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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1051748
Sex: M
Age: 80
State: OH

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tested positive for Covid-19 on 2/11/2021. Admitted into hospital. Stayed for 7 days. Released on oxygen

Other Meds: Hydrochlorothiazide 25mg Gipizide ER 5mg

Current Illness: Diabetes

ID: 1051749
Sex: F
Age: 62
State: OH

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 02/24/2021
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: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: severe headache, general flu-like symptoms started 4 hours after vaccine and lasted 36 hours

Other Meds: lexapro, clonapin, synthroid, lamictal,

Current Illness: none

ID: 1051750
Sex: F
Age: 33
State: OH

Vax Date: 12/28/2020
Onset Date: 01/12/2021
Rec V Date: 02/24/2021
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: miralax

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

Symptoms: Prior to the vaccine my pregnancy was progressing along normally with both normal AFI and fetal size. My first dose was given 12/28/20 at 30 weeks 3 days lot #026L20A, my second dose lot # 013L20A was given 1/25/21 at 34w3d. After receiving the vaccine my fetus began to measure small for dates. An ultrasound showed the fetus has dropped in to the low 20% percentile for weight. Then my AFI decreased also. On all recent scans the AFI has been 6, prior to the vaccines all scans indicated more amniotic fluid.

Other Meds: Flonase, omeprazole, prenatal vitamin, Tylenol PRN

Current Illness: No

ID: 1051751
Sex: F
Age: 75
State: MI

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient stated she got a severe headache after vaccination. Onsite EMS was called and vitals taken BP 190/94 HR 72 99% O2 room air. Patient went home.

Other Meds:

Current Illness:

ID: 1051752
Sex: F
Age: 66
State:

Vax Date: 02/14/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Latex, redwine

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

Symptoms: Moderna COVID?19 Vaccine EUA. Red, sore, warm and itching skin around injection point. It is roundish, with a diameter of about 4 inches

Other Meds: None

Current Illness: n/a

ID: 1051753
Sex: F
Age: 64
State: NJ

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Administered dose 1 Moderna 026L20A 1/22/2021 Administered dose 2 Pfizer EL1284 2/23/2021, instead of Moderna dose 2.. Patient sat on Pfizer side instead of Moderna side. Observed for 30 minutes. Closely monitored with no adverse side effects reported.

Other Meds:

Current Illness:

ID: 1051754
Sex: F
Age: 52
State: FL

Vax Date: 02/10/2021
Onset Date: 02/16/2021
Rec V Date: 02/24/2021
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: Aspirin, Penicillin, Tetracycline, Advil, Ibuprofen, Sulfas.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Tiredness, out of breath after a few normal activities. Five days later cold/sinus symptoms started with a sore throat, severe dryness of throat, nose, then congestion, runny nose, chills, NEVER a fever. A week later still tire, a little congestion, cough, some white liquid flem.

Other Meds: Zyrtec, Turmeric, B-12

Current Illness: Environmental allergies

ID: 1051755
Sex: M
Age: 64
State: MI

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient experienced chest tightness and anxiety 5 minutes after vaccination. Onsite EMS was called vitals are HR 89 BP 160/79 99% O2 room air. Patient went home.

Other Meds:

Current Illness:

ID: 1051761
Sex: M
Age:
State: AR

Vax Date: 06/24/2016
Onset Date:
Rec V Date: 02/24/2021
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: painful outbreak of skin rash; Information has been received from a lawyer, regarding a case in litigation, and refers to a male patient (pt) of unknown age. The pt's medical history, concurrent conditions and concomitant medications were not provided. On or around 24-JUN-2016, 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, subsequent to zoster vaccine live (ZOSTAVAX) being administered, the pt developed a painful outbreak of skin rash. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the pt's symptoms had resulted in physical limitations not presenting prior to using the suspect vaccine. The pt also experienced mental and emotional distress due to resulting physical limitations and seriousness of his 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. All damage proximately caused by the aforementioned characteristics of zoster vaccine live (ZOSTAVAX) that rendered the product unreasonably dangerous, arose from the reasonably anticipated use of the product by the pt. The outcome of the event was not recovered/not resolved. The reporter considered the event to be related to zoster vaccine live (ZOSTAVAX). The reporter considered the event of rash to be disabling.

Other Meds:

Current Illness: Routine health maintenance

ID: 1051764
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/24/2021
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: Shingles; Chest,back legs,hands, itch; Bleeding from scratching all The time; This case was reported by a consumer via interactive digital media and described the occurrence of shingles in a patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season. On an unknown date, 2 days after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced shingles, pruritus and wound bleeding. On an unknown date, the outcome of the shingles, pruritus and wound bleeding were unknown. It was unknown if the reporter considered the shingles, pruritus and wound bleeding to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were provided as follows: The age at vaccination was not reported. The patient got Flu shot and two days later developed shingles. The patient's chest, back, legs and hands itch and there was bleeding from scratching all the time.

Other Meds:

Current Illness:

ID: 1051767
Sex: F
Age: 77
State: NJ

Vax Date: 03/01/2020
Onset Date:
Rec V Date: 02/24/2021
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: suspected Vaccination failure; Eye irritation that was diagnosed as shingles in the eye; Eye irritation; Irritation underneath the right armpit; Right armpit with little red dots / from her back to the breast; Bad sensation upon touch and a reaction (like it has a life of its own); This case was reported by a consumer via call center representative and described the occurrence of suspected vaccination failure in a elderly female patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Herpes zoster (Shingrix) for prophylaxis. In March 2020, the patient received the 1st dose of Shingrix. In June 2020, the patient received the 2nd dose of Shingrix. On an unknown date, between 11 and 12 months after receiving Shingrix and between 8 and 9 months after receiving Shingrix, the patient experienced vaccination failure (serious criteria GSK medically significant), ophthalmic herpes zoster (serious criteria GSK medically significant), eye irritation, skin irritation, red rash and tenderness. The patient was treated with topical antibiotic (nos) (Antibiotic Ointment (Trade Name Unknown)) and antivirals nos (Antiviral (Drug Name Unknown)). On an unknown date, the outcome of the vaccination failure, ophthalmic herpes zoster, eye irritation, skin irritation, red rash and tenderness were unknown. It was unknown if the reporter considered the vaccination failure, ophthalmic herpes zoster, eye irritation, skin irritation, red rash and tenderness to be related to Shingrix and Shingrix. Additional details were provided as follows: Age at vaccination was not reported. The patient received 1st dose of the Shingrix vaccine back in last March and the 2nd dose last June. The patient stated that in the beginning of this month she had an eye irritation that was diagnosed as shingles in the eye by her doctor. The patient reported that there were no pimples or pustules on the face. She was prescribed an antibiotic ointment and an antiviral that cleared it up. A week later, she had another irritation underneath the right armpit with little red dots that stretched from her back to the breast. The patient was given the same antiviral to take. The patient stated that the irritation did not show anything on the body, except there was a bad sensation upon touch and a reaction (like it has a life of its own). The reporter did not consent to follow-up. Not all information was available. This case was reported as suspected vaccination failure since the details regarding laboratory confirmation was not given.

Other Meds:

Current Illness:

ID: 1051768
Sex: M
Age: 69
State: FL

Vax Date: 01/19/2021
Onset Date: 01/14/2021
Rec V Date: 02/24/2021
Hospital: Y

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: Tested positive for COVID-19; More aches and pains; Tiredness; Sleeping more; Low-grade fever; A spontaneous report was received from a consumer concerning her husband, a 69-year-old male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced low-grade fever/MedDRA PT: Fever, Tested positive for COVID-19/MedDRA PT: COVID-19, more aches and pains/MedDRA PT: Pain, tiredness and sleeping more/MedDRA PT: hypersomnia. The patient's medical history was not provided. Concomitant medication information was not provided. On 14 Jan 2021, the patient developed a low-grade fever. On 16 Jan 2021, the patient tested positive for COVID 19. On 19 Jan 2021, the patient received the first dose of two planned doses of mRNA-1273 in the right arm for prophylaxis of COVID-19 infection. On an unknown date, patient developed "more aches and pains, tiredness and sleeping more. The patient was seen at Urgent Care. Treatment included Vitamin C, Vitamin D, azithromycin, zinc and "mucus relief". He was hospitalized for 12 days. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events of low-grade fever, tested positive for COVID-19, more aches and pains, tiredness and sleeping more was considered unknown.; Reporter's Comments: This case concerns a 69-year-old male was hospitalized for a serious unexpected event of COVID-19, as well as NS unexpected events of hypersomnia and pain, and NS expected events of fever and fatigue. The event of COVID-19 occurred 12 days after the first dose of mRNA-1273. Treatment 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: 1051769
Sex: U
Age:
State: GA

Vax Date:
Onset Date:
Rec V Date: 02/24/2021
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: vaccine overdosage administered to 4 patients; A spontaneous report was received on 09 FEB 2021 from a healthcare professional concerning an unknown age, unknown gender patients who received Moderna's COVID-19 vaccine, higher dose than 0.5 ml. The patients medical history was not provided. No relevant concomitant medications were reported. On unknown date, four patients received their one of two planned doses of mRNA-1273(Lot number: unknown), for the prophylaxis of COVID-19 infection. The healthcare professional reported that four patients were given a higher dose than 0.5 ml of Moderna's COVID-19 vaccine at their office. Treatment for the event was not provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome of the event, vaccine over dosage administered to 4 patients, was considered recovered/resolved.; Reporter's Comments: This report refers to 4 cases of accidental vaccine overdose, administered for mRNA-1273, lot # unknown with no associated AEs.

Other Meds:

Current Illness:

ID: 1051770
Sex: F
Age: 73
State:

Vax Date: 01/19/2021
Onset Date: 02/01/2021
Rec V Date: 02/24/2021
Hospital: Y

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: Cellulitis; A spontaneous report was received from a consumer concerning a 73-year old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and cellulitis. The patient's medical history was included lymphedema in her legs. Concomitant product use was not provided. On 19 Jan 2021, prior to the onset of symptoms, the patient received their first dose of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient was hospitalized on 01 Feb 2021 for cellulitis. Treatment for the events included intravenous antibiotics, which the patient reported were antibacterial medications. The patient was switched to oral antibiotics but remained hospitalized. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event was unknown.; Reporter's Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1051771
Sex: F
Age: 65
State: CA

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: area was hot to touch; really red area below where she got her injection; 2&1/2" high and 4" wide; little soreness afterwards; she suspects that the injection was given subcutaneous instead of intramuscular; A spontaneous report was received from a consumer regarding herself, a 65-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and suspects the injection was given subcutaneous instead of intramuscular/inappropriate route of vaccination, area was hot to touch/vaccination site warmth, little soreness afterwards, really red area below where she got her injection/vaccination site erythema, and site 2&1/2 inches high and 4 inches wide/vaccination site swelling. The patient's medical history was not provided. Products known to have been used by the patient were not included. On 25 Jan 2021, prior to the onset of the events, the patient received the first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 25 Jan 2021, the patient reported that she experienced a little soreness afterward and felt as if the dose was given subcutaneously instead of intramuscularly. On 05 Feb 2021, approximately 11 days after the patient received the vaccine, she reports that she had warmth, swelling and a raised circle at the injection site. Treatment information was not provided. Consent to follow up was obtained. Action taken with mRNA-1273 was not provided. The outcome of the events, suspects the injection was given subcutaneous instead of intramuscular, area was hot to touch, little soreness afterwards, really red area below where she got her injection, site 2&1/2 inches high and 4 inches wide, was unknown.; Reporter's Comments: This case concerns a 65-year-old female who had a NS unexpected event of Incorrect route of product administration with associated adverse events of NS unexpected vaccination site warmth and NS expected vaccination site pain, vaccination site erythema, vaccination site swelling. Event onset 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: 1051772
Sex: M
Age: 24
State: CO

Vax Date: 02/09/2021
Onset Date: 02/09/2021
Rec V Date: 02/24/2021
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: Patient received the Moderna second dose 15 minutes after 6 hour throw away time; A spontaneous report was received from a nurse concerning a 24-year-old male patient, who was administered Moderna's second dose fifteen minutes after six hours throw away time. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their second planned doses of mRNA-1273 (Batch number: 09L20A) on 09 Feb 2021 for the prophylaxis of COVID-19 infection. On 09 Feb 2021 the patient received the second dose of vaccine,however the dose suffered an excursion and remained out of the refrigeration 15 minutes after the 6 hour throw away time after being punctured. The nurse states it was only 15 min after the 6 hour time frame. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, administered Moderna's second dose fifteen minutes after six hours throw away time, was considered resolved.; Reporter's Comments: This report refers to a 24-year-old male who had an NS unexpected event of Expired product administered for mRNA-1273, lot # 09L20A with no associated adverse events. The event occurred the same day as the second dose of mRNA-1273. Reporter stated dose was affected by an excursion out of refrigeration more than 6 hours after being punctured, given 15 minutes after the 6 hours. Very limited information regarding this event has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1051773
Sex: M
Age: 74
State: MD

Vax Date: 02/07/2021
Onset Date: 02/07/2021
Rec V Date: 02/24/2021
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: felt some drops going down; felt some drops going down; A spontaneous report was received from a consumer concerning a 74-year-old male patient who stated he received the Moderna COVID-19 vaccine and as the needle was being withdrawn, he felt some drops going down his arm/underdose. The patient's medical history was not provided. Products known to have been used by the patient included statin, morniflumate, blood pressure medicine, and clonazepam. On 07 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly in left arm for prophylaxis of COVID-19 infection. The consumer received first dose of the Moderna COVID-19 vaccine on 07Feb2021. He received the shot on his left (non-dominant) arm. As the needle was being withdrawn, he felt some drops going down his arm. He is not sure whether he received the full dose or not. 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 report refers to a case of Vaccine underdose and exposure via skin contact for mRNA-1273 (Lot number: unknown) with no associated AEs.

Other Meds: STATIN [ATORVASTATIN CALCIUM]; FLOMAX [MORNIFLUMATE]; Blood pressure medicine; CLONAZEPAM

Current Illness:

ID: 1051774
Sex: F
Age: 88
State: NJ

Vax Date: 01/15/2021
Onset Date:
Rec V Date: 02/24/2021
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: Wasn't able to get second dose; A spontaneous report was received from a consumer concerning her mother(M-S) who is 88 year old female, who received her first dose of Moderna Covid -19 vaccine and couldn't take the 2nd dose as scheduled. The consumer's medical history was not provided except she had a pelvic fracture. Her relevant concomitant medications were not provided. No information on allergies. On 15-JAN-2021, prior to the onset of events, the patient received her first of two planned doses of Covid-19 vaccine intramuscularly for the prophylaxis of Covid-19 infection. She couldn't take her 2nd dose due to hospitalization. She is being hospitalized for a pelvic break prior to her first dose of vaccine and been admitted in rehab facility since then. She is unable to receive her 2nd dose as scheduled. Action taken with 2nd dose of Moderna Covid-19 vaccine was unknown. The outcome of the event inappropriate schedule of vaccination is unknown at the time of report.; Reporter's Comments: This report refers to a case of inappropriate schedule of product administration for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness: Pelvic fracture (Pelvic break)

ID: 1051775
Sex: F
Age: 49
State: RI

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/24/2021
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: Needle leaked (Not sure if any of the dose got in to the patient's muscle); Needle leaked (Not sure if any of the dose got in to the patient's muscle); A spontaneous report was received from a healthcare professional concerning a 49-year-old, female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the following: needle leaked (device connection issue), not sure if any of the dose got into the patient's muscle (vaccine underdose) The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 11 Feb 2021, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot #: 031L20A) intramuscularly for prophylaxis of COVID-19 infection. On 11 Feb 2021, while administering the vaccine to the patient, the nurse noted that the needle was not attached properly. The vaccine leaked and the reporter was not sure if the patient received any of the dose. Action taken with mRNA-1273 in response to the event was unknown. The event, needle leaked and not sure if any of the dose got into the patient's muscle, was considered resolved.; Reporter's Comments: This report refers to a case of underdose and device connection issue for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 1051776
Sex: F
Age: 59
State: NJ

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 02/24/2021
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: barely soreness; all the liquid from the needle ran down arm; all the liquid from the needle ran down arm; A spontaneous report was received from a consumer concerning a 59-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and liquid from the needle ran down her arm and experienced barely soreness. 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 atorvastatin 10 mg, amlodipine 2.5 mg, acidophilus, vit D, aspirin, and coQ10. On 26 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. Patient stated that she had her 1st dose of the Moderna Covid-19 vaccine 26 Jan 2021 and felt all the liquid drip down her arm. She was sure if she got anything from the "1st" dose. She felt the needle go in, barely experienced soreness for that day. Treatment information was not provided. Action taken with the drug in response to the events is unknown. The outcome of the event barely soreness was resolved on 26 Jan 2021. The event vaccine underdose and device connection issue was considered resolved on 26 Jan 2021.; Reporter's Comments: Based on the current information and temporal association between the use of the product and the start date of soreness, a causal relationship cannot be excluded. The causality of events of vaccine underdose and device connection is not applicable.

Other Meds: ATORVASTATIN; AMLODIPINE; ACIDOPHILUS BIFIDUS; VITAMIN D NOS; ASPIRIN [ACETYLSALICYLIC ACID]; COQ10 COMPLEX

Current Illness:

ID: 1051777
Sex: F
Age: 76
State: CA

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 02/24/2021
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: Incomplete dose; A spontaneous report received from a consumer concerning a 76-year-old female patient who received the first dose of Moderna COVID-19 (mRNA-1273) vaccine and received incomplete dose. The patient's medical history was not reported. Concomitant medication was not reported. On 18 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch #: 025620A) intramuscularly for prophylaxis of COVID-19 infection. On 18 Jan 2021, When the nurse administered the vaccine, the patient was told that she was only going to receive a 0.25ml dose. The patient did not experience any side effects from the vaccine but would like to report that she did receive an incomplete dose. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event was considered resolved on 18 Jan 2021.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273 vaccine, batch number 025620A, with no associated AEs. Causality of these events is not applicable.

Other Meds:

Current Illness:

ID: 1051778
Sex: U
Age:
State: PA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/24/2021
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: 5 or 6 drops of vaccine dropped on patient's arm; syringe malfunction; A spontaneous report was received from a pharmacist concerning an unknown age and gender patient who experienced syringe malfunction and 5 or 6 drops of vaccine dropped on patient's arm during administration of Moderna's COVID-19 vaccine. Patient medical history was not provided. No relevant concomitant medications were reported. On 11 Feb 2021, patient received their one of two planned doses of mRNA-1273 (Lot/ batch number: unknown) intramuscularly for the prophylaxis of COVID-19 infection. On 11 Feb 2021, when they administered the vaccine to a patient, there was a syringe malfunction and 5 or 6 drops of vaccine dropped on patient's arm during administration of Moderna's COVID-19 vaccine. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, syringe malfunction and 5 or 6 drops of vaccine dropped on patient's arm during administration of Moderna's COVID-19 vaccine, were considered resolved.; Reporter's Comments: This report refers to a case of vaccine underdose and syringe malfunction, for mRNA-1273, lot number unknown, with no associated AEs. Causality of these events is not applicable.

Other Meds:

Current Illness:

ID: 1051779
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/24/2021
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: Had one dose of Pfizer and then got first dose of Moderna and then another dose of Moderna; Had one dose of Pfizer and then got first dose of Moderna and then another dose of Moderna; A spontaneous report was received from a healthcare professional concerning a patient who had one dose of Pfizer and then got first dose of Moderna and then another dose of Moderna. The patient's medical history was not provided. No relevant concomitant medications were reported. On unknown date, patient received one dose of Pfizer vaccine for prophylaxis of COVID-19 infection. On unknown date, patient received their first of two planned doses of mRNA-1273 (Lot number: unknown), for prophylaxis of COVID-19 infection. On unknown date, patient received their second of two planned doses of mRNA-1273(Lot/ batch number: unknown), for prophylaxis of COVID-19 infection. Treatment for the events were not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events, had one dose of Pfizer and then got first dose of Moderna and then another dose of Moderna, was considered resolved.; Reporter's Comments: This report refers to a case of Product administration error of Extra dose administered and Interchange of vaccine products for mRNA-1273, lot # unknown , with no associated AEs.

Other Meds:

Current Illness:

ID: 1051780
Sex: M
Age: 44
State: NY

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Food allergy, i.e., shell fish, nuts and Pollen allergy

Symptom List: Injection site pain, Pain

Symptoms: Severe Vertigo at night on the same day of vaccination. I am not sure if it is related to vaccination. Though I have a history of previous vertigo events, but it did not happen in last more than 6 months.

Other Meds: Aspirin, Lisinopril, Simvastatin, Centrizine, Meloxicam

Current Illness: Mineara disease, history of 2 strokes at age 37, knee and back shoulder pain, high blood pressure

ID: 1051782
Sex: M
Age: 28
State: TX

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever 99,5 Chills No Appetite

Other Meds: None

Current Illness: None

ID: 1051783
Sex: F
Age: 63
State: OK

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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: No allergies to meds, no allergies to foods, carries an epi pen for hx of anaphylactic reaction to bee or wasp stings

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

Symptoms: Pt complained of throat tightness and being lightheaded beginning at 1127 hours (5 minutes after vaccine). She arrived at emergency/symptoms reporting station at 1129 hours. She denied tongue swelling, denied rash, denied difficulty speaking. No rash was seen by medics either. Pt did not have wheezing or stridor. Medics on scene and student medics under the direction of Medics, placed the patient on the monitor. Her HR was stable in the 70s and her sats were 99-100% on room air, with a strong pulse and RR of 16. The pt became more anxious and demanded that someone assist her with her Epi pen administration. RN explained sxs of anxiety and sxs of anaphylaxis. Pt became agitated and again remained adamant that medics give her Epi. At 1132 hours a student medic under the direction of Medics administered the pts own epi pen to her. Vitals signs after epi were HR of 88, BP of 170/97, RR 22, sats 100% . A transport unit was called as precaution and to potentially transport. Pt appeared to have an increase in agitation as indicated by her speech with medics being short and her stating that she was "irritated" with "everyone talking", that she "can't hear everyone all at the same time", that this is just "too much" and waving her hands in the air. Pt was transported to the ER via Medics for continued care and follow up.

Other Meds: Lisinopril, Levothyroxine, Wellbutrin, another unknown mood stabilizer

Current Illness: None

ID: 1051784
Sex: M
Age: 31
State: NY

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Post vaccine patient was pale, diaphoretic, and hypotensive BP 81/49 mm/Hg HR 41 BPM Patient moved to stretcher and trendelenburg position and vitals improved

Other Meds:

Current Illness:

ID: 1051785
Sex: F
Age: 24
State: VA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/24/2021
Hospital: Y

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

Lab Data:

Allergies: Bactrim- hives

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Per providers notes: "I was called to the waiting room ~30 minutes after patient received her immunizations and glucola test d/t patient feeling dizzy. She was then lowered to the ground and reported difficulty breathing along with tongue swelling. A BP was not detected w/ electronic or manual cuff. Pulse oximeter ranged from 70s to 90s. At this point, I administered an epi-pen in patient's left thigh and supplemental O2 was provided while awaiting for EMS. A glucola was 140s. FHT of 150 was detected with doppler after event. Details of events were communicated with FOB, Sterling. Patient going to ED via EMS and OB team notified. " Per event report provided by RN "I was called out to the waiting room for pt that was passing out. Pt had her Tdap, Flu injections, and her 50gm glucose test 30 mins prior so she was waiting out in the waiting room. I walked out pt was lowered to the floor with the assistance of 2 CMAs after they found her shaking and rocking in the chair in the waiting room and unable to walk to a exam room. I asked pt her name and starting rubbing her back to try and stimulate her into talking because she was in and out of consciousness. I asked staff to call for assistance and to tell someone to call 911 services. I assisted pt to her side and put a pillow under her head. We tried to get a blood pressure x2 unsuccessfully Pts pulse was 61 BPM and weak when I took it manually. Dr. then came out and I gave report to her from what I saw and interventions I did to keep her talking and conscious through incident. Dr. then did her assessment and pt stated "she couldn't breathe" and "feels like her tongue was swelling" very limited communication took place because of pt being so weak and unable to exert that much energy. At that time Dr. asked for and Epi-Pen, oxygen and vital machine. Dr. asked staff to try to get another blood pressure reading on pt with the machine and again was unsuccessful pt pulse ox ranged to 70s-90s. Dr. then administer the Epi-pen in pt's left thigh and administered O2 by oxygen re-breather mask. Pt's random glucose reading was 140s, FHT was detected with a handheld doppler of 150s while waiting for EMT services. EMT's were taking the Pt out of the building. Report was given by Dr. to EMT's and provided snapshot of Pt's information, and gave report to OB team at the ED."

Other Meds: Glucose for OB glucose tolerance test. Albuterol, Symbicort, PNV,

Current Illness: PMH of asthma, iron deficiency anemia, and colitis; 28 weeks pregnant

ID: 1051786
Sex: M
Age: 77
State: NJ

Vax Date: 02/03/2021
Onset Date: 02/07/2021
Rec V Date: 02/24/2021
Hospital: Y

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: none

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

Symptoms: Four days after receiving the first Phizer COVID-19 vaccination (2/7/2021) I began experiencing double vision. This double vision was intermittent, lasting for several hours at one time. This double vision persisted and worsened with double vision all day long. At the ER prior to discharge, Dr. diagnosed me with possible "Ocular myasthenia gravis" and prescribed me with Pyridostigmine Bromide. After having been 30mg of this medicine daily for 1 week, the double vision has not subsided. Starting today (2/24), I am beginning to take 60mg daily. This double vision continues today (2/24/2021) even with the newly prescribed medication

Other Meds: Omeprazole for Acid Reflux; Gabapentin for Back Pain; Simvastatin for Cholesterol

Current Illness: none

ID: 1051787
Sex: F
Age: 38
State: TX

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

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: c/o burning sensation 10min after injection on the injection site, rated sensation as 3/10 on a scale of 0-10. Denies chest pain, SOB, lightheaded, rash. Cleared, no acute distress. Advised to go to ER if symptom worsen

Other Meds: Glimepiride, Vit C

Current Illness:

ID: 1051788
Sex: F
Age: 25
State:

Vax Date: 02/13/2021
Onset Date: 02/20/2021
Rec V Date: 02/24/2021
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: large oval shaped red inflammation around the injection site, was hard to the touch and sent tingling pain down my arm. A few days later it morphed into inflammation that just encircled the original inflamed area and began moving down my arm a couple inches. It is also now itchy.

Other Meds:

Current Illness:

ID: 1051789
Sex: M
Age: 63
State: AZ

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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: Sore arm at the location of the injection. Strong headache.

Other Meds:

Current Illness:

ID: 1051791
Sex: M
Age: 41
State: AR

Vax Date: 01/25/2021
Onset Date: 01/28/2021
Rec V Date: 02/24/2021
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: N/A

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

Symptoms: Woke up a few days later with terrible lower back pain. I do not recall injuring my back the days prior. I have had back pain before over the years from my job. However, this pain was the worst its been and lasted more than 2 weeks. I saw a chiropractor to help with the symptoms. They have gotten much better, but are still there. I also noticed that my right and left index finger were swollen and stiff in the knuckle closet to my hand.

Other Meds: Vit C and multi-vitamin

Current Illness: N/A

ID: 1051792
Sex: F
Age: 28
State: IL

Vax Date: 02/20/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Seasonal allergies, dairy

Symptom List: Tremor

Symptoms: At first, I had normal side effects: fatigue, chills, hot flashes, body aches, injection site pain, and body pain. But yesterday evening on day 3, I just started to have my upper left arm burn, swell, itch, and turn red. I looked it up online and it turns out I have "COVID" arm which is a rare adverse side effect of the vaccination. It said it would subside in 24 hours to a week. This was not listed on any of the forms I got as a possible side effect so I thought I should report it.

Other Meds: Claritin D, Tylenol, Zinc, Iron, and Oil of Oregeno

Current Illness: IBS

ID: 1051793
Sex: F
Age: 44
State:

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Erythema, Pruritus

Symptoms: Axillary Lymph swelling with erythema extending from insertion site streaking medially to the axilla. Pain to axillary region and upper arm with tingling and heaviness to lower arm.

Other Meds: Vitamin B complex, Vitamin D, Vitamin K

Current Illness: None

ID: 1051794
Sex: M
Age: 58
State: PR

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: NSAID

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

Symptoms: SM developed and urticarial rash (both arms, back and torso and legs) 24-48 hrs after a COVID-19 second vaccine. The vaccine was administration last Monday and developed an generalized rash and itch since yesterday. No difficulty breathing associated symptoms to this vaccine administration. Referred to PMC for Tx. Routine medical care. OTC TX recommended to the member.

Other Meds: NO

Current Illness:

ID: 1051795
Sex: F
Age: 50
State: MI

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
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: AFTER WAITING PER PROTOCOL FOR 15 MINUTES SHE THOUGHT HER THROAT TIGHTEND. ON SITE EMS RESPONDED. PER EMS HER THROAT APPEARED NORMAL UPON EXAM. HER VITALS ARE BELOW. SHE WAS OFFERED 25MG BENADRYL AND REFUSED. SHE WAS RELEASE TO HOME

Other Meds:

Current Illness:

ID: 1051796
Sex: F
Age: 46
State: NY

Vax Date: 02/20/2021
Onset Date: 02/20/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Chills: intermittent during a 12-hour period. Treatment: rest. Fever: low grade, during 12 hour period. Treatment: rest/fluids. Body aches: 24-48 hours. Treatment: rest, and took Aleve starting 36 hours after vaccine dose. Fatigue/weakness: 48-72 hours. Treatment: rest. Headache: 48-72 hours (turned into migraine with nausea/vomiting). Treatment: sumatriptan

Other Meds: Celexa 20mg/day Iron supplement 65mg/day

Current Illness: none

ID: 1051797
Sex: F
Age: 43
State: VA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: methotrexate, Augmentin, smz-tmp, azthioprine, Environmental elements, trees, grasses, Cockroaches, Dustmites, Mold

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

Symptoms: Waited 30 minutes at the facility with no side effects, got in my car, started driving and felt part of my lower right check and upper lip going numb but it went away in like 10 minutes and didn't return. So it happen around 45 min after getting injected.

Other Meds: Xyzal 5 mg

Current Illness: None

ID: 1051798
Sex: F
Age: 68
State: WA

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Sudden Onset of Chest tightness and numbness in left arm. History of AFIB and Diabetes. PT Denies SOB, Nausea, or Vomiting. Pt given 324 mg ASA prior to medic arrival. M48/L48 responded and evaluated patient including cardiac monitoring. Pt refused treatment or tx.

Other Meds:

Current Illness: None

ID: 1051799
Sex: F
Age: 70
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 02/24/2021
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: Throat closed up Pt was brought to ED after receiving covid vaccine number 1 approx 40 min prior to arrival. Pt states she started feeling some mild tightness in her throat. Pt denies any trouble breathing. Arrives tearful and appears anxious. No rash noted. No facial swelling or mouth swelling noted. Pt states she did have a mild reaction to flu vaccine and bee stings. Carries any epi pen but did not use it. Patient returned to baseline and was sent home- no acute distress, lungs clear Patient allergies: bee venom (not specified) , ciprofloxacin (rash, swelling), iodine (hives), bactrim (swelling), cephalexin (not specified), procaine (not specified)

Other Meds:

Current Illness:

ID: 1051800
Sex: F
Age: 65
State: MI

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: Patient experienced dizziness and giddiness after vaccination . Onsite EMS was called vitals BP 169/83 99% O2 room air HR 95. Patient Treated, Transported by the EMS to the hostipal.

Other Meds:

Current Illness:

ID: 1051801
Sex: F
Age: 26
State: PA

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 02/24/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Severe muscle and joint pain, fever, and vomiting

Other Meds: Zyrtec, Zoloft

Current Illness: None

ID: 1051802
Sex: M
Age: 73
State: GA

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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: None noted at time injection was given. Patient received Moderna vaccine for 1st on 01/25/2021 and Pfizer was given for 2nd dose on 02/22/2021.

Other Meds:

Current Illness:

Date Died: 01/15/2021

ID: 1051803
Sex: F
Age: 47
State: GA

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 02/24/2021
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: unknown- not the facility that administered the vaccine

Symptom List: Vomiting

Symptoms: unknown, was informed by Health Director that person had passed away

Other Meds: unknown- not the facility that administered the vaccine

Current Illness: unknown

ID: 1051804
Sex: M
Age: 34
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 02/24/2021
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: n/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The evening after the Moderna COVID-19 vaccine was given the patient started experiencing chills, shaking, headache, muscle aches and extreme fatigue. The headache, muscle aches and extreme fatigue continued for 2 days after vaccine administration. The patient took tylenol and ibuprofen for his fever and headache symptoms. To date, he is still experiencing headaches. He will be visiting his PCP for his annual 2/26/21 and will bring up the reaction to him for further direction.

Other Meds: n/a

Current Illness: n/a

ID: 1051806
Sex: F
Age: 81
State: FL

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 02/24/2021
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: Levaquin - swelling/hives allergy to latex

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

Symptoms: #1 Moderna 1/24/2021 1500 #2 Moderna 2/21/2021 1500 #1Moderna lot 029L208 #2Moderna lot 039K208 Side effects started that day after, that include pain to abdomen, chest, pelvic area and chills, felt feverish did not check temp, headache, injection site pain. Did the adverse event start after the first or second vaccination? Side effects started after each vaccines the following day, she just now realized this today. Symptoms severity about the same compared to 1st shot. Symptoms started resolving after a week or so.

Other Meds: loratadine 10 mg daily gabapentin 300mg meloxicam 15mg levothyroxine 300mcg atorvastatin 80mg telmisartan 40mg daily furosemide 20mg if feet is swollen hydrocodone/apap 5/325 pantoprazole probiotic Vit D 50,000 IU calcium

Current Illness:

ID: 1051807
Sex: M
Age: 38
State: NJ

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 02/24/2021
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: SWELLING UNDER LEFT ARMPIT. MOST LIKELY LYMPH NODE SWELLING.

Other Meds: ALEVE

Current Illness:

ID: 1051808
Sex: M
Age: 90
State: MN

Vax Date: 02/17/2021
Onset Date: 02/18/2021
Rec V Date: 02/24/2021
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 know

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

Symptoms: fall with lethargy and 101.2 temp

Other Meds: Lantus, Novolog, ASA, Calmdroz, clopidogrel, deep sea nasal spray, hydrochlorothiazide, onglyza

Current Illness: none acute

ID: 1051809
Sex: F
Age: 29
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/24/2021
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: Dairy, latex

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

Symptoms: Moderate to severe: Fever, headache, nausea, chills, neck and back aches/burn, deep arm soreness, weakness, fatigue for 18 hours Mild arm soreness and body aches for 2-3 days

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm