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: 1049255
Sex: F
Age: 40
State: GA

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 02/23/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: generalized muscle ache fatigue injection site swelling, errythema and pain Headache

Other Meds: none

Current Illness: none

ID: 1049256
Sex: M
Age: 68
State: WI

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 02/23/2021
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: Allergic to MRI contrast agents

Symptom List: Anxiety, Dyspnoea

Symptoms: The day following the injection the client's left arm from the injection site to his elbow was red and very itchy. A few days later the redness traveled down to his forearm and a bumpy rash also appeared from the injection site to the forearm. The client reports that his arm is so itchy that he has not slept much since 01/28/2021. The client sought medical attention on 02/17/2021 and was put on a prednisone taper. The client indicates he feels the rash and itchiness is "a little better". The client's medical provider told him to RTC if symptoms were not improving. The client reports that he feels they are improving and he is not going to see his medical provider at this time.

Other Meds: Takes Vitamin K and Vitamin D daily

Current Illness: No

ID: 1049257
Sex: F
Age: 42
State: CA

Vax Date: 01/10/2021
Onset Date: 01/17/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaginal bleeding about an hour after first dose

Other Meds: pre natal vitamins

Current Illness:

ID: 1049258
Sex: M
Age: 71
State: TX

Vax Date: 01/12/2021
Onset Date: 01/29/2021
Rec V Date: 02/23/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient's family report that patient was in the hospital with Pneumonia due to COVID-19 virus

Other Meds:

Current Illness:

ID: 1049259
Sex: F
Age: 74
State: FL

Vax Date: 02/13/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: vaccine administered on 2/13, reaction on 2/21. Site itching, redness, 2 swollen areas.

Other Meds: osteo bi-flex triple strength, turmeric, daily vitamin, eye vitamin, and eye drops

Current Illness:

ID: 1049260
Sex: F
Age: 46
State: MA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, muscle aches, arm pain, fever - for 48h Headaches continued for 7 days

Other Meds: lexapro

Current Illness:

ID: 1049272
Sex: U
Age:
State: CA

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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: shingles; other zoster-related conditions; Information has been received from a lawyer and a patient of unknown age and gender regarding a case in litigation. Information about concurrent condition, medical history and concomitant medication was not reported. In 2014, the patient was vaccinated with zoster vaccine live (ZOSTAVAX) (strength, dose, lot#, expiration and route unknown) for the long-term prevention of shingles and zoster-related conditions. Subsequent to the inoculation (date not reported), the patient was treated by health care providers for shingles and other zoster-related conditions. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient has and will continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and will continue to suffer such losses, and damages in the future. The outcome of the event shingles and other zoster-related conditions was not recovered. The causality assessment was considered as related by the lawyer.

Other Meds:

Current Illness:

ID: 1049273
Sex: U
Age:
State: NM

Vax Date: 11/01/2012
Onset Date:
Rec V Date: 02/23/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: shingles; other zoster-related conditions; Information has been received from a lawyer and a patient of unknown age and gender regarding a case in litigation. Information about concurrent condition, medical history and concomitant medication was not reported. In or about November 2012, the patient was vaccinated with zoster vaccine live (ZOSTAVAX) (strength, dose, lot#, expiration and route unknown) for the long-term prevention of shingles and zoster-related conditions. Subsequent to the inoculation (date not reported), the patient was treated by a physician for shingles and other zoster-related conditions. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient has and will continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and will continue to suffer such losses, and damages in the future. The outcome of the event shingles and other zoster-related conditions was not recovered. The causality assessment was considered as related by the lawyer.

Other Meds:

Current Illness:

ID: 1049274
Sex: F
Age:
State: DC

Vax Date: 08/19/2011
Onset Date:
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: shingles; Information has been received from a lawyer, regarding a case in litigation, and refers to a female patient (pt) of unknown age. The pt's medical history, concurrent conditions and concomitant medications were not provided. On or around 19-AUG-2011, the pt was inoculated with zoster vaccine live (ZOSTAVAX) (dose, route of administration, anatomical location, lot # and expiration date were not provided) for routine health maintenance and for its intended purpose: the prevention of shingles (herpes zoster). On an unknown date, shortly after receiving zoster vaccine live (ZOSTAVAX), the pt suffered and was diagnosed with shingles. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the pt's symptoms had resulted in physical limitations not present prior to using the suspect vaccine. The pt experienced mental and emotional distress due to resulting physical limitations and seriousness of her condition. As a result of the manufacture, marketing, advertising, promotion, distribution and/or sale of zoster vaccine live (ZOSTAVAX), the pt sustained severe and permanent personal injuries. Further, as a tragic consequence, the pt suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result, the pt had suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of the event was not recovered/not resolved. The reporter regarded the event as related to zoster vaccine live (ZOSTAVAX). The reporter considered the event of herpes zoster to be disabling.

Other Meds:

Current Illness: Routine health maintenance

ID: 1049278
Sex: F
Age: 75
State: CO

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 02/23/2021
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: Second shot at gap of 35 days; Left arm sore; Bodyache; This spontaneous report was received from consumer on 05-feb-2021, concerning a 75 year old female patient who was administered Moderna COVID-19 vaccine9( mRNA-1273). and she had experienced sore arm, body ache and Inappropriate schedule of vaccine administered. The patient's medical history was not provided. Concomitant medication also not provided. The patient received suspect product mRNA-1273 on 05/Jan/2021, prior to the onset event, the patient received their first dose of mRNA-1273 (lot number:025L20A) intramuscularly on the left arm for prophylaxis of COVID-19 infection On 05 Jan 2021, the patient received her first shot in her left arm. She experienced a sore arm for 2 days and body ache for a couple of hours following the vaccination. On 25 Jan 2021, at surgical center she received steroid epidural injection in her back for pain, her Moderna Vaccine is scheduled 2 days after the steroid shot. But, she was able to reschedule her second dose 5 weeks from 1st shot that is on coming Tuesday 09Feb2021. Caller enquired having second shot at gap of 35 days is fine. Having a steroid injection prior to Moderna COVID Vaccine is safe and will it have any effect on the vaccine effectiveness. Action taken with the second dose of mRNA-1273 in response to the event was not reported; Reporter's Comments: This case concerns a 75-year-old female who had NS expected adverse events of Vaccination site pain and Myalgia occurring 1 day after the first dose of mRNA-1273. She had a NS unexpected event of Inappropriate schedule of vaccine administered without associated AEs after a delay in the second dose of mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the adverse events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1049279
Sex: F
Age:
State: NY

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: when vaccine was being administered, the needle disconnected from the syringe; caused some vaccine to end up on the patient's arm; incorrectly administered dose; A spontaneous report was received from a pharmacist (PharmD) concerning a 62-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced when vaccine was being administered, the needle disconnected from the syringe (device connection issue) that caused some vaccine to end up on the patient's arm (exposure via skin contact) and an incorrectly administered dose (underdose). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 28 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (lot number: 012M20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. When the vaccine was being administered, the needle disconnected from the syringe. This caused some of the vaccine to end up on the patient's arm and an incorrectly administered dose. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events, when vaccine was being administered, the needle disconnected from the syringe that caused some vaccine to end up on the patient's arm, and an incorrectly administered dose, were considered recovered/resolved on 28 Jan 2021.; Reporter's Comments: This report refers to a case of device connection issue, exposure via skin contact and underdose with no associated AEs.

Other Meds:

Current Illness:

ID: 1049280
Sex: F
Age:
State: CA

Vax Date: 02/02/2021
Onset Date: 02/02/2020
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: got pain in the arm; fatigue; chills; Vaccinated from a prefilled syringe that surpassed 6 hours; A spontaneous report was received from a pharmacist who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced pain in the arm, fatigue, chills following vaccination from a prefilled syringe that has surpassed six hours. The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received her first of two planned doses of mRNA-1273 (BATCH # 041L20A) on 02 Feb 2021 intramuscularly in the left arm for prophylaxis against COVID-19 infection. Pharmacist received first dose on 02 Feb 2020 to left non dominant arm. Pharmacist stated I got pain in the arm, fatigue, chills after the dose. Pharmacist stated they were conducting clinics at hospital site, extra unused doses in syringe were brought back to pharmacy, and being used for administering other patients for last two weeks that were in syringes for over six hours. HCP (healthcare professional) wanted to know how long it can be stable in syringe, as she knew punctured vials needed to be discarded after six hours but what about dose in syringe. Also, she asked if they could transport in syringe to different sites and conditions to maintain for transport when they are in syringes. Approximately thirty patients were administered from those syringes. HCP stated that it was first dose for all patients. HCP does not know any information on those patients except, was one of the recipients of dose of vaccine from that syringe. Consented for safety follow-up with reporter. Pregnancy status unknown, age not provided. No further information was reported. No treatment information was provided. Action taken with RNA-1273 in response to the event was unknown. The outcome of the events was unknown. The reporter did not provide an assessment for the events, got pain in the arm, fatigue, chills and vaccinated from a prefilled syringe that surpassed six hours.; Reporter's Comments: This report refers to a case of "Expired Product Administration" of mRNA-1273, lot # # 041L20A with associated adverse events of limb discomfort, fatigue and chills. 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: 1049281
Sex: F
Age: 69
State: TX

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: arm was slight red; lump appeared at injection site; administer went past muscle to the bone; when administrator removed needle, fluid rolled down arm; unsure if received any vaccine; A spontaneous report was received from a consumer, who was also a 69-year-old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced administrator went past muscle to the bone (product administration error), when administrator removed needle, fluid rolled down arm (exposure via skin contact), unsure if received any vaccine (underdose), arm was slight red (erythema), and lump appeared at injection site (injection site mass). The patient's medical history was not provided. Concomitant medications included levothyroxine sodium and lovastatin. 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. On 05 Jan 2021, the same day as the onset of the events, the patient received their second of two planned doses of mRNA-1273 (Batch number: 013M20A) intramuscularly in the arm for prophylaxis of COVID-19 infection. On 05 Feb 2021, the vaccine administrator went past the muscle to the bone. When the administrator removed the needle, fluid rolled down the patient's arm. The patient was unsure of she received any vaccine. The patient also reported her arm was slight red and a lump appeared at the injection site. No treatment information was 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 was not applicable. The outcome of the events, administrator went past muscle to the bone; when administrator removed needle, fluid rolled down arm; and unsure if received any vaccine, was considered recovered/resolved on 05 Feb 2021. The outcome of the events, arm was slight red and lump appeared at injection site, was unknown.; Reporter's Comments: This report refers to a case of product administration error, exposure via skin contact, underdose, injection site erythema, and injection site mass for mRNA-1273, unknown lot #, with no associated AEs.

Other Meds: SYNTHROID; LOVASTATIN

Current Illness:

ID: 1049282
Sex: M
Age: 44
State: PA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/23/2021
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: Couldn't feel arm; Couldn't feel arm and had no range in motion; Pain in upper shoulder area by his neck; Thinks the administration was done incorrectly; Aching in legs as if he was getting sick; Aching in legs as if he was getting sick; Pain in upper shoulder area by his neck; A spontaneous report was received from a nurse concerning her son, who was a 44-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced couldn't feel arm and had no range in motion (hypoaesthesia, joint range of motion decreased), pain in upper shoulder area by the neck (arthralgia, neck pain), thinks administration was done incorrectly (product administration error), and aching in legs as if was getting sick (arthralgia, malaise). The patient's medical history was not provided. Concomitant medication included escitalopram. On 04 Feb 2021, on the same day as the onset of the events, the patient received their first of two planned doses of mRNA-1273 (batch number: 030L20A) in the left arm for prophylaxis of COVID-19 infection. On 04 Feb 2021, a couple of hours after the vaccination, the patient couldn't feel his arm and he had no range in motion. He also had pain in his upper shoulder area by his neck. The reporter thought the administration was done incorrectly but she "wasn't there to conform 100%." At night on 04 Feb 2021 and 05 Feb 2021, the patient had aching in his legs "as if he was getting sick." Treatment for the events included ibuprofen which helped, and the patient was feeling better at the time of this report. Action taken with mRNA-1273 in response to the events was not reported. The events, couldn't feel arm and had no range in motion, pain in upper shoulder area by the neck, and aching in legs as if was getting sick, were considered recovering/resolving at the time of this report. The event, thinks administration was done incorrectly, was considered recovered/resolved on 04 Feb 2021.; Reporter's Comments: This case concerns a 44-year-old male who experienced NS unexpected events of hypoaesthesia, joint range of motion decreased, arthralgia, neck pain, product administration error, malaise, and NS expected arthralgia. The events occurred 1 day after the first dose of mRNA-1273. Events resolved. 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.; Sender's Comments: US-MODERNATX, INC.-MOD-2021-012275: US-MODERNATX, INC.-MOD-2021-012263:

Other Meds: ESCITALOPRAM

Current Illness: No adverse event (No reported medical history)

ID: 1049283
Sex: F
Age: 41
State: CA

Vax Date: 01/21/2021
Onset Date: 01/25/2021
Rec V Date: 02/23/2021
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:

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

Symptoms: Hypertrophic Cardiomyopathy; Chest Pain; Chest Pressure; Numbness in Left Arm; Back Pain; A spontaneous report was received from a nurse concerning herself, a 41-years-old, female patient who experienced hypertrophic cardiomyopathy, chest pain, chest pressure, numbness in left arm, and back pain. The patient's medical history was not provided. concomitant medications included metoprolol, omeprazole and acetylsalicylic acid. On 21 Jan 2021, approximately four days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 [Lot number 0412L0A] intramuscularly in the for prophylaxis of COVID-19 infection. On 25 Jan 2021, four days after the vaccine administration, the patient started experiencing chest pain, chest pressure, numbness in left arm, back pain and hypertrophic cardiomyopathy and was hospitalized in emergency room for 48 hours from 25 Jan 2021 to 26 Jan 2021. The event hypertrophic cardiomyopathy was also considered to be medically significant. Treatment information was not provided. Action taken with mRNA-1273 in response to the events were not provided. The outcome of the events chest pain, chest pressure, numbness in left arm, back pain and hypertrophic cardiomyopathy were considered unknown at the time of this report.; Reporter's Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.

Other Meds: METOPROLOL; OMEPRAZOLE; ASPIRIN [ACETYLSALICYLIC ACID]

Current Illness:

Date Died:

ID: 1049284
Sex: F
Age:
State: VA

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

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

Lab Data:

Allergies:

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

Symptoms: Died; A spontaneous report was received from a consumer concerning a 58-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and patient was died. The patient's medical history was reported as underlying health issue. Concomitant product use was not provided by the reporter. On an unknown date, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: if reported or unknown) intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, patient with underlying health issue died after getting the Moderna COVID-19 vaccine. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on an unknown date. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter's Comments: This case concerns a 58-year-old female who died on unknown date after first dose of mRNA-1273, lot # unknown. Very limited information regarding this event has been provided at this time, therefore it is difficult to assess a cause and effect relationship. No further information will be available. Of note, patient's medical history included unknown underlying health issues.; Reported Cause(s) of Death: Unknown cause of death

Other Meds:

Current Illness:

ID: 1049285
Sex: M
Age: 42
State: IL

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/23/2021
Hospital: Y

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: Difficulty breathing; Allergic reaction; Pain in the arm that radiated up to the neck; Hot and cold flashes; Hot and cold flashes; A spontaneous report was received from a consumer, who was also a 43-year-old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced an allergic reaction, hot and cold flashes, difficulty breathing and pain in the arm that radiated up to the neck. The patient's medical history, as provided by the reporter, included asthma and allergies. Concomitant medications were not reported. On 15 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot number: 026L20A; expiration date: 28 Jul 2021) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 15 Jan 2021, four hours after vaccination, the patient experienced hot and cold flashes and pain in his arm that radiated up to his neck. He had some food and went to bed. The next day, on 16 Jan 2021, the patient had an "adverse reaction, allergic reaction". This event was considered to be medically significant. treatments at home but had no relief. The patient still had trouble breathing so he went to the emergency room as his physician told him to. He was given three more nebulizers of ipratropium bromide (+) albuterol sulfate, steroids, diphenhydramine hydrochloride, and famotidine but he still had trouble breathing. Therefore, the patient was admitted into the hospital for observation. The patient was discharged on 17 Jan 2021 with two to three bags of normal saline and four bags of "lactose ringers". In addition, his physician put him on a steroid and inhaler. Action taken with mRNA-1273 in response to the events were not reported. The outcomes of the events, allergic reaction, difficulty breathing, hot and cold flashes, and pain in the arm that radiated up to the neck, were unknown at the time of this report.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset date of the events, a causal relationship cannot be excluded. Of note, patient's significant medical history included asthma and allergies.

Other Meds:

Current Illness: Allergy (has allergies (not specified)); Asthma

ID: 1049286
Sex: F
Age:
State: TX

Vax Date:
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
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: got 3 vaccinations; Sore; Sleepy; Chills; Temp of 99.6?F; Interchanged covid-19 products; A spontaneous report was received from a consumer concerning a 66-years-old female patient, who received 3 doses of the COVID-19 vaccine. After the 2nd Moderna shot her arm got sore she felt sleepy, got the chills and had an elevated temp of 99.6?F, Interchanged covid-19 products. The patient's medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included Rosuvastatin 10mgxDay, Paroxetine 20mgxDay, Alendronate 70mg 1xWeek. The patient received her first of two planned doses of mRNA-1273 (Lot # 027L20A) on 06 Jan 2021. On 03 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Lot #013M20A) intramuscularly for prophylaxis of COVID-19 infection. Caller states that she received 3 doses of the COVID-19 vaccine. She received the Moderna vaccine on 06 Jan 2021 from a pharmacy. Then on Monday 01 Feb 2021 she received the 1st dose of the Pfizer's vaccine (and had a sore arm). The Pfizer's dose is EL9265. The pharmacy called for the 2nd Moderna dose on 03 Feb 2021. After the 2nd Moderna arm got sorer, she felt sleepy, got the chills and had a raised temperature of 99.6?F. 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 outcome of the events, sore arm, she felt sleepy, got the chills and had an elevated temp of 99.6?F, Interchanged covid-19 products were unknown/not reported.; Reporter's Comments: This case concerns a 66-year-old female patient who received their second of two planned doses of mRNA-1273 (Lot: 013M20A), reporting Extra dose administered and Interchange of vaccine products, associated with Vaccination site pain, Somnolence, Chills and Pyrexia. Based on the current available information and temporal association between the use of the product and the onset date of the events, a causal relationship cannot be excluded.

Other Meds: ROSUVASTATIN; PAROXETINE; ALENDRONATE

Current Illness:

ID: 1049287
Sex: F
Age: 16
State: NY

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 02/23/2021
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: Patient received the first dose of the Moderna COVID-19 vaccine that was under 18 years of age; A spontaneous report was received from a healthcare professional concerning a 16-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) (product administered to patient of inappropriate age). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 12 Jan 2021, the patient received her first dose of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The Director of Medical Operations called in stating that it was reveled on 12 Jan 2021 that a patient in his clinic received the first dose of the Moderna COVID-19 vaccine that was under 18 years of age. The administration was made in error. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome for the event, patient received the first dose of the Moderna COVID-19 vaccine that was under 18 years of age, was considered resolved on 12 Jan 2021.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age (16 year old female) for mRNA-1273 (lot number unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049288
Sex: M
Age: 67
State: GA

Vax Date: 01/22/2021
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: received second shot early; A spontaneous report was received from a Reporter like a nurse concerning a ?63 Years-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced event inappropriate schedule of vaccine administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22-Jan-2021, the patient received their first of two planned doses of mRNA-1273 (lot/batch: unknown) intramuscularly in the anatomical location for prophylaxis of COVID-19 infection. The patient is scheduled to receive his second shot on 19-FEB-2021, but received the vaccine (early) on, 09-FEB-2021. Action taken with mRNA-1273 in response to the events was not reported. On 09-feb-2021, the outcome of the events was unknown.; Reporter's Comments: This report refers to a case of inappropriate schedule of vaccine administered for mRNA-1273 (lot #unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049289
Sex: M
Age:
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: received the 2nd dose 20 days after the 1st one; A spontaneous report was received from a health care professional, concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and the patient received the 2nd dose 20 days after the 1st one. 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 for prophylaxis of COVID-19 infection. On an unknown date, the patient received their second of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. On an unknown date, it was reported that the patient received their second dose 20 days after receiving their first vaccination. Action taken with study drug was not applicable as the subject had already received both scheduled doses The outcome of the event, the patient received the 2nd dose 20 days after the 1st one was resolved.; Reporter's Comments: This report refers to a case of inappropriate schedule of product administration for mRNA-1273 (lot# unknown) with no associated AEs reported after the second dose.

Other Meds:

Current Illness:

ID: 1049290
Sex: F
Age: 17
State: WA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/23/2021
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: Gave vaccine to 17 year old; A spontaneous report was received from a nurse concerning a 17-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and resulting in the event, gave vaccine to a 17-year-old/inappropriate age of dose of administration. The patient's medical history was not provided. Concomitant medications were not reported. On 05 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number: 013M20A) for prophylaxis of COVID-19 infection. On 05 Feb 2021, the patient received the vaccine resulting in the event of inappropriate age of dose of administration. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, gave vaccine to a 17-year-old, was considered resolved on 05 Feb 2021.; Reporter's Comments: This report refers to a case of Product administered to patient of inappropriate age for mRNA-1273, lot # 013M20A with no associated AEs.

Other Meds:

Current Illness:

ID: 1049291
Sex: U
Age:
State: TN

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

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

Lab Data:

Allergies:

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

Symptoms: a person who received 2 doses of the vaccine in a fairly quick succession; A spontaneous report was received from a health care professional, concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and reported the patient had received 2 doses of the vaccine in a fairly quick succession. 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 for prophylaxis of COVID-19 infection. On an unknown date, the patient received their second of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. On an unknown date, it was reported that the patient received both doses of the vaccine in a fairly quick succession. Action taken with study drug was not applicable as the subject had already received both scheduled doses The outcome of the event, a person who received 2 doses of the vaccine in a fairly quick succession was resolved.; Reporter's Comments: This report refers to a case of "Product administration error" for mRNA-1273, lot # unknown. with no associated adverse events..

Other Meds:

Current Illness:

ID: 1049292
Sex: F
Age: 76
State: CO

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/23/2021
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: Received a partial dose during their second dose of Moderna; the needle coming off during administration; A spontaneous report was received from a healthcare professional concerning a 76-year-old female patient, who received a partial dose during her second dose of Moderna vaccine administration / MedDRA PT: underdose due to the needle coming off during administration /MedDRA PT: device connection issue. The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received her first of two planned doses of mRNA-1273 (Lot number not provided) on an unknown date. On 07-Feb-2021, prior to the onset of the events, the patient received her second of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of Covid-19 infection. It was reported that a female patient did not get the full dose of the Moderna vaccine due to the needle coming off during administration. No further information was provided. Treatment information was unknown. Consent given to follow-up. 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, received a partial dose during her second dose of Moderna vaccine due to the needle coming off during administration, were considered resolved.; Reporter's Comments: This report refers to a case of underdose and syringe issue for mRNA (lot # unknown) with no reported AEs in the second dose.

Other Meds:

Current Illness:

ID: 1049293
Sex: U
Age:
State: OR

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Syringe Leaked (Suboptimal Dose administered); Syringe Leaked (Suboptimal Dose administered); A spontaneous report was received from a physician concerning a patient of unknown/undisclosed age and gender who experienced syringe leak (Suboptimal Dose Administered) and underdose The patient's medical history was not provided. Concomitant product use was not provided/unknown by the reporter. On 3FEB2021, the patient received one of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. Female Physician called to report that while mass-vaccinating with the Moderna COVID-19 vaccine on 3FEB2021, the syringe leaked on two cases. She reported the needle was not properly attached to the barrel. As a result, two patients possibly did not receive the full dose of the Vaccine. Action taken with mRNA-1273 in response to the events was not provided. The events, syringe leak (Suboptimal Dose Administered) and underdose, was considered recovered/resolved or recovered/resolved.; Reporter's Comments: This report refers to a case of underdose and syringe issue for mRNA-1273 (lot # unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049294
Sex: F
Age: 37
State: IA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Unsure if shot was administered intramuscularly in the deltoid; Muscles on the whole right side of her body are flaring up and tensing up; The big gland in her axillary area are really big; Scapula and shoulder blade area was very tense and balling up; Arm was sore; A regulatory authority report was received from a healthcare professional concerning a 37-year old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced unsure if shot was administered intramuscularly in the deltoid, muscles on the whole right side of her body are flaring up and tensing up, arm was sore, the big gland in her axillary area are really big and her scapula and shoulder blade area was very tense and balling up. The patient's medical history was not provided. No relevant concomitant medications were reported. On 15 Jan 2021, approximately 0 days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot 025L20A) intramuscularly in the right, dominant arm for prophylaxis of COVID-19 infection. On 15 Jan 2021, the patient received first shot in right, dominant arm at the peak of shoulder, between the clavicle and humerus and is unsure if shot was administered intramuscularly in the deltoid. She reported the muscles on the whole right side of her body flared and tensed up, arm was sore, the big gland in her axillary area was really big and her scapula and shoulder blade area was very tense and balling up. Treatment for the event included paracetamol, diphenhydramine citrate, and ibuprofen. Action taken with mRNA-1273 in response to the events was not reported. The event, unsure if shot was administered intramuscularly in the deltoid, was considered resolved on 15 Jan 2021. The outcomes of the events, muscles on the whole right side of her body are flaring up and tensing up, arm was sore, the big gland in her axillary area are really big and her scapula and shoulder blade area was very tense and balling up, were unknown.; Reporter's Comments: This report refers to a 37 Y/O female who had NS event Product administered at inappropriate site with NS unexpected Muscle tightness, Musculoskeletal stiffness, and NS expected Injection site lymphadenopathy, Injection site pain. Event onset the same day as first dose mRNA-1273. Treated with paracetamol, diphenhydramine, ibuprofen. 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: 1049295
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
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: received both doses of the Moderna Covid-19 vaccine 2 weeks apart not 1 month.; A spontaneous report was received from a consumer concerning a patient of unknown age and gender, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced receiving both doses 2 weeks apart/inappropriate schedule of vaccine administration. The patient's medical history is not provided by the reporter. Concomitant medications were not reported. The patient received their first and second of two planned dose of mRNA-1273 on an unknown date (Lot number: unknown). Per the patient, a second dose was received 2 weeks after the first, not 1 month. Action taken with mRNA-1273 in response to the events was not reported. The outcome of event is unknown.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their second of two planned doses of mRNA-1273 (Lot unknown), reporting Inappropriate schedule of product administration without any associated adverse events.

Other Meds:

Current Illness:

ID: 1049296
Sex: U
Age:
State: OR

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Did not receive full dose; Fell drops on their arms; A spontaneous report was received from a Healthcare Professional concerning a patient who was administered Moderna's COVID-19 vaccine and did not receive full dose. The patient medical history was not included. Patient concomitant was not included On 07-FEB-2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: Unknown) prophylaxis of COVID-19 infection. Caller states there were 2 patients that received the vaccine on 07-feb-2021. The needles were not attached completely and they did not receive the full dose. The patients fell drops on their arms. She reported this through VAERS. She wants to know if she should repeat the shot or continue. Treatment of these event (s) were not provided. Action taken with mRNA-1273 in response to the event was not provided/unknown. The outcome of the event was unknown/not reported; Reporter's Comments: This report refers to a case of underdose and exposure via skin contact with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049297
Sex: F
Age: 63
State: NJ

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: administered "10 cc"; A spontaneous report was received from a healthcare professional concerning a 63-year-old female patient who stated that after her injection she asked the nurse what dose she received and the nurse stated she administered "10 cc"/accidental overdose. The patient's medical history included allergy to hydromorphone hydrochloride (has severe vomiting), diabetes and hypertension. Products known to have been used by the patient included insulin detemir, insulin aspart, carvedilol, and losartan. On 08 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 039K20A) intramuscularly in left arm for prophylaxis of COVID-19 infection. After the injection, the consumer asked the nurse what dose she received, and the consumer reported that the nurse stated she was administered "10 cc". The consumer stated she was going to call the vaccination site back to verify what dose she was given. She reported that she isn't experiencing any adverse events or side effects after the vaccination. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome for the event was not reported.; Reporter's Comments: This case concerns a 68-year-old female patient who received their first of two planned doses of mRNA-1273 (Lot: 039K20A), reporting accidental overdose without any associated adverse events.

Other Meds: LEVEMIR; NOVOLOG; CARVEDILOL; LOSARTAN

Current Illness: Diabetes; Drug allergy (allergy to Dilaudid (severe vomiting)); Hypertension

ID: 1049298
Sex: U
Age:
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: nurse mistakenly administered 0.1ml of the vaccine to 8 patients; gave the remaining dose of the vaccine; A spontaneous report was received from a physician concerning eight patients who received Moderna's COVID-19 vaccine (mRNA-1273 and were mistakenly administered 0.1ml of the vaccine, returned and rest of the full dose was administered. Medical history for patients was not provided, nor were any concomitant medications. On an unspecified date, a nurse in a physician's office administered the incorrect dose of mRNA-1273 for prophylaxis of COVID-19 infection to eight patients. Lot number was not reported. Injection site not provided. Seven of the eight patients came back to have the rest of the full dose administered. Physician wanted to know if this was the correct course of action. No other actions taken with mRNA-1273 were reported. Outcome for this event, eight patients receiving the incorrect dose of the vaccine was considered resolved.; Reporter's Comments: This is a case of vaccine exposure in a patient of unknown age and gender who was mistakenly administered 0.1ml of the vaccine (vaccine underdose) and rest of the full dose was administered (extra dose administered) for mRNA-1273 vaccine Lot # unknown. There was no associated adverse event reported for the events of underdose and extra dose administered.

Other Meds:

Current Illness:

ID: 1049299
Sex: U
Age:
State: IL

Vax Date: 01/22/2021
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Administered the second dose of the Moderna COVID-19 vaccine today (09 Feb 2021) seventeen days from the first dose (22 Jan 2021); A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and patient was administered the second dose of the Moderna COVID-19 vaccine today (09 Feb 2021) seventeen days from the first dose (22 Jan 2021). The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 on 22 Jan 2021 intramuscularly for prophylaxis of COVID-19 infection. The patient received their second of two planned doses of mRNA-1273 on 09 Feb 2021 intramuscularly for prophylaxis of COVID-19 infection. HCP (healthcare professional) reported that a patient was administered with the second dose of the Moderna COVID-19 vaccine today (09 Feb 2021) seventeen days from the first dose (22 Jan 2021). No further information was reported. No treatment information was provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. The outcome of the event was unknown. The reporter did not provide an assessment for the event, patient was administered the second dose of the Moderna COVID-19 vaccine today (09 Feb 2021) seventeen days from the first dose (22 Jan 2021).; Reporter's Comments: This report refers to a case of inappropriate schedule of vaccine administered for mRNA-1273 (lot #unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049300
Sex: F
Age:
State: WA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
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: 16 years of age, received the first dose; A spontaneous report was received from a Pharmacist concerning a 16-year-old, female patient who was administered Moderna's COVID-19 vaccine (mRNA-1273), resulting in the event, 16 years of age, received the first dose/product administered to patient of inappropriate age. The patient's medical history was not provided. No relevant concomitant medications were reported. On 09 Feb 2021, the patient received their first of two planned of mRNA-1273 (Lot number: 011M20A) Intramuscularly in the right arm for prophylaxis of COVID-19 infection Pharmacist called in 09-FEB-2021 to report giving first dose of mRNA-1273 to a female patient 16 years of age. The pharmacist inquired if the dose regimen should be discontinued or completed with the second dose when due. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The event, 16 years of age, received the first dose, was considered resolved on 09 Feb 2021.; Reporter's Comments: This report refers to a case of Product administered to patient of inappropriate age for mRNA-1273, lot # 011M20A with no associated AEs.

Other Meds:

Current Illness:

ID: 1049301
Sex: M
Age:
State: MA

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 02/23/2021
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: Instead of the injection being injected into the delta muscle, he received it in teh bursa area of his shoulder; A spontaneous report was received from a consumer concerning a male patient who received an Moderna vaccine injection into the wrong body part (bursa). The patients medical history was not provided. Concomitant product use was not provided/unknown by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number not provided) on 01-FEB-2021 in the bursa area of his shoulder for prophylaxis of COVID-19 infection. Instead of the injection being injected into the delta muscle, the patient received it in the bursa area of his shoulder. Treatment information was not provided/unknown. Action taken with mRNA-1273 in response to the event was not provided/unknown. The event was considered recovered/resolved.; Reporter's Comments: This report refers to a case of incorrect route of product administration for mRNA-1273 (lot # unknown) with no associated AEs reported.

Other Meds:

Current Illness:

ID: 1049302
Sex: F
Age:
State: CT

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
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: COVID arm reaction, was diagnosed as cellulitis; A spontaneous report was received from a healthcare professional concerning a female patient who developed "covid arm" reaction, diagnosed as cellulitis/PT: cellulitis. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On an unknown date, the patient received dose of mRNA-1273 (Lot #, route of administration, and injection site unknown) for prophylaxis of COVID-19 infection. On an unknown date, the patient had "covid arm" reaction, went to the emergency room (ER) and was diagnosed as cellulitis and treated that way. Treatment details were unknown. Action taken with mRNA-1273 was not provided. The outcome of event "covid arm" reaction, diagnosed as cellulitis was unknown.; Reporter's Comments: This case concerns a female of unknown age who experienced a serious unexpected event of cellulitis in the arm occurring with unknown latency after the first dose of mRNA-1273. Treatment for cellulitis. Outcome not reported. 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: 1049303
Sex: U
Age:
State:

Vax Date:
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
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: accidentally administered 1mL instead of the standard 0.5mL; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) was given twice the amount of the vaccine. The patient's medical history was not provided. Concomitant product use was not provided/unknown by the reporter. On 09 Feb 2021, the patient received accidentally administered 1mL instead of the standard 0.5mL dose to a patient. The pharmacist was not in the office and did not have access to the Patient Information or Medical Information. Pharmacist is inquiring about the most common side effects reported with the Moderna COVID19 Vaccine. Pharmacist would like to receive information via email. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided The event gave twice the amount of the vaccine was considered resolved on 09 Feb 2021.; Reporter's Comments: This report refers to a case of incorrect dose administered, and overdose for mRNA-1273 with no associated AEs.

Other Meds:

Current Illness:

ID: 1049304
Sex: F
Age: 71
State: MO

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Lots of bloating; Not feeling good; Arm got really sore; Afib; Lots of chills; Redness itching at the injection site; Itching at the injection site; A spontaneous report was received from a consumer who is a 71-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and developed atrial fibrillation, arm got really sore, redness itching at the injection site, lots of bloating, lots of chills and just not feeling good, The patient's medical history included tachycardia, COVID-19, atrial fibrillation, asthma and lung inflammation. Products known to have been used by the patient, within two weeks prior to the event, included diltiazem, flecainide and rivaroxaban. On 10 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 031L20A) in the left arm intramuscularly for prophylaxis of COVID-19 infection. On 10 Feb 2021, at noon, post vaccination, the patient reported she had atrial fibrillation. She was able to get it under control until it started back again at approximately 4 pm the same day. At 6 pm that evening, the patient reported her arm was really sore, there was redness and itching at the injection site. She had lots of bloating, chills and overall, not feeling good. The patient stated it felt like having COVID again. Treatment for the event included hydrocortisone cream. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event, afib/atrial fibrillation, was considered not resolved. The outcome of the events arm got really sore, redness itching at the injection site, lots of bloating, lots of chills, just not feeling good, and feeling like having COVID all over again were considered unknown. Follow-up received on 16 Feb 2021 included date of when patient had COVID-19, treatment information and added redness and itching at the injection site to the events.; Reporter's Comments: Based on the current available information, which includes a strong temporal association with onset of the reported events and the use of the product, a causal association cannot be excluded.

Other Meds: DILTIAZEM; FLECAINIDE; XARELTO

Current Illness: AFib; Asthma; Tachycardia

ID: 1049305
Sex: F
Age: 53
State: AL

Vax Date: 12/31/2020
Onset Date: 02/09/2021
Rec V Date: 02/23/2021
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: Deviation from time-frame: second shot on the 42 day; A spontaneous report was received from a Reporter like HCP concerning a 53 year old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced inappropriate schedule of vaccine administration. The patient had an emergency dental procedure because root canal was not done properly. Concomitant medications included cymbalta 30 mg and bystolic 5 mg. The patient is on antibiotics and steroids. On Date 31-DEC-2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: unknown) in the Left arm for prophylaxis of COVID-19 infection and on 09-FEB-2021 patient received second of two planned doses in right arm (lot/ batch: Not provided). On 9-FEB-2021, the patient experienced her second shot on the 42nd day after the first vaccine. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event "deviation from time-frame: second shot on the 42 day" was considered resolved on 09-FEB-2021.; Reporter's Comments: This case concerns 53 year old female patient who received second of two planned doses in right arm (lot/ batch: Not provided) 42 days after the first dose. No reported adverse events after the vaccine was administered in this case of inappropriate schedule of product administration.

Other Meds: CYMBALTA; BYSTOLIC

Current Illness:

ID: 1049306
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/23/2021
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: Angioedema; Swelling around surgical clips in her mouth; A spontaneous report was received from a health care professional concerning a female patient (age unknown) who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced angioedema and swelling around surgical clips in her mouth. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On an unknown date, the patient received one of two planned doses (first or second dose not specified) of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, the patient experienced angioedema and swelling around surgical clips in her mouth. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the events, angioedema and swelling around surgical clips in her mouth, was not reported.; Reporter's Comments: This case concerns a female of unknown age who had a serious unexpected event of angioedema and a nonserious unexpected event of mouth edema. The events occurred with unknown latency after both the first dose of mRNA-1273. Treatment information not reported. 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: 1049307
Sex: F
Age: 81
State:

Vax Date: 10/07/2020
Onset Date: 10/07/2020
Rec V Date: 02/23/2021
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: Arm started hurting; The injection site is not as sore; but still sensitive; Runny noise started, not a sinus or cold runny nose; This is a spontaneous case was received 19-Jan-2021 from other non-health professional (consumer) via Med Communications (reference number: SEQW21-00231) with additional document received on 20-Jan-2021 (being processed together) and concerned a 81-year-old, female patient. The patient's medical history and concomitant medications were not reported. It was reported that the patient could not take ten medications. On 07-Oct-2020, the patient was vaccinated with Fluad unknown if trivalent or quadrivalent (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59; dose: 0.5 ml, route of administration, anatomical location: not reported) as influenza prophylaxis. The batch number was not reported. On the same day, after receiving Fluad, the patient's arm started hurting and injection site was sore. On an unspecified date in 2020, unknown of time after receiving Fluad, the patient experienced runny nose, but not a sinus or cold runny nose. The patient was not sure exactly when runny noise started. The patient visited her health care provided (HCP) for other issues and men-tioned the arm pain but received no information from HCP regarding the pain. At the time of initial reporting on 19-Jan-2021, the patient had not recovered form the event of 'pain in arm' since had aches still as of yesterday but had not noticed the pain today. Also, the patient was recovering from the event of 'vaccination site pain' since it was not as sore but still sensitive and of the event 'runny nose' since it was not as bad as it had been. The patient took no treatment measures associated with event. The reporter did not provide causality assessment but was wondering if this could be side effects from the vaccine. The case was assessed as non-serious. Company Comment: A 81-year-old, female patient developed rhinorrhoea, pain in extremity and vaccination site pain after vaccination with the suspect product, Fluad (unknown if trivalent or quadrivalent). There is lack of information regarding the vaccination date and onset date of event rhinorrhoea. Therefore, chronology for this event is unassessable. Advanced age confounds causality. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Based on unclear time relationship, causality for the event rhinorrhoea is unassessable. Causality for all other events is assessed as possibly related.; Sender's Comments: A 81-year-old, female patient developed rhinorrhoea, pain in extremity and vaccination site pain after vaccination with the suspect product, Fluad (unknown if trivalent or quadrivalent). There is lack of information regarding the vaccination date and onset date of event rhinorrhoea. Therefore, chronology for this event is unassessable. Advanced age confounds causality. Information regarding the underlying medical history, related diagnostic findings and concomitant medications have not been provided. Based on unclear time relationship, causality for the event rhinorrhoea is unassessable. Causality for all other events is assessed as possibly related.

Other Meds:

Current Illness:

ID: 1049308
Sex: M
Age:
State:

Vax Date: 11/27/2018
Onset Date: 11/27/2018
Rec V Date: 02/23/2021
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: Rash; This spontaneous case was retrieved on 01-Feb-2021 reported by other health professional and concerned a 35-year-old, male patient. The patient's medical history and concomitant medications were not reported. On 27-Nov-2018, the patient was vaccinated with Afluria Quadrivalent (influenza vaccine; anatomical location: left arm, route of administration, dose and indication: not reported). The batch number reported was YF42409. On the same day, after receiving Afluria Quadrivalent, the patient experienced rash. The outcome of the event was not reported. The reporter did not provide a causality assessment. This case was assessed as non-serious. Company comment: The event of 'rash' is assessed as related to Afluria Quadrivalent.; Sender's Comments: The event of 'rash' is assessed as related to Afluria Quadrivalent.

Other Meds:

Current Illness:

ID: 1049309
Sex: F
Age: 57
State:

Vax Date: 10/06/2015
Onset Date:
Rec V Date: 02/23/2021
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: Secretions from eyes and nose; Numbness in mouth and lips; Secretions from eyes and nose; This spontaneous case was received on 02-Feb-2021 from other non-health professional via Med Communications (reference number: SEQW21-00380) and concerned a 57-year-old, female patient. The patient's concurrent condition included unspecified problems with her thyroid. The patient's concomitant medication included levothyroxine for unreported indication. On 06-Oct-2015, the patient was vaccinated with Afluria Quadrivalent (influenza vaccine; dose: 0.5 ml, anatomical location, indication and route of administration: not reported). The batch number was not reported. On an unspecified date, unknown amount of time after receiving Afluria Quadrivalent, the patient had secretions from eyes and nose for several hours and numbness in mouth and lips. On an unspecified date, the patient recovered from the events 'nasal discharge' and 'discharge eye'. The outcome of the event 'numbness oral' was not reported. The reporter did not provide a causality assessment. The case was assessed as non-serious. Company Comment: A 57-year-old, female patient developed eye discharge, hypoaesthesia oral and rhinorrhoea after vaccination with the suspect product, Afluria Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. More information regarding the underlying medical history is needed. Information regarding the related diagnostic findings have not been provided. Due to lack of information, causality for the reported events is unassessable.; Sender's Comments: A 57-year-old, female patient developed eye discharge, hypoaesthesia oral and rhinorrhoea after vaccination with the suspect product, Afluria Quadrivalent. There is lack of information regarding the vaccination date and events onset date. Therefore, chronology is unassessable. More information regarding the underlying medical history is needed. Information regarding the related diagnostic findings have not been provided. Due to lack of information, causality for the reported events is unassessable.

Other Meds: LEVOTHYROXINE

Current Illness: Thyroid disorder NOS

ID: 1049310
Sex: F
Age: 56
State:

Vax Date: 01/01/2018
Onset Date: 01/01/2018
Rec V Date: 02/23/2021
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: Felt like razor blades in the throat; Facial swelling of eyes; Had an allergic reaction; This spontaneous case from the United States was received on 04-Feb-2021 reported by other non-health care professional (consumer) via Med Communications (reference number: SEQW21-00404) and concerned a 56-year-old, female patient. The patient had no relevant medical history. The patient's concomitant medications included metoprolol, Baby aspirin (acetylsalicylic acid), Zetia (ezetimibe) and Crestor (rosuvastatin calcium), all for an unreported indication. On an unspecified date in Jan-2018, the patient was vaccinated with Afluria Quadrivalent (influenza vaccine, route of administration, anatomical location, dose, batch number and expiration date: not reported) for influenza prophylaxis. The batch number was not reported. On an unspecified date in Jan-2018, during the night after receiving Afluria Quadrivalent, the patient experienced an allergic reaction, facial swelling of eyes and felt like razor blades in the throat. The patient missed work the next day due to reaction and was clear the following day to return to work. The patient did not receive any treatment. On an unspecifed date, the patient recovered from the events. The reporter did not provide causality assessment. Company comment: A 56-year-old patient was administered Afluria Quadrivalent. During the night after receiving Afluria Quadrivalent, the patient experienced an allergic reaction, facial swelling of eyes and felt like razor blades in the throat. The patient missed work the next day due to reaction and was clear the following day to return to work. The patient did not receive any treatment. Chronology is plausible. Causal role of the suspect vaccine is assessed as possibly related for eye swelling, oropharyngeal discomfort and hypersensitivity.; Sender's Comments: A 56-year-old patient was administered Afluria Quadrivalent. During the night after receiving Afluria Quadrivalent, the patient experienced an allergic reaction, facial swelling of eyes and felt like razor blades in the throat. The patient missed work the next day due to reaction and was clear the following day to return to work. The patient did not receive any treatment. Chronology is plausible. Causal role of the suspect vaccine is assessed as possibly related for eye swelling, oropharyngeal discomfort and hypersensitivity.

Other Meds: METOPROLOL; BABY ASPIRIN; ZETIA; CRESTOR

Current Illness:

ID: 1049311
Sex: F
Age: 72
State: PA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/23/2021
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: penicillin

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

Symptoms: Headache began the evening after receiving the vaccine by the next day, headache pain more than a 10. After consulting dr who told her to take Tylenol. Tylenol has brought the pain level to about 7, 2 weeks later.

Other Meds: Synthroid, Vit B12

Current Illness: None

ID: 1049312
Sex: M
Age: 47
State: NV

Vax Date: 02/18/2021
Onset Date: 02/23/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Finger nodule on the right hand, ring finger.

Other Meds: Fish oil - 12 years

Current Illness: None

ID: 1049313
Sex: F
Age: 70
State: CO

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: Environmental only

Symptom List: Vomiting

Symptoms: 2 hrs. After injection mild chills & fatigue. 14 hrs. After injection mild chills, mild headache, very tired/fatigue, moderate to severe upper body muscle aches, mild migratory chest pains for about 30 minutes. 24 hrs after injection just overwhelming fatigue& mild headache continued for another 12 hrs. 48 hrs. After injection symptoms gone.

Other Meds: Levothyroxine, pantoprazole, fluticasone nasal spray, zyrtec

Current Illness: None

ID: 1049314
Sex: M
Age: 62
State: IL

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
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, HEADACHE, AND FEVER

Other Meds:

Current Illness:

ID: 1049315
Sex: F
Age: 94
State: OH

Vax Date: 02/20/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: Amoxicillin Albuterol

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

Symptoms: Red, itchy rash on arm 2 days after injection Very sore arm 1 day after injection and slightly swollen arm at injection site A feeling of heaviness in the arm Some Nausea 3 days after injection

Other Meds: Levothyroxine Prilosec Hydrochloride Carvedilol Pravastatin

Current Illness: None

ID: 1049316
Sex: M
Age: 20
State: KY

Vax Date: 02/21/2021
Onset Date: 02/21/2021
Rec V Date: 02/23/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Started with a fever that slowly worsened to a high temperature. This resulted in chills, aches, pains, fatigue. nausea, congestion, sore throat, headaches, and weakness. There was also swelling at the injection site and swelling of my eyelids.

Other Meds: None

Current Illness: None

ID: 1049318
Sex: F
Age: 83
State: NJ

Vax Date: 02/17/2021
Onset Date: 02/22/2021
Rec V Date: 02/23/2021
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: Develope a cough with chest pain

Other Meds: Levothyroxine

Current Illness: None

ID: 1049319
Sex: F
Age: 70
State: NE

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 02/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Complaints of nausea, vomiting and chills. In the Emergency room. Had to have IV Zofran, promethazine, and Normal Saline Bolus.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm