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: 1074866
Sex: M
Age: 52
State: TX

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: 10:05 PT C/O ITCHING AND REDNESS ON RIGHT HAND AND FOREARM. PT STATES HIS NOSE FEELS CONGESTION. 10:11 PT DENIES ANY SHORTNESS OF BREATH 10:15 AM PT STATES HE CAN DRIVE HOME AND WILL TAKE SOME BENADRYL

Other Meds: N/A

Current Illness: N/A

ID: 1074867
Sex: F
Age: 57
State: WI

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: Morphine, Remicaid, Orencia.

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received vaccine at 12:01, she stated that approximately 12:30 she noticed her right palm felt itchy and she noticed red bumps on the inside of her right wrist. She reported the symptoms to the onsite paramedics. She stated that she was placed on a stretcher and given 60 mg of liquid benadryl by the paramedics. She stated she started feeling dizzy, but after 3 minutes the dizziness resolved. She stated that soon after that the itchy right palm resolved, and the red spots on her right wrist diminished. She stated the paramedics took her blood pressure, 150/100 and placed her on oxygen. She stated she was monitored until 1:30 pm, then was discharged, at the time of discharge she had no dizziness, no itching, and only slight red bumps on her wrist. When she got home she stated her eyes felt itchy at about 5:30 pm, she took 2 OTC benadryl tablets, the symptoms resolved. She has been asymptomatic since that time.

Other Meds: Celebrex, fluoxetine, topomax, Propanolol, Hydroxychloroquine, flonase, zyrtec, xiilidra eye drops, sumatrittan, compazine, CBD gummies, xeljanz, and tylenol

Current Illness: None

ID: 1074868
Sex: F
Age: 71
State: RI

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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: pcn & derivitives, cheese, yeast, alcohol

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

Symptoms: 1044 - c/o lips tingling w/inner lips swelling BP 110/70, HR 92 RR 18 O2 99%. 1044 Benadryl 25mg PO administered 1045 119/71 88 18 100%, NAD 1050 118/70 82 18 100% NAD 1100 116/75 84 20 100% NAD, pt states swelling gone, numbness around mouth 1113 107/71 82 18 100% lips numb 1115 states a small amount of numbness remains, NAD 1127 107/62 16 100%, ststae she feels much better, dc to home. advised pt to notify PCP of incident

Other Meds: n/a

Current Illness: ileostomy

ID: 1074869
Sex: F
Age: 55
State: IL

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Leukocytoclastic vasculitis bilateral legs

Other Meds: trazodone, metformin

Current Illness:

ID: 1074871
Sex: F
Age: 26
State: MI

Vax Date: 01/12/2021
Onset Date: 02/19/2021
Rec V Date: 03/05/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: Severe thrombocytopenia Petichiae

Other Meds: Motrin

Current Illness: none

ID: 1074872
Sex: F
Age: 67
State: MS

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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: None

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

Symptoms: Moderna COVID-19 Vaccine EUA Redness, swelling and pain at the injection site. Was most painful and swollen on the day following the injection. The pain and redness lessened each day without any interaction. By the 4th day following the injection, the injection site is still slightly red with a very small bit of pain when touching it.

Other Meds: Armour thyroid, pantoprazole, Zyrtec, Flonase, advil

Current Illness: None

Date Died: 02/26/2021

ID: 1074873
Sex: F
Age: 82
State: MD

Vax Date: 12/29/2020
Onset Date: 02/10/2021
Rec V Date: 03/05/2021
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: lisinopril, sodium hypochlorite, tetanus toxoid, tuberculin.ppd

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient had COVID pneumonia in January 2021. Readmitted 2/10 for nausea/vomiting found to be in DKA. Treated with IV insulin, fluids, pressors and admitted to ICU. DKA resolved but continued to have ongoing nausea and dysphagia. EGD showed possible candidiasis, GI symptoms started to improve and was discharged home 2/24 with O2, life care, home health care. Patient recorded deceased 02/26/2021.

Other Meds:

Current Illness: recent COVID-19 pneumonia 1/2021

ID: 1074874
Sex: F
Age: 51
State: WA

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Pharyngeal swelling

Symptoms: Syncope, hypotension, Pt. Vitals returned to normal after the 30 minute observation. Pt. stated this was normal for her when she gets injections.

Other Meds: Similin, Levothyroxine,

Current Illness: None

ID: 1074875
Sex: M
Age: 60
State: TN

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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: The described waking up around 9pm after going to be early the day after he received the vaccine. He said that his hands burned and itched. He took Benadryl and the symptoms eased after about an hour. He reports he had a similar experience after being exposed to rubella many years ago. At that time the symptoms spread to his whole body.

Other Meds:

Current Illness:

ID: 1074876
Sex: F
Age: 68
State: MN

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Day 1 after shot , left arm was swollen and a little red at shot site and had a mild fever, of 98.5 normal temp for me is around 97.2. Day 2 the red area around the shot site has grown about 2" X 3" and the site itches, and swollen where the red mark is, and hurts to the touch.

Other Meds: Zinc, Vitamin C, Lysine, Cranberry tablets, Vitamin D, Tynenol

Current Illness: NO

ID: 1074877
Sex: F
Age: 63
State:

Vax Date: 02/25/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: penicillin, crabs

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

Symptoms: after 6 (six) days of the 1st (first) shot, had fever of 100.2 degree by arm and whole body aches. the symptoms gradually and finally went away in 36 hours

Other Meds: none

Current Illness: none

ID: 1074878
Sex: M
Age: 32
State: KS

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/05/2021
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: Progress Notes 2/24/2021 Patient: Date: 2/24/2021 Subjective is a 32 y.o. male who was seen at COVID Vaccine Clinic today for his first dose of the COVID 19 vaccination. He was given the Pfizer vaccination in the right deltoid muscle. During his 15 minute waiting period after the injection, the patient began to experience lightheadedness, nausea and headache. He denied difficulty breathing, difficulty swallowing, wheezing and throat tightness. He ate breakfast this morning and was feeling well prior to having his vaccine. This provider was notified of patient reaction and he was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to rapid progression of symptoms, respiratory distress and vomiting. ALLERGY REVIEW OF SYSTEMS: Patient complains of dizziness and headaches Patient denies chills, facial swelling, cough, chest tightness, shortness of breath, wheezing, vomiting and abdominal pain +Nausea: Previous Reactions: Denies Objective Vitals Vitals: 02/24/21 1126 02/24/21 1222 BP: (!) 144/85 122/64 Pulse: 62 67 SpO2: 98% 100% Physical Exam Constitutional: Appearance: Normal appearance. HENT: Head: Normocephalic. Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. No posterior oropharyngeal erythema. Comments: No swelling or lips or tongue. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing or rales. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: He is alert and oriented to person, place, and time. Assessment/Plan Treatment included: water and Pepcid Follow up response to treatment: good. Sx resolved prior to discharge. Patient discharge: Stable to go home and follow up with PCP.

Other Meds:

Current Illness:

ID: 1074879
Sex: F
Age: 53
State: VA

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Sensitive to Aspirin

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

Symptoms: I had a swollen lymph node on left arm lasting 5 days.

Other Meds: Prilosec, Magnesium

Current Illness: No

ID: 1074880
Sex: F
Age: 71
State: CO

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: Woke up morning after shot feeling slightly unwell. Then by mid-morning I was running a fever and had aches in my lower back, and chills. Took temperature at 4:00 p.m. and it was 100.1. Also had a sore left arm where shot was given. Slept through the night and awoke 2nd morning after covid shot feeling fine and back to my normal self.

Other Meds:

Current Illness:

ID: 1074881
Sex: F
Age: 28
State:

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/05/2021
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: "the next day [after vaccination] the injection site was extremely sore and the pain went up to my neck and down into my hand. From what I heard this is pretty normal so I had no concerns. Over the next couple days the injection site pain was gone along with the neck pain but the wrist/hand pain persisted. It?s now been a week since the pain started and my wrist/hand/forearm are still really sore/achy. I?ve been icing it multiple times a day but the pain persists. It?s especially bad when typing or doing any repetitive motions with my hand. "

Other Meds:

Current Illness:

ID: 1074882
Sex: M
Age: 72
State: NJ

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 1 hour after the shot I experienced colorful floaters of different shapes This lasted about 45 minutes. 2 hours later chills and nausea. This lasted about 3 hours Approximately 12 hours after the shot feeling normal with no nausea or colorful floaters

Other Meds: Levothyroxine 100 mc

Current Illness: None

ID: 1074883
Sex: M
Age: 38
State: MA

Vax Date: 03/02/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: Sulfa.based drugs, erythromycin, ambien

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

Symptoms: Headache, fever, chills, muscle ache, Nausea

Other Meds: Methotrexate, pantoprazole, folic acid

Current Illness: None

ID: 1074884
Sex: F
Age: 66
State: CA

Vax Date: 02/20/2021
Onset Date: 03/01/2021
Rec V Date: 03/05/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Lobster, gold, opiates, diflucan.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: "Covid Arm". Developed a hot, red, itchy welt at the injection site 10 days post-injection. Today is day 13 and it is gradually going away. I've used 2% Hydrocortisone cream on it 3x.

Other Meds: Estradiol patch .075 mg 2x weekly

Current Illness: None

ID: 1074885
Sex: F
Age: 70
State: IL

Vax Date: 01/02/2021
Onset Date: 02/05/2021
Rec V Date: 03/05/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: sea food, Idoline, sulfur, codeine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I did not experience an immediate reaction to the shot as they had me wait 30 mins to assure that I was not allergic to the shot as I do have allergies. Not sure if the medical complications that I experience a week later after having the shot is related to the shot or not and my primary doctor or my endocrinology dr. is not sure either and had concerns as to weather I should take the second shot or not. I went to the emergency dr. because the (burning, itching, pain, pins/needles) were so bad in my upper and lower extremities. They prescribe me pain med and another med that has help a lot. I visited my endocrinology dr. for my dietetics. After running all kinds of test she stated that my A1C levels were a 6.point. She could not attributed my severe neuropathy to diabetics or to the virus shot. She set me for an appointment to see a neurologist. I also developed a week later severe bumps on my face, neck and both arms. I went to urgent care and they gave me a shot of some sort and sent me home with steroids and take Benadryl. My skin cleared up in a few days. I had never had that happen to me.

Other Meds: Zyrtec, Tylenol

Current Illness: Dietetics, Asthma, high blood pressure, Stint in heart and pace maker

ID: 1074886
Sex: F
Age: 36
State: NY

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

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

Lab Data:

Allergies: TETNUS VACCINE AS A CHILD

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

Symptoms: PT BEING MONITORED FOR 30 MINUTES. AT 0930 PRIOR TO LEAVING. 0931: PT STATED THAT HER THROAT FELT SCRATCHY AND HER CHEST FELT FUNNY. PT AIRWAY ASSESSED. ERYTHEMA TO THROAT AND UVULA NOTED, NO EDEMA OR SWELLING NOTED AT THIS TIME. PT BROUGH BACK TO OBSERVATION FOR FURTHER ASSESSMENT, BY WRITER, PHYSICIAN AND EMT. PT PLACED ON CARDIAC MONITOR- NORMAL SINUS RHYTHM. PT DENIES ANY CHEST PAIN, PALPITATIONS, PRESSURE, SOB, N/V/D NOTED. MD RECOMMENED PT GO TO ER FOR FURTHER EVALUATION PT REFUSED, BUT AGGREED TO STAY FOR TREATMENT OF IV BENADRYL AND IV DEXAMETHASONE. BOTH ADMINISTERED BT EMT AT 0958. PT TOLERATED WELL. PT CONTINUED TO BE MONITORED UNTIL S/S OF REACTION SUBSDED AT 10:20AM. PT STATES THAT THERE IS NO LONGER A SCRATCH FEELING IN THROAT AND HER CHEST FELT MUCH BETTER. VSS REMAIN STABLE. PT STILL REFUSES TO GO TO ER PRIOR TO LEAVING FACILIT. PT AMBULATED OFF SITE. ACCOMPANIED BY FAMILY.

Other Meds: BIRTH CONTROL

Current Illness: NONE

ID: 1074887
Sex: M
Age: 72
State: UT

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Right arm swollen and hot to the touch, my temperature got up to 103 and lasted two days.

Other Meds: Aspirin, CoQ 10, D3, Eliquis, Amlodipine, hydrochloride, Omeprazole, Metoprolol, Atarvastatin, Terazosen

Current Illness: None

ID: 1074888
Sex: M
Age: 66
State:

Vax Date: 02/13/2021
Onset Date: 02/26/2021
Rec V Date: 03/05/2021
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: started with shingles rash left chest about about 2/26/2021 (<14 days after receiving vaccine)

Other Meds:

Current Illness:

ID: 1074889
Sex: F
Age: 59
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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: None

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

Symptoms: Palpitations 4 mins after receiving the vaccine. Vital signs were checked : BP 160/72, Pulse =77, 02 sat =98% Pt was monitored for 30 mins with resolution of her symptoms

Other Meds: Januvia 100mg qd, Liptor 20mg qd, Atenolol 50mg qd, Lisinopril 20mg qd, ASA 81mg qd, Timolol 0.5%

Current Illness: None

ID: 1074890
Sex: F
Age: 78
State: RI

Vax Date: 02/27/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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: nuts sulfur

Symptom List: Injection site pain, Pain

Symptoms: woke up about 3am on March 5 with my whole left side hurting me the vaccine site was swollen and red

Other Meds: none

Current Illness: Waldrum lymphoma blood disease

ID: 1074891
Sex: M
Age: 78
State:

Vax Date: 02/09/2021
Onset Date: 03/01/2021
Rec V Date: 03/05/2021
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: body weakness, nausea, diariah throwing-up.

Other Meds: insulin, metformin, clonazepam, citalopram, metoprolol, atorvastatin, bupropion & aspirin.

Current Illness: none

ID: 1074892
Sex: M
Age: 35
State: GA

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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: None

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

Symptoms: 4 hours post inject pain at injection site dissipated at 6 hours post injection. 12 hours post injection fever of 100 detected, no pain, no aches, no fatigue, no sweats. 16 hours post injection awakened from sleep by fever of 104.3 and treated with running cool water for 1 hour which brought it down to 102 then 400mg of Nuprin taken (17 hours post) and attempted to lay back down but 20 minutes later fever was back to 104.7 so back to cool water until fever went down to 101 and medicine seemed working (18 hours post). Fever remained at 100-101 until finally dissipating at 40 hours post injection. All throughout there was no fatigue or sweats or aches/pain

Other Meds: None

Current Illness: None

ID: 1074893
Sex: M
Age: 71
State: FL

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/05/2021
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: Pt. c/o feeling flush in the face and slight chest congestion. Pt. voice that he had a history of bypass and ablation. Pt. seen and assessed by EMT and vitals are: Bp 140/90, HR 74, O2 97%. After 20 min. of observation pt. voiced that he felt ell enough to go home and was cleared to do so by EMT.

Other Meds:

Current Illness:

Date Died: 02/11/2021

ID: 1074894
Sex: M
Age: 94
State: NY

Vax Date: 01/26/2021
Onset Date: 02/11/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Bactrim DS, Zetia, Flomax, Crestor, Proscar

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient became ill with pneumonia on 1/29/21 and then recurrent pneumonia on 2/10/21. Pt's plan of care was subsequently changed to comfort-focused on 2/11/21 and patient was deceased that same day.

Other Meds: Eliquis, Metoprolol succinate, Upcal w/Vitamin D, senna, levothyroxine, vitamin D3

Current Illness: None

ID: 1074895
Sex: F
Age: 35
State: IL

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: None

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

Symptoms: Beginning roughly 12 hours after vaccination, I had a very sore injection site, which lasted an additional 32 hours. Also about 12 hours after injection, I experienced a low grade fever, shaking and chills, entire body soreness/achiness, fatigue, and a headache. These symptoms lasted appx 24 hours, with the fever, shaking and chills dissipating around 20 hours and the remaining symptoms gone after 24-30 hours. Additionally, I am lactating and noticed a dramatic color change in my expressed milk roughly 17 hours after injection (normally a creamy yellow, 17 hours post-vaccination it appeared much more translucent and blue-tinted).

Other Meds: None

Current Illness: 01/25/21 first dose of sars-cov-2 vaccination

ID: 1074896
Sex: F
Age: 42
State: GA

Vax Date: 02/10/2021
Onset Date: 02/15/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Nausea

Symptoms: enlarged painful lymph node beginning 5 days after vaccine and persisting > 3weeks

Other Meds: bupropion, cyanocobalamin, ambien, alprazolam, biotin, vitamin D, calcium

Current Illness: none

ID: 1074897
Sex: F
Age: 66
State: SC

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfa

Symptom List: Injection site pain

Symptoms: Started a week after injection as egg-shape and size, swelling, red, hot, itching. Progressed to larger area each day but more like a red oval ring - larger and larger in diameter but less swollen, still hot and itchy. Today circles entire upper arm, more red on the perimeter. Took antihistamine last two days and less itchy

Other Meds: Rosuvastatin 5mg, Letrozole 2.5mg, Alprazolam .25mg, Prolia 60mg (01/25/2021), Restasis .05% solution, Centrum Silver 50+ women, Estroven Xtra, HSN (Bioten etc), Magnesium Calm, Fish Oil 1000mg

Current Illness: None

ID: 1074898
Sex: F
Age: 53
State: MI

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Sulfa, Ceclor, Clindamycin, Augmentin, influenza vaccine, as well as the preservative free vaccine, 1st dose of the Live MMR, which I reported to VAERS, and now Moderna COVID-19 vaccine, first dose given 3/4/21 at 12:04 pm. Respiratory distress, hives and welts after attacked by balded faced hornets. as well as wasps.

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

Symptoms: 3 minutes after the vaccination, I was standing up waiting to schedule my 2nd dose, then became lightheaded, a clerk immediately sat me down in a chair, then I had trouble breakthing, had neck spasms radiating to my arms, then my fingers clenched shut the my whole body, arms and legs were shaking uncontrollably. The team acted very quickly by giving me an injection of Epinephrine and Benadryl, placed me in a wheelchair then rushed to the ER, given oxygen, IV fluids, prednisone and valium to control the neck spasm as my whole body was again shaking and causing difficulty breathing, rapid breathing. Once I was stablized I was wheeled to my vehicle where I was driven home by a family member. Once I was home, 4 hours later I was still having neck spasms, also across my upper chest and tingling in my hands, this is notmal for me so it is diffiult to determine if this was still due to the vaccine and Epinephrine and Benadryl or the Moderna vaccine. This was the first time I was ever given or used Epinephrine.

Other Meds: Premarin 0.625 mg 1 tablet every bedtime Montelukast 10 mg 1 tablet every bedtime Biotin 5,000 mcg 1 capsule every bedtime Zyrtec 10 mg 1 tablet every bedtime

Current Illness: No.

ID: 1074899
Sex: F
Age: 46
State: MN

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/05/2021
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: kna

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

Symptoms: Fever, chills, skin painful to touch, body pain, nausea, headache, lethargy. Hot flashes, nausea, fatigue and headache continuing 72 hours after shot.

Other Meds: Imitrex, sumitriptan prn for migraine

Current Illness: none

ID: 1074900
Sex: F
Age: 25
State: CA

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: Neosporin

Symptom List: Tremor

Symptoms: Fever, chills, migraine, vomiting, nausea, dizziness, fatigue

Other Meds: Levothyroxine

Current Illness:

ID: 1074901
Sex: M
Age: 65
State: OH

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: No

Symptom List: Erythema, Pruritus

Symptoms: Fatigue, soreness around shot area

Other Meds: Supplements: Turmeric+, SuperLysine, Ashwagandha, GreenDetox Energy Drink

Current Illness: No

ID: 1074902
Sex: F
Age: 66
State: IN

Vax Date: 02/21/2021
Onset Date: 02/22/2021
Rec V Date: 03/05/2021
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: Codine, erythromycin, flagyl

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

Symptoms: Chills, headache, stiff neck, lethergy

Other Meds: Coq10 200 mg, D3 2000iu, multi vitamin, astrovastin 20mg, zyrtec

Current Illness: None

Date Died: 03/01/2021

ID: 1074903
Sex: M
Age: 90
State: AL

Vax Date: 02/27/2021
Onset Date: 03/01/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: caller (son) stayed w/ the pt for about an hour after he received the vax and the pt stated the only symptoms at that time was some achiness on the arm around the injection site. Son went home after that. He tried to contact him on 3/1/2021 but wasn't able to reach him. On 3/2/21 the brother tried to contact him and wasn't able to reach him. They contacted the police dept on 3/2/2021 around 8:00 AM to do a well check. Pt was found on the couch like he had fallen asleep but was deceased. They suspect he probably expired on 3/1/2021. No autopsy will be conducted per the son.

Other Meds: numerous dietary supplements and herbal meds

Current Illness: no

ID: 1074904
Sex: F
Age: 76
State: WA

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 03/05/2021
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: About 24 hours after first dose, patient reports that both her knees were red and itchy. The next day, the knees were normal. Also, patient reported that 9 days after first dose, the injection site on her arm had become itchy, red and warm.

Other Meds:

Current Illness:

ID: 1074905
Sex: M
Age: 73
State:

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/05/2021
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: Muscle aches, joint pain, headache, and low-grade fever. Also, lethargy. These symptoms lasted 24 to 30 hours.

Other Meds:

Current Illness:

ID: 1074906
Sex: M
Age: 41
State: NY

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/05/2021
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: Pfizer covis vaccine was mixed with 0.8 ml of saline instead of 1.8ml

Other Meds: Pfizer covid vaccine

Current Illness: none

ID: 1074907
Sex: F
Age: 22
State:

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

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

Lab Data:

Allergies: Cat dander, cashews, tree nuts. NKDA

Symptom List: Pain in extremity

Symptoms: 0925 patient in general observation, ambulated to nurse stating she felt funny. Color pale, ambulated to private observation area. States she feels nauseated. Sat in chair and given emesis bag. HR 157; O2 99%: BP 138/72. HR ausculated and rate confirmed. State she has no history of tachycardia or rapid heart beat. Denies "feeling" heart race. Denies itching, shortness of breath or difficulty swallowing. States she took her lisinopril and anxiety meds this morning. States she ate breakfast and performed her self catherization. 0940 Offered EMS transport/evaluation. Patient declined. 0942 patient states nausea resolved, BP 140/82; HR 136: O2 99% remains on rooms air. 0945 Auscultated Heart Rate at 140, strong/regular. Bilateral breath sounds clear to ausculation. Patient sitting in chair at rest. Color remains pink. Denies chest pain. 0948 Mother called patient's physician and reported to physician. PCP to return call to patient 0952 Patient to restroom, mom accompanied. 0955 Upon return from restroom, HR 160; O2 99% r/a, Denies feeling clammy, or having chest pain. denies hx of sinus tachycardia. Re-offered EMS eval due to elevated HR. Patient agreed to EMS eval. 0957 EMS activated 1013 Patient sitting in chair wringing hands. states she has excessive sweat glands and normally is very diaphoretic, states she feels dry at the moment. HR 144; O2 99% 1015 EMS and FD arrived. 1017 BP 103/61; HR 138; O2 99% and per EKG in ST per EMS monitors 1019 EMS recommended transport. Patient agreed. 1020 Transported via stretcher to ambulance to Hospital ED.

Other Meds: Lisinopril, singulair, macrobid, myrbetriq, zoloft, lamotrigine, ADHD med, BCP (shot), methylprednisone 5 day pack currently on day 3.

Current Illness: right wrist tendonitis - steroid pack for treatment

ID: 1074908
Sex: M
Age: 40
State: NJ

Vax Date: 02/25/2021
Onset Date: 03/03/2021
Rec V Date: 03/05/2021
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: Cyst on collar bone and armpit

Other Meds:

Current Illness:

ID: 1074923
Sex: F
Age:
State:

Vax Date: 06/15/2016
Onset Date:
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Flare up throughout the body due to covid vaccination; Flare up throughout the body due to winter; Allergic to Enbrel; Asthma flare-up; Sinus infection; Bronchitis; Covid 19 vaccine route of administration: Endocervical; This is a spontaneous report from a contactable healthcare professional, based on the information received by Pfizer from agency (manufacturer control number: US-AMGEN-USASP2020193179), license party for etanercept (ENBREL). This spontaneous report (USASP2020193179) was reported to agency on 25/NOV/2020 by an other health professional and involves a 41-year-old female patient who was allergic to Enbrel [PT: drug hypersensitivity], asthma flare-up [PT: asthma], sinus infection [PT: sinusitis], and bronchitis [PT: bronchitis] while receiving Otezla and Enbrel. No historical medical condition was reported. The patient's current medical condition included psoriatic arthropathy, cough, disease of upper respiratory tract, herpesviral (herpes simplex), irritable bowel syndrome, lupus erythematosus, infection of the skin, migraine, oligomenorrhea, personal history of other diseases of psoriasis, unspecified skin changes and asthma. The patient had allergic to Arava (Leflunomide), cimzia prefl kit (certolizumab pegol), Depo-Medrol (Methylprednisolone Acetate), Humira (Adalimumab), lidocaine, methotrexate, stelara (Ustekinumab), tetracycline, and allergic to Latex gloves and secure glove. The patient's concomitant medications included albuterol [salbutamol], benzonatate, Cymbalta (duloxetine hydrochloride), fexofenadine, multivitamin [vitamins nos], thyroid, and prednisone, Wal Zyr (cetirizine hydrochloride) and amoxicillin and potassium clavulanate. No co-suspect medications were reported. The patient began Otezla on 15/JUN/2016 and Enbrel on an unknown date. On an unknown date, the patient had bronchitis and asthma flare-up that later resulted in a sinus infection. The patient confirmed that she was established on Otezla therapy. On an unknown date, the patient had been allergic to Enbrel. No treatment information was received. The outcome of the events sinusitis, bronchitis, asthma were reported as not recovered. The outcome of the event drug hypersensitivity was reported as unknown. Action taken with Otezla was continued for the events sinusitis, bronchitis and asthma. Action taken with Enbrel was reported as unknown for the event drug hypersensitivity. The other health professional reported that the event drug hypersensitivity was possibly related to Enbrel. The causal relationship between the events sinusitis, bronchitis, asthma, drug hypersensitivity and Otezla was not provided by the other health professional. The causal relationship between the events sinusitis, bronchitis, asthma and Enbrel was not provided by the other health professional. Follow-up has been requested for lot number only. Agency's assessment: the events Drug allergy, Sinus infection, Bronchitis, and Asthma aggravated were assessed as non-serious. Follow-up (22Feb2021):This is a follow up spontaneous report from a contactable consumer, based on information received by Pfizer from agency (manufacturer control number: US-AMGEN-USASP2020193179), license party for etanercept (ENBREL). ADDITIONAL INFORMATION RECEIVED ON 22/FEB/2021: In this follow-up information, This serious spontaneous report involves an adult female patient who had flare up throughout the body due to covid vaccination [PT: psoriatic arthropathy], due to winter [PT: sensitivity to weather change] while receiving Otezla, Enbrel. The patient's concomitant medications included azelastine, famotidine, ferrous gluceptate, folic acid, montelukast, and progesterone. The patient's co-suspect medications included Covid 19 vaccine. The patient began Otezla on 15/JUN/2016 and Enbrel on an unknown date. On an unknown date, the patient had flare up throughout the body due to covid vaccination (two round) and also due to winter. The outcome of the events psoriatic arthropathy, sensitivity to weather change was reported as not recovered/not resolved. Action taken with Otezla was continued for the events sensitivity to weather change and psoriatic arthropathy. Action taken with Enbrel was reported as unknown for the events sensitivity to weather change and psoriatic arthropathy. The causal relationship between the events sensitivity to weather change, psoriatic arthropathy and Otezla was not provided by the other health professional. The causal relationship between the events sensitivity to weather change, psoriatic arthropathy and Enbrel was not provided by the other health professional. Agency Comment: This safety report does not necessarily reflect a conclusion by agency that apremilast, etanercept, caused or contributed to the adverse events reported; however, consistent with regulatory reporting requirements, this case is being reported because it contains one or more suspected adverse reactions

Other Meds: ALBUTEROL [SALBUTAMOL]; BENZONATATE; CYMBALTA; FEXOFENADINE; MULTIVITAMIN [VITAMINS NOS]; THYROID; PREDNISONE; WAL ZYR; AMOXICILLIN AND POTASSIUM CLAVULANATE; AZELASTINE; FAMOTIDINE; FERROUS GLUCEPTATE; FOLIC ACID; MONTELUKAST; PROGESTERONE

Current Illness: Asthma; Cough; Herpes viral infection NOS ((herpes simplex)); Irritable bowel syndrome; Latex allergy (Latex gloves and secure glove); Lupus erythematosus; Migraine; Oligomenorrhea; Psoriasis (personal history of other diseases of psoriasis); Psoriatic arthropathy; Respiratory tract disorder (Disease of upper respiratory tract); Skin disorder (unspecified skin changes); Skin infection (infection of the skin)

ID: 1074925
Sex: M
Age:
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 03/05/2021
Hospital: Y

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: stroke; vertigo attack; severe headaches; severe dizziness; A spontaneous report was received from a consumer who was also a male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and who experienced severe headaches / headache, severe dizziness / dizziness, vertigo attack / vertigo, and stroke / cerebrovascular accident. The patient's medical history was not provided. No relevant concomitant medications were reported. On 13 Feb 2021, prior to the onset of the events, the patient received their second dose of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 13 Feb 2021, about 12 hours after receiving the vaccine, the patient experienced severe dizziness and severe headaches which lasted for about 4 days. On 17 Feb 2021, while driving, the patient thought he was having a vertigo attack and went to the emergency room. He had a cat scan (results not provided) and was treated with TPA (tissue plasminogen activator). After three days in the hospital, they determined he had a stroke. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events, severe headaches, severe dizziness, vertigo attack, and stroke, was not provided.; Reporter's Comments: This case concerns a male patient, who experienced a serious unexpected event of cerebrovascular accident among others, 5 days after receiving 2nd dose of mRNA- 1273 (Lot# unknown). Very limited information regarding this event has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1074926
Sex: F
Age: 80
State: MN

Vax Date: 02/25/2021
Onset Date:
Rec V Date: 03/05/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: sepsis; surgery to put stent in; Blood pressure dropped to 70/20; kidney stone; A spontaneous report was received from a consumer who is an 80-years-old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and who experienced sepsis, kidney stone, stent replacement and ended up in ICU and blood pressure dropped to 70/20. The patient's medical history included 6 months of chemo and cataracts surgery in both eyes (not specified). The concomitant product was not provided . On an unknown date prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: Unknown) in the right arm and patients second dose was scheduled on 25-Feb-2021 for prophylaxis of COVID-19 infection. On an unknown date, after vaccination patient experienced sepsis, put the stent in and ended up in ICU and blood pressure dropped to 70/20/ blood pressure low (18-Jan-2021) and kidney stone. The patient was hospitalized for sepsis, stent replacement and ended up in ICU and blood pressure dropped to 70/20/ blood pressure low. On 04-Mar-2021, she was going to have surgery to have kidney stone which was 9cm long removed and to have stent replaced. Treatment information was not provided. Action taken with respect to mRNA-1273 in response to the events. The outcome of the events was not reported for all events.; Reporter's Comments: Very limited information regarding these events has been provided at this time. Further information has been requested. However, the events of kidney stone and stent replacement are unlikely because the kidney stone was preexisting and the procedure of stent replacement was planned for a later date.

Other Meds:

Current Illness:

ID: 1074927
Sex: M
Age:
State:

Vax Date:
Onset Date: 02/14/2021
Rec V Date: 03/05/2021
Hospital: Y

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: COUGH; oxygenation needs quickly escalated; SHORTNESS OF BREATH; A spontaneous report received from a Healthcare Professional concerning, an 82-year-old male patient who received 2nd dose of the Moderna COVID-19 vaccine and experienced serious adverse events of cough, shortness of breath and hypoxia (reported as oxygenation needs quickly escalated). The patient's medical history included hypertension and hyperlipidemia. Patient's concomitant medications were not included. On unknown date, the patient received their 2nd dose of the two planned doses of mRNA-1273 in unknown arm (Batch #: unknown) intramuscularly for prophylaxis of COVID-19 infection. Healthcare Professional stated that Approximately 36 hours after his second vaccination, (on 14-Feb-2021), during a trip with his family, he developed mild cough and SOB that progressed to severe symptoms requiring hospitalization. Healthcare Professional stated patient oxygenation quickly escalated requiring high flow nasal cannula. Patient was initially treated as COVID and high-altitude pulmonary edema. Healthcare Professional stated COVID PCR/ respiratory PCR were negative x 3 and all infectious workup was negative. Healthcare Professional stated the care team began to treat patient with high dose steroids in case of hypersensitivity pneumonitis or eosinophilic lung disease due to vaccination. Patient required a higher level of care but was not stable for transfer home, so the decision was made to transfer patient to ICU where he is currently under the care of ICU and infectious disease specialists. Healthcare Professional stated patient echocardiogram was normal and infectious workup (including COVID and respiratory PCR and cultures) thus far remain negative. Healthcare Professional stated patient is still on high-flow nasal cannula, though skirting intubation. Healthcare Professional feels the process is likely inflammatory versus infectious. Healthcare Professional stated Autoimmune workup is pending. Treatment included high-flow oxygen, solumedrol and empiric antibiotics. Action taken with mRNA-1273 in response to these events was not applicable. The outcome of these events was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1074928
Sex: F
Age: 68
State: PA

Vax Date: 01/15/2021
Onset Date: 02/17/2021
Rec V Date: 03/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Knees were on fire inside, tight, stiff, and can't bend them; Aches; Fatigue; A a spontaneous case report was received from a 68 year old female Other Health Professional concerning herself who received second dose of Moderna COVID-19 Vaccine (m-Rna-1273).. The patients past medical history included double mastectomy and was a cancer survivor. Once the patient took a cancer pill and it made her knees feel like they were on fire. This was 6 years ago. Ongoing conditions of the patient included arthritis and blood pressure. Concomitant medications of the patient included meloxicam, multi vit , atenolol, losartan potassium ,hydrochloroth (hydrochlorothiazide) and potassium chloride. On 15 Jan 2021 the patient started taking Moderna COVID-19 Vaccine for COVID-19 vaccination. The patient took the second dose of vaccine on 12 Feb 2021 into left arm intramuscularly. Five days later on 17 Feb 2021, the patient developed Knee arthritis. The patient also developed aches and fatigue. It hit in the knees and she could barely walk. She had o sit down from room to room. The patient reported the serious criteria to be temporary disability. Patient reported her arm was still black and blue from the first shot when she went for the second one. She had to get both the doses in left arm due to double mastectomy. No treatment information was provided. Action taken with mRNA-1273 in response to the event was unknown. Outcome of the events fatigue and aches was unknown and that of Knees were on fire inside, tight, stiff, and can't bend them was not recovered not resolved. The reporter causality for the events was not provided.; Reporter's Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.

Other Meds: MELOXICAM; ATENOLOL; HYDROCHLOROTH; POTASSIUM CHLORIDE; LOSARTAN POTASSIUM; MULTIVITAMIN [VITAMINS NOS]

Current Illness: Arthritis (slight arthritis in the knees); Blood pressure

ID: 1074929
Sex: U
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 03/05/2021
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: Admelog vials, lantus Vials, Lantus solstar, Toujeo, Flublok, Fluzone QD PFS, Typhim Vi and Apidra vials exposed at 46-53.5 deg F for 13 hours. Excursion happened when refrigerator door was not closed fully with no AE; Potential PTC:No Description:Rph wanted to gather stability information on Admelog vials, lantus Vials, Lantus solstar, Toujeo, Flublok, Fluzone QD PFS, Typhim Vi and Apidra vials exposed at 46-53.5 deg F for 13 hours. Excursion was happened when refrigerator door was not closed fully. Caller refused to provide the Lot# of the products. Additional Description of event Adverse events :Rph wanted to gather stability information on Admelog vials, lantus Vials, Lantus solstar, Toujeo, Flublok, Fluzone QD PFS, Typhim Vi and Apidra vials exposed at 46-53.5 deg F for 13 hours. Excursion was happened when refrigerator door was not closed fully. Caller refused to provide the Lot# of the products. Clarification note: Kindly reassess and delete suspect drugs if not required at step as it was not clearly mentioned if patients was using the reported drugs. Update outcome as not applicable.

Other Meds: ADMELOG; APIDRA; TOUJEO; LANTUS SOLOSTAR

Current Illness:

ID: 1074930
Sex: F
Age: 46
State: NY

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

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

Lab Data:

Allergies: Ceftin- Anaphylaxis Adhesive tapes - rash and localized swelling Band aide- rash/itching Grass pollen/dust molds tress

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

Symptoms: Patient received vaccine at 10:39am and was in the observation area. At about 3 minutes (10:42 am) she began to feel " a tingly sensation in my tongue" and felt warm. She also had localized redness and swelling at the site of injection (Right deltoid). She denied any symptoms of chest pain, SOB, palpitations, difficulty swallowing, drooling, nausea/vomiting, dizziness or light-headed or near syncope. Patient was observed by provider for a course of one hour. We recommended to be taken by EMS to ER for further observation, she refused. Patient drove herself and was not able to take Benadryl. Initial vital signs taken 10:54am 177/114; HR 92; O2 98% RA; RR 18 -sitting position Second vitals 11:35am 134/96; HR 79; O2 100% RA ; RR 16- sitting position Patient was observed for an hour and decided to drive home. Recommend hydration and call 911 if needed.

Other Meds: Famotidine 20 mg daily Singulair 10mg daily Levothyroxine 50mcg daily Imvexxy 10mcg daily Fluticasone 50mcg Breo-Elipta 100-25mcg Lipitor

Current Illness: None

ID: 1074931
Sex: F
Age: 52
State: CO

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 03/05/2021
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: Allergic to dogs, cats, weeds, grass, mold, pollen, horses- Get allergy shots every week

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

Symptoms: Typical flu-like symtoms the next day *For me- Increased myofascial tightness of muscles; also *A rash over my entire trunk (like sandpaper/red bumps) * An inflammatory rash on my chest

Other Meds: Yes. Cymbalta Clonazepam Zyrtec (for major allergies) Thyroid Estrogen/Progesterone mix

Current Illness: Myofascial pain - It was controlled.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm