVID vaccines]. None of the current Rabies vaccines contains these ingredients to my knowledge, but she want to confirm with the manufacturer that prior formulations did not include them either. Laboratory details were not reported. It was not reported if the patient received a corrective treatment. The event outcome was unknown for anaphylactic reaction. Batch number has been requested for suspect product for this case.; Sender's Comments: This case concerns a female patient presented with anaphylactic reaction after vaccination with RABIES VACCINE (unknown manufacturer). The time to onset is unknown. Medical history, concomitant medication, lab data ruling out alternative etiologies would be needed for complete assessment. Based upon the reported information role of an vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1041260
Sex: F
Age:
State:

Vax Date: 11/01/2020
Onset Date:
Rec V Date: 02/19/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Redness; Swelling; Itching; This spontaneous case was received on 07-Jan-2021 from Med Communications (reference number: SEQW21-00089), reported by other non-health professional (consumer) and concerned a female patient of unreported age. The patient's medical history included allergy to polyethylene glycols (PEG). The patient's concomitant medications were not reported. On an unspecified date in Nov-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; anatomical location, dose, route of administration: not reported) for flu prevention. The batch number was not reported. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, as reported, the patient developed swelling, redness and itching. The outcome of the events was not reported. The reporter assessed the events as related to Flucelvax Quadrivalent. As reported, the patient had mild adverse reaction to Flucelvax Quadrivalent. The reporter assessed the case as non-serious. Company comment: A patient of an unreported age was vaccinated with Flucelvax Quadrivalent. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, the patient developed swelling, erythema and pruritus. Causal role of the suspect vaccine is assessed as possibly related.; Reporter's Comments: Consumer inquires if Flucelvax Quad contains PEG. She wants to know because she is allergic to it, but on November she got Flucelvax Quad and she only had a mild adverse reaction (swelling, redness and itching).; Sender's Comments: A patient of an unreported age was vaccinated with Flucelvax Quadrivalent. On an unspecified date, 30 hours after receiving Flucelvax Quadrivalent, the patient developed swelling, erythema and pruritus. Causal role of the suspect vaccine is assessed as possibly related.

Other Meds:

Current Illness: Allergy to chemicals

ID: 1041261
Sex: F
Age:
State:

Vax Date: 10/25/2018
Onset Date:
Rec V Date: 02/19/2021
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:

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

Symptoms: Rash; This spontaneous case was received on 08-Jan-2021 from physician via Med Communications (reference number: SEQW21-00113) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. On 25-Oct-2018, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, route of administration: intramuscular, indication and anatomical location: not reported). The batch number reported was 252659 and expiry date was 31-May-2019. On an unspecified date, unknown amount of time after receiving Flucelvax Quadrivalent, the patient developed rash. The outcome of the event was not reported. The reporter did not provide causality assessment. The case was assessed as non-serious. This case is linked with cases 202100472 and 202100473 (the same patient). Company comment: The event of 'rash' is considered as related to Flucelvax Quadrivalent.; Sender's Comments: The event of 'rash' is considered as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness:

ID: 1041262
Sex: F
Age:
State: NY

Vax Date: 09/24/2020
Onset Date:
Rec V Date: 02/19/2021
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: Allergic to thiomersal; Rash; This spontaneous case was received on 08-Jan-2021 from physician via Med Communications (reference number: SEQW21-00113) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. The patient's past vaccinations included Flucelvax Quadrivalent on 25-Oct-2018 and Afluria Quadrivalent on 04-Oct-2019 for flu prevention, after which the patient developed rash both times. On 24-Sep-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, route of administration: intramuscular and anatomical location: not reported) for flu prevention. The batch number was not reported. On an unspecified date, unknown amount of time after receiving Flucelvax Quadrivalent, the patient developed rash and discovered that she was allergic to thiomersal. The outcome of the events was not reported. The reporter did not provide causality assessment. The case was assessed as non-serious. This case is linked with cases 202100471 and 202100472 (the same patient). Company Comment: A female patient of an unknown age developed allergy to chemicals (reported as allergic to thiomersal) and rash after vaccination with the suspect product, Flucelvax Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Although chronology is unclear, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).; Sender's Comments: A female patient of an unknown age developed allergy to chemicals (reported as allergic to thiomersal) and rash after vaccination with the suspect product, Flucelvax Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Although chronology is unclear, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).

Other Meds:

Current Illness:

ID: 1041263
Sex: F
Age:
State:

Vax Date: 02/01/2018
Onset Date: 02/01/2018
Rec V Date: 02/19/2021
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: Pain in extremity

Symptoms: Hives generalized all over her body; Allergic reaction; This spontaneous case was received on 08-Jan-2021 from other non-health professional (consumer) via Med Communication (reference number: SEQW21-00106) and concerned a female patient of an unknown age. The patient's medical history and concomitant medications were not reported. On an unspecified day in Feb-2018, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent, dose, route of administration and anatomical location: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified day in Feb-2018, four hours after receiving Flucelvax Qudrivalent, the patient had hives generalized all over her body. The patient experienced an allergic reaction. It was not anaphylaxis. The patient was treated with Benadryl (diphenhydramine hydrochloride) and the reaction was resolved within 24 hours. The reporter wanted to know what was the ingredient that caused the allergic reaction. On an unspecified date in Feb-2018, the patient was recovered from the events. The reporter assessed the events as related to Flucelvax Quadrivalent. The case was assessed as non-serious. Company comment: The events of allergic reaction and 'hives' are assessed as related to Flucelvax Quadrivalent.; Reporter's Comments: The reporter wanted to know what was the ingredient that caused the allergic reaction.; Sender's Comments: The events of allergic reaction and 'hives' are assessed as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness:

ID: 1041264
Sex: F
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Rash, but it was hardly a rash at all; This spontaneous case was received on 13-Jan-2021 from other non-health professional (consumer) via Med Communications (reference number: SEQW21-00170) and concerned a female patient of an unspecified age. The patient's concurrent conditions included many allergies and eczema. The patient's concomitant medications were not reported. On an unspecified date in Jan-2021, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose; 0.5 ml, route of administration and anatomical location: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified date in Jan-2021, an unknown amount of time after receiving Flucelvax Quadrivalent, the patient experienced rash, but it was hardly a rash at all. The outcome of the event was not reported. The reporter did not provide a causality assessment. This case as assessed as non-serious. Company comment: The event of 'rash' is considered as related to Flucelvax Quadrivalent.; Sender's Comments: The event of 'rash' is considered as related to Flucelvax Quadrivalent.

Other Meds:

Current Illness: Allergy NOS; Eczema

ID: 1041265
Sex: F
Age: 46
State:

Vax Date: 01/03/2013
Onset Date: 01/03/2013
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Lump in her throat; This spontaneous case was received on 13-Jan-2021 from other non-health professional (consumer) via Med Communications (reference number: SEQW21-00155) and concerned a 46-year-old, female patient. The patient's concurrent conditions included anxiety disorder. The patient's concomitant medications were not reported. The patient stated she had influenza vaccines before and never had an issue. On 03-Jan-2013, the patient was vaccinated with Afluria (TIV) (influenza vaccine; route of administration, anatomical location, dose: not reported) as prevention of seasonal influenza. The batch number was not reported. On the same day, after receiving Afluria (TIV), the patient experienced a lump in her throat. The patient stated she had no swelling in her throat and was able to breath. Moreover, the patient stated she did not experience any anaphylactic shock and had no other complications. On an unspecified date, three and a half months after receiving Afluria (TIV), the patient was still experienced "a lump in her throat". On an unspecified date, the patient visited emergency room (ER), and had blood oxygen level and blood pressure measured, and results were all good. The patient also stated she is going to consult with an allergist and requested to be provided the ingredients of the Afluria (TIV) vaccine. At the time of initial reporting, the patient had not recovered from the event. The reporter did not provide a causality assessment, but the patient stated she was not sure if the above experienced adverse event is related to her anxiety disorder or not. The case was assessed as non-serious. Company Comment: A 46-year-old, female patient developed a pharyngeal mass on the same day after vaccination with the suspect product Afluria (TIV). More information regarding the related diagnostic findings is needed. Due to plausible time relationship, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).; Sender's Comments: A 46-year-old, female patient developed a pharyngeal mass on the same day after vaccination with the suspect product Afluria (TIV). More information regarding the related diagnostic findings is needed. Due to plausible time relationship, causality of the suspect product cannot be totally excluded and is assessed as possible (defaults to related in the safety database for reporting purposes).

Other Meds:

Current Illness: Anxiety disorder

ID: 1041266
Sex: F
Age: 26
State:

Vax Date: 10/26/2020
Onset Date: 10/26/2020
Rec V Date: 02/19/2021
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: Nausea; Headache; This is a spontaneous case was received on 18-Jan-2021, reported by other non-health professional to Med Communications (reference number: SEQW21-00213) and concerned a 26-year-old, female patient. The patient's concurrent conditions were not reported. The patient was not taking any concomitant medications. On 26-Oct-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, anatomical location and route of administration: not reported) for flu prophylaxis. The batch number reported was 283849 and expiry date reported was 30-Jun-2021. On the same day, after receiving Flucelvax Quadrivalent, reported as ever since, the patient had been suffering from headaches and nausea. On an unspecified date, the patient visited numerous medical specialists and underwent tests in search of a root cause. The patient's father stated she had done tons of blood works, cat scan of the brain and the pelvis. The treatment measures included steroids and migraine medicines. At the time of initial reporting, the patient had not recovered from the events. The reporter did not provide causality assessment. Company comment: The events of nausea and headache are assessed as related to Flucelvax Quadrivalent.; Sender's Comments: The events of nausea and headache are assessed as related to Flucelvax Quadrivalent

Other Meds:

Current Illness:

ID: 1041267
Sex: F
Age:
State:

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

Symptom List: Vomiting

Symptoms: Flush feeling all over body; Lightheaded; Weak; This spontaneous case was received 19-Jan-2021 from other non-health professional (consumer) via Pfizer (reference number: 2020502909) and concerned a female patient of an unreported age. The patient's relevant medical history and concomitant medications were not reported. The patient had no known allergies. On an unspecified date in 2018, the patient was vaccinated with Afluria (TIV) (influenza vaccine; dose, route of administration, anatomical location and indication: not reported). The batch number was not reported. On an unspecified date in 2018, immediately after receiving Afluria (TIV), the patient was lightheaded, weak and had flush feeling all over her body. The patient went to the hospital, sat in the waiting room for about 30 minutes and symptoms went away totally. The patient did not require treatment. On the same day, the patient recovered from the events. The reporter did not provide causality assessment. The patient hadn't had a flu shot since per her doctor's advice. The patient wanted to get Pfizer-Biontech COVID-19 Vaccine, and she wanted to know what ingredients Afluria TIV and Pfizer-Biontech COVID-19 Vaccine might have in common. The case was assessed as non-serious. Company comment:The patient developed flushing, dizziness and asthenia on the same day after receiving Afluria (TIV). Chronology is suggestive. The patient's relevant medical history and concomitant medications were not reported. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).; Sender's Comments: The patient developed flushing, dizziness and asthenia on the same day after receiving Afluria (TIV). Chronology is suggestive. The patient's relevant medical history and concomitant medications were not reported. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).

Other Meds:

Current Illness:

ID: 1041268
Sex: U
Age:
State:

Vax Date: 10/01/2020
Onset Date: 10/01/2020
Rec V Date: 02/19/2021
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: Pain to gums and teeth; Pain to gums and teeth; This spontaneous case from was received on 25-Jan-2021 from non-heath professional (consumer) and concerned a patient of an unreported age and gender. The patient's medical history and concomitant medications were not reported. On an unspecified date in Oct-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose, route of administration, indication and anatomical location: not reported). The batch number was not reported. On the same day, a few hours after receiving Flucelvax Quadrivalent, the patient experienced pain in gums and teeth. The outcome of the events was not reported. The reporter did not provide a causality assessment. Company Comment: A of an unreported age and gender developed toothache and gingival pain on the same day after vaccination with the suspect product, Flucelvax Quadrivalent. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Due to lack of information, causality for the reported events is unassessable.; Sender's Comments: A of an unreported age and gender developed toothache and gingival pain on the same day after vaccination with the suspect product, Flucelvax Quadrivalent. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Due to lack of information, causality for the reported events is unassessable.

Other Meds:

Current Illness:

ID: 1041269
Sex: F
Age: 68
State:

Vax Date: 11/13/2020
Onset Date: 11/13/2020
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pressure on the side of her face radiating into temple; Right arm and shoulder swelling; Right arm and shoulder swelling; Wasn't able to bent the arm; Trouble thinking; She felt she couldn't breath; Fatigue; Allergic reaction within 1-2 hours of receiving the vaccines; Fever; She felt the medicine was trapped in the tissue of her arm; Sharp pains at the injection site; The patient was administered both vaccines in the right arm; This spontaneous case was received on 27-Jan-2021 from other health professional via Med Communications (reference number: SEQW21-00323) and concerned a 68-year-old, female patient. The patient's concurrent conditions included 22 allergies including allergy to dog and cat hair. The patient stated she had allergy alert and the allergies were listed in their computer. The patient's past medical history included anaphylaxis. The patient's concomitant medications included levothyroxine, Singulair (montelukast sodium) and sucralfate, all used for unreported indications. On 13-Nov-2020, the patient was vaccinated with Flucelvax Quadrivalent (influenza vaccine, subunit influenza virus vaccine polyvalent; dose: 0.5 ml, anatomical location: right deltoid, route of administration: not reported) (explicitly coded as 'Product administration error') for influenza prophylaxis. The batch number reported was 283852 and expiry date was 30-Jun-2021. On the same day, the patient was vaccinated with non-company co-suspect pneumococcal vaccine (brand not specified, anatomical location: right arm, dose, route of administration, indication and batch number: not reported). On the same day, one to two hours after receiving Flucelvax Quadrivalent and pneumococcal vaccine, the patient had an allergic reaction. The patient started having fever, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm. The patient also had sharp pains at the injection site. The patient called the physician's office and was told he was not available. She was advised to come into the office, but she was a private duty medical assistant (MA) and was taking care of a patient and unable to leave. The patient had drunk detox tea and kept the injection site warm. At the time of initial reporting, the patient had not recovered from the events. The reporter did not provide a causality assessment. The case was assessed as non-serious. Company comment: A 68-year-old patient was vaccinated with Flucelvax Quadrivalent and non-company co-suspect pneumococcal vaccine. On the same day, after receiving vaccines, the patient had an allergic reaction. The patient started having pyrexia, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm (Feeling abnormal) The patient also had vaccination site pain. Causal role of the suspect vaccine is assessed as possibly related for head discomfort, joint swelling, peripheral swelling, pyrexia, hypersensitivity, injected limb mobility decreased, bradyphrenia, dyspnoea, fatigue, and vaccination site pain. The patient was administered both vaccines in the right arm. Feeling abnormal is assessed as not related to the suspect vaccine. Product administration error is assessed as not related based on company's conventions. Brighton Collaboration criteria could not be assessed, due to lack of information.; Sender's Comments: A 68-year-old patient was vaccinated with Flucelvax Quadrivalent and non-company co-suspect pneumococcal vaccine. On the same day, after receiving vaccines, the patient had an allergic reaction. The patient started having pyrexia, pressure on the side of her face radiating into temple, right arm and shoulder swelling, and fatigue. She was not able to bent the arm, and she had trouble thinking. At night the patient felt she couldn't breath and had to get up and walk around. The patient felt that the medicine was trapped in the tissue of her arm (Feeling abnormal) The patient also had vaccination site pain. Causal role of the suspect vaccine is assessed as possibly related for head discomfort, joint swelling, peripheral swelling, pyrexia, hypersensitivity, injected limb mobility decreased, bradyphrenia, dyspnoea, fatigue, and vaccination site pain. The patient was administered both vaccines in the right arm. Feeling abnormal is assessed as not related to the suspect vaccine. Product administration error is assessed as not related based on company's conventions. Brighton Collaboration criteria could not be assessed, due to lack of information.

Other Meds: LEVOTHYROXINE; SINGULAIR; SUCRALFATE

Current Illness: Allergy NOS (She says she has allergy alert and the allergies are listed in their computer.); Allergy to animal

ID: 1041270
Sex: F
Age: 72
State:

Vax Date: 11/23/2020
Onset Date:
Rec V Date: 02/19/2021
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: Unable to move her arms from the elbow up but this was worse in the left arm/Felt paralyzed from the elbows up to the shoulders/still having problems with pulling up her pants; Shoulders went tight; Lymph nodes were swollen/swelling in her armpit, groin and base of neck; Chills; Rash in her arm pits; Some pain at the injection site; Hear a clicking sound in her shoulder joints and feels some relief afterward; This spontaneous case was received on 09-Feb-2021 reported by other non-health care professional (consumer) to Med Communications (reference number: SEQW21-00442) and concerned a 72-year-old, female patient. The patient's concurrent conditions included thyroid issues and blood pressure problems. The patient's concomitant medications included unspecified thyroid medication and blood pressure medication. On 23-Nov-2020, the patient was vaccinated with Seqirus influenza virus vaccine polyvalent (brand not specified; anatomical location: left arm, dose, route of administration: not reported) as influenza prophylaxis. The batch number was not reported. On an unspecified date in 2020, about a week to ten days after receiving influenza virus vaccine polyvalent, the patient said her shoulders went tight and she had the chills, lymph nodes were swollen and she experienced some pain at the injection site. The patient also experienced swelling in her arm pits, groin and base of neck. The patient had rash in her arm pits and was unable to move her arms from the elbow up, but this was worse in the left arm. The patient felt paralyzed from the elbows up to the shoulders and could hear a clicking sound in her shoulder joints and felt some relief afterward. The patient visited her physician twice and was given prednisone and celebrex and instructed on exercises to help with shoulders. At the time of initial reporting on 09-Feb-2021, the patient had not recovered from the event of 'vaccination site pain' since she still had problems with some pain. Also, the patient was recovering from all other events since it was reported that the medications helped and the she was better, but still had problems with pulling up her pants. The reporter assessed the events as related to influenza virus vaccine polyvalent. The reporter stated that the patient received her first flu vaccine ever on 23-Nov-2020 and has had reactions to it. Company comment:The patient developed mobility decreased, joint stiffness, lymphadenopathy, chills, rash, vaccination site pain and joint noise after vaccination with the suspect product, influenza virus vaccine polyvalent. Chronology seems plausible. No alternative etiology was provided. Causality for joint noise is assessed as not related as the event likely developed due to other experienced events (mobility decreased and joint stiffness). Considering all above mentioned, causal relationship for all other events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).; Reporter's Comments: The reporter stated the patient received her first flu vaccine ever on 23-Nov-2020 and has had reactions to it.; Sender's Comments: The patient developed mobility decreased, joint stiffness, lymphadenopathy, chills, rash, vaccination site pain and joint noise after vaccination with the suspect product, influenza virus vaccine polyvalent. Chronology seems plausible. No alternative etiology was provided. Causality for joint noise is assessed as not related as the event likely developed due to other experienced events (mobility decreased and joint stiffness). Considering all above mentioned, causal relationship for all other events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes).

Other Meds:

Current Illness: Blood pressure abnormal; Thyroid disorder NOS

ID: 1041272
Sex: F
Age: 46
State: OH

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 02/19/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: First dose - fever, severe headache, achy. 2 weeks later - rash on face and then injection site. 3 weeks later - rash on face and then injection site again. Second dose - fever but NO headache, extreme exhaustion, and achy to the point where I could not even brush my hair. Rash at injection site and all over arm.

Other Meds: Lamictal, Yasmin, Vitamin D, Fish Oil, Folic Acid

Current Illness: None

ID: 1041273
Sex: F
Age: 70
State: SC

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 02/19/2021
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: Penicillin Sulfur Iodine adhesive glues Seasonal Allergies

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

Symptoms: Sore arm, headache, nausea, sweats Time: from 7PM (Feb. 17th) until morning of the second day (Feb. 19th).

Other Meds: Lovaza 1gm BID Vytorin 10/20 QD (Bed) Multi-vitamin 1 pill QD Vitamin D-3 50 mcg BID Probiotic 10 QD (PM) Tylenol PM 1 QD Aller-Tec 1 QD Flonase 2 puffs QD (AM) Saline 2 puffs QD (AM) Montelukast 10mg QD (PM)

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm