VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer

Incidents per State

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

ID: 1136529
Sex: F
Age: 37
State: FL

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

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

Lab Data:

Allergies: Penicillin, codeine, horseradish

Symptom List:

Symptoms: "COVID 19 Arm" Hot and itchy at the site of injection 7 days after injection.

Other Meds: Singulair, Claritin, Lexapro, multivitamin, fish oil

Current Illness: N/A

ID: 1136530
Sex: F
Age: 78
State:

Vax Date: 03/20/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Pt reports rash under left breast after covid shot.

Other Meds:

Current Illness:

ID: 1136531
Sex: M
Age: 30
State:

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Patient checked in to the observation room. A patient sitting adjacent reported he 'dropped his phone and was out' momentarily. The patient did not fall and MD was alerted. Patient was red, flushed, clammy but alert. BP 73/42mmHg, HR 85, O2sat 97%, and RR 12. He was placed on a stretcher. He had no difficulty breathing or cutaneous symptoms. BP recovered to 120/75mmHg, HR 80, O2sat 96% and RR 12 within 15 minutes. Pt felt well and was able to be discharged home.

Other Meds: None

Current Illness: None

ID: 1136532
Sex: F
Age: 32
State: NY

Vax Date: 03/24/2003
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, sulfur, Claritin

Symptom List:

Symptoms: Confusion, dizziness, loss of coordination, excruciating body pain, nauseous,diarrhea, headache, vomiting Within 48 hours of both vaccines menstrual cycle began with severe cramping , heavy bleeding and 2 weeks early

Other Meds: None

Current Illness:

ID: 1136533
Sex: F
Age: 32
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Pineapple

Symptom List:

Symptoms: Around 1:00 pm felt nauseous went away. 8:30 pm soreness in arm nausea around food. 9-10 pm chills, fever, muscle aches. 2:30-4:45 am on 3/26/2021 headache, chills, muscle aches. 5:15-6:00 am headache

Other Meds: Tylenol extra strength 500 mg

Current Illness: None

ID: 1136534
Sex: F
Age: 62
State: OH

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Severe Celiac Disease/dx'd @ 50 yrs. old.

Symptom List:

Symptoms: Ever so slight tingle in tongue within 30 mins with difficulty moving legs. Arrived home and slept 5 hours. Spouse woke me up to eat. I was polite and took a few bites. Went to bed @ 10 pm. The next morning I woke in the fetal position and COULD NOT MOVE! Called husband for help. He lifted me to the sit up position by my rib cage. Very difficult to move for 4 days. Had Gammagard treatment on March 16. 2021. That was a mistake, I guess. I could not even think clearly enough to try to fill out this form.

Other Meds: GAMMAGARD S/D...20GM...EVERY 21 DAYS AND CYMBALTA 90 MG...ONCE A DAY

Current Illness:

ID: 1136535
Sex: F
Age: 72
State: MA

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/26/2021
Hospital: Y

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

Lab Data:

Allergies: Atorvastatin, Benazopril, Contrast, Isosorbide, PCN, Rosuvastatin

Symptom List:

Symptoms: Patient reported fevers as high as 105 at rehab and myalgias along with weakness, She was subsequently admitted to the hospital for these symptoms.

Other Meds: Ponatinib, Chlorthalidone, Amio, Toprol, Amlodipine, Losartan, Eliquis

Current Illness: CML

ID: 1136536
Sex: F
Age: 74
State: VA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Aspirin

Symptom List:

Symptoms: Hands, bilaterally erythematous and hot to touch. One-25 mg Benadryl was given at 2:25.

Other Meds: Citalopram/ Famotidine/Rosuvastatin/Tizanidine/Tramadol/Zolpidem

Current Illness:

ID: 1136537
Sex: F
Age: 74
State: RI

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Dogs, latex, codeine, Augmentin

Symptom List:

Symptoms: Pt entered the monitoring area of the high-risk anaphylaxis clinic at noon for her 30 minutes of monitoring. At 12:30pm when her 30 minutes had passed and the patient was ready to leave, patient reported to RN that her tongue felt itchy and mild tingling. Evaluation of her tongue revealed no redness or swelling. Pt states she is allergic to dogs, latex, codeine, and Augmentin (severe reaction). She does have a dog at home and reacts to his dander for which she take a Benadryl nightly. Pt was given diphenhydramine 25mg PO x 1. VS = 78, 148/85, 98% O2 sat. Pt reported resolution of tongue symptoms at 12:56pm. VS 71, 159/65, 98% O2 sat. Pt discharged home in no apparent distress at 1:05pm.

Other Meds:

Current Illness:

ID: 1136538
Sex: M
Age: 67
State: MI

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
Hospital: Y

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

Lab Data:

Allergies: atorvastatin did not work for him

Symptom List:

Symptoms: tongue swelling and shortness of breath

Other Meds: flomax ASA lisinopril HCTZ pravachol naproxen

Current Illness: BPH hyperlipidemia Hypertension , Irritable bowel syndrome

ID: 1136539
Sex: F
Age: 56
State: NY

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Cellullitis with large blisters & orange draining watery fluid

Other Meds: Wellbutrin, viibryd, symbicort, proair, nasonex

Current Illness: none

ID: 1136540
Sex: F
Age: 64
State: PA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Allergic to eggs as a baby. Outgrew that since becoming an adult.

Symptom List:

Symptoms: Pfizer -BioNTech COVID-19Vaccine EUA About 10 minutes after having the shot, I had a rush to my head and a feeling of being faint, followed by a rapid heartbeat. This subsided after a few minutes, but the rapid heartbeat seemed to remain for hours. It felt like a low blood sugar attack. I had not eaten a proper breakfast before having this shot and I am wondering if that had something to do with it. I want to make sure I can have the second shot if I eat well before I go and have hydration with me. I waited an extra 10 minutes and got out to my car and ate some nuts and drank water. Felt like I had too much caffeine the rest of the day.

Other Meds: Lumigan eye drops - prescription, Ocuvite over 50 - OTC, Viviscal - OTC, Zinc - 30mg - 1 daily - OTC, magnesium oxide - 250mg daily - OTC, B-complex - OTC, Calcium - 500mg Plus D3 25mg - OTC, D3 - 25-50mcg daily - OTC

Current Illness: none

ID: 1136541
Sex: F
Age: 78
State:

Vax Date: 02/25/2021
Onset Date: 03/17/2021
Rec V Date: 03/26/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient reportedly recevied COVID vaccine on 2/25/21 but unsure of manufacterer or lot number. Patient admitted to hospital on 3/17 for altered mental status and suspected UTI. COVID screen test on 3/17 resulted positive. Patient was asymptomatic for COVID. Patient was discharged on 3/21/21 with no clinical deterioration from COVID.

Other Meds:

Current Illness:

ID: 1136542
Sex: F
Age: 51
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: cilin and sulpha antibiotics

Symptom List:

Symptoms: vomiting, temperature over 101, chills, extreme body aches, vomiting stopped after 12 hours, other symptoms took longer and were slower to stop. It took 48 hours for temperature to return to normal, and body aches to stop

Other Meds: Zyrtec Metformin Singular Prozac Farxiga Januvia Losartan Potassium

Current Illness:

ID: 1136543
Sex: F
Age: 69
State: MS

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: C/O HEART RACING; SHAKING EPISODE X 3 ; AFTER THIRD EPISODE AGREED TO GO TO ER; AMBULANCE TRANSPORTED TO HOSPITAL.. SPOKE WITH CASE @0803 ON 3/26/2021; STATES THEY DID NOT KEEP HER. OBSERVED HER IN ER FOR A WHILE THEN DISCHARGED HER. NO FURTHER PROBLEMS. FINE TODAY

Other Meds: METOPROLOL; LORSTATIN; ELQUIS

Current Illness: HTN; AFIBWITH ABLATION

ID: 1136544
Sex: F
Age: 25
State: MA

Vax Date: 03/18/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Allergic to tree nuts, penicillin

Symptom List:

Symptoms: Bruising and redness following day of shot. Redness/swelling subsided after 3-4 days, however 8 days following the shot started up again. Red and itchy.

Other Meds: Lexapro 10 mg, Tri-previfem (birth control), zyrtec

Current Illness:

ID: 1136545
Sex: F
Age: 54
State: PA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Immediately after vaccination patient felt flushed and had "a funny taste in her mouth". She was evaluated by an on-site EMT and symptoms resolved within 30 minutes. Patient has a history of panic attacks.

Other Meds:

Current Illness:

ID: 1136546
Sex: M
Age: 70
State: MN

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient received a Pfizer dose on 3/5/21 and was accidentally given a Moderna dose on 3/25/21. He didn't experience any adverse effects at the time of vaccination.

Other Meds:

Current Illness:

Date Died: 03/14/2021

ID: 1136547
Sex: F
Age: 92
State:

Vax Date: 02/19/2021
Onset Date: 03/14/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: 92 y/o - Severe dementia. Hospice

Other Meds:

Current Illness:

ID: 1136548
Sex: F
Age: 40
State: OH

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Allergies to bivalves, fish, lettuce, pecans

Symptom List:

Symptoms: Headache, fatigue, and local pain in Left Arm lingering for longer than 48 hours.

Other Meds: Sertraline: 150mg Montelukast:10mg Certraline: 10mg Multivitamin Vitamin D:500mg Prazocin: 2mg

Current Illness: Seasonal allergies

ID: 1136549
Sex: F
Age: 62
State: NJ

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Very painful sore arm, shoulder and neck. Slight Headache Taking Tylenol

Other Meds: Metformin, Actos, Glimepiride, Invokana, Iron tablet, Atorvastatin Supplements: Vitamin D3; Vitamin C, Zinc, Magnesium, Quercetin,

Current Illness: none

ID: 1136550
Sex: F
Age: 65
State: GA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Numbness in face and hands. This lasted off and on for the 21 days between shots

Other Meds: Lantus insulin

Current Illness:

ID: 1136551
Sex: F
Age: 72
State: NY

Vax Date: 02/15/2021
Onset Date: 02/16/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Iodine dye

Symptom List:

Symptoms: Chills, fever, extremely lethargic , vomiting for about 3 hours Lethargic for over a week. Fever for 2 days

Other Meds: Paxil 20 mg

Current Illness: None

ID: 1136552
Sex: M
Age: 63
State: NY

Vax Date: 03/06/2021
Onset Date: 03/08/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: penicillin, amoxicillin

Symptom List:

Symptoms: HEAD TO FOOT TOTAL BODY RASH......

Other Meds: concerta 54 mg once a day eliquis 5 mg twice a day lisinopril 10 mg once a day carvediol 6.25 mg once a day - morning carvediol 3.125 mg once a day - night metformin 500 mg once a day atorvastatin 10 mg once a day nexium 40 mg once a day

Current Illness:

ID: 1136553
Sex: F
Age: 45
State: NJ

Vax Date: 01/05/2021
Onset Date: 01/14/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: on day 8th after vaccine, itching and painful circular area noted at the site (left arm) about 5inch in diameter, swollen and warm to touch, called primary physician who contacted allergist and 5 day course of Prednisolone was prescribed

Other Meds: Neurontin 300mg Levothyroxine 150mcg Syeda once a day

Current Illness:

ID: 1136554
Sex: F
Age: 63
State: KY

Vax Date: 03/22/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Bactrim causes rash

Symptom List:

Symptoms: Pt received 2nd Moderna vaccine 3/22/2021. On 3/23/21 she experienced a headache, nausea, vomited 1 time and had fatigue. Awoke on 3/24/2021 with hives from neck down. States included back, abdomen, arms and legs but did not involve face .Complained of severe itching. Took Benadryl and rested that day at home. Saw primary care doctor 03/25/2021 because rash was more severe. Was given steroid injection and oral steroids for 5 days.

Other Meds: Spironolactone 50mg BID, Simvastatin 20mg QD, Oxybutynine 5mg BID, Lisinopril 10mg QD, Sertraline 100mg QD, Doxycycline 200mg QD, E2/T/D 1.5/10/20 hormone cream applied to arm daily.

Current Illness: Denies any recent illnesses

ID: 1136555
Sex: F
Age: 57
State: TX

Vax Date: 03/04/2021
Onset Date: 03/08/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List:

Symptoms: Extreme breast pain, both right and left for six days. Swollen lymph glands in both arm pits.

Other Meds: Vit D

Current Illness: None

ID: 1136556
Sex: F
Age: 58
State: SC

Vax Date: 03/16/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Circular patch that was red and itchy. Somewhat swollen and tender with a slight rash. 2 days later the swelling and tenderness had gone away but the rash remained and the redness spread as if disipating.

Other Meds: Prempro

Current Illness: none

ID: 1136557
Sex: F
Age: 28
State: MO

Vax Date: 03/17/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Red rash at injection site developed ~8 days after vaccination. Approximately 3" diameter. No itching or pain, no systemic symptoms.

Other Meds: Junel + multivitamin

Current Illness: N/A

ID: 1136558
Sex: F
Age: 59
State: FL

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List:

Symptoms: Sore arm got significantly worse overnight. Pain is severe. Painful to move arm. Ice is not helping.

Other Meds: none

Current Illness: Lyme Disease, Epstein-Barr, Bartonella

ID: 1136559
Sex: F
Age: 64
State: NC

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: penicillin, steroid drugs, sulfa drugs

Symptom List:

Symptoms: On 3/25/2021. Within about 10 minutes after taking the covid vax the pt started saying she could not swallow. BP was little elevated, her O2 was 94, Pulse rate 88. Pt started to panic and then given Epi injection which did not help. 911 was called. Pt was talking and able to walk to the gurney. She was transported by ambulance to ER .

Other Meds: Losartan 100-25mg, metformin 1000mg, farxiga 5mg, omeprazole 20mg,

Current Illness:

ID: 1136560
Sex: F
Age: 33
State: IN

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Fatigue, moderate body aches, throbbing headache, moderate joint pain

Other Meds:

Current Illness:

Date Died:

ID: 1136577
Sex: F
Age:
State: TN

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient passed away; This case was reported by a consumer via patient support programs and described the occurrence of unknown cause of death in a 66-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced unknown cause of death (serious criteria death and GSK medically significant). On an unknown date, the outcome of the unknown cause of death was fatal. The reported cause of death was unknown cause of death. The reporter considered the unknown cause of death to be unrelated to Shingrix. Additional details were as follows: The age at vaccination was not reported. The patient's history was unknown. The patient received Shingrix and died. The cause of death was unknown and autopsy performed was unknown.; Reported Cause(s) of Death: unknown cause of death

Other Meds:

Current Illness:

ID: 1136578
Sex: F
Age:
State: WA

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: I have arthritis; This case was reported by a consumer via call center representative and described the occurrence of arthritis in a 67-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced arthritis. On an unknown date, the outcome of the arthritis was unknown. It was unknown if the reporter considered the arthritis to be related to Shingrix. Additional details were provided as follows: The case was reported by patient herself. The age at vaccination was not reported. The patient had arthritis but was not clear if it occurred after getting 1st shot of Shingrix or if it was patient's current condition. No further information was provided. The consented to follow up was unknown. The case been linked with the case US2021AMR066208, reported by the same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR066208:Same reporter.

Other Meds:

Current Illness:

ID: 1136579
Sex: F
Age:
State: MI

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Has had sore arms from flu shots / Was 60 at the time of the last flu vaccine; This case was reported by a other health professional via other manufacturer and described the occurrence of pain in arm in a female patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2020-2021 season) for prophylaxis. The patient's past medical history included sjogren's. Previously administered products included Influenza vaccine with an associated reaction of pain in extremity (Multiple Flu shots received in the past refer case US2021AMR066251). On an unknown date, the patient received Influenza vaccine Quadrivalent 2020-2021 season. On an unknown date, less than 2 years after receiving Influenza vaccine Quadrivalent 2020-2021 season, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was unknown. It was unknown if the reporter considered the pain in arm to be related to Influenza vaccine Quadrivalent 2020-2021 season. Additional details were provided as follows: The reporter was a retired medical tech who reported for herself. The reporter stated that last flu vaccine caused sore arm. This was 1 of 3 cases reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR066243:Same reporter US-GLAXOSMITHKLINE-US2021AMR066251:Same reporter.

Other Meds:

Current Illness:

ID: 1136581
Sex: U
Age:
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Symptoms: got sick; This case was reported by a consumer via interactive digital media and described the occurrence of sickness 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, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced sickness. On an unknown date, the outcome of the sickness was unknown. It was unknown if the reporter considered the sickness to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were provided as follows: The age at vaccination was not reported. The patient was fed up with these shots. The patient got sick after the flu shot. The consent to follow-up was not asked.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR062659:same reporter US-GLAXOSMITHKLINE-US2021AMR069219:same reporter

Other Meds:

Current Illness:

ID: 1136582
Sex: F
Age:
State: CO

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Symptoms: After the first / arm itched at the injection site; This case was reported by a other health professional and described the occurrence of injection site itching in a adult female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced injection site itching. On an unknown date, the outcome of the injection site itching was recovered/resolved. It was unknown if the reporter considered the injection site itching to be related to Shingrix. Additional case details were reported as follows: The patient reported case for herself. The age at vaccination was not reported. After the first dose of Shingrix vaccine patient's arm itched at the injection site for several weeks, but that was all. For tolerance of 2nd dose refer case US2021AMR069511. The reporter consented to follow up.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR069511:Same patient. Same reporter., 2nd dose.

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Current Illness:

ID: 1136583
Sex: U
Age:
State: NY

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Symptoms: Syncopal event after first dose; This case was reported by a other health professional via sales rep and described the occurrence of syncope in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced syncope (serious criteria GSK medically significant). On an unknown date, the outcome of the syncope was unknown. It was unknown if the reporter considered the syncope to be related to Shingrix. Additional information was provided as follows: The age at vaccination was not reported. The age group was captured as an adult as per vaccine indication. The patient experienced syncopal event after first dose and was concerned that it might exclude from future vaccination. The reporter consented to follow up.

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Current Illness:

ID: 1136585
Sex: F
Age: 72
State: CA

Vax Date: 01/22/2021
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Rec V Date: 03/26/2021
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Symptoms: Shingles; Pain; This case was reported by a pharmacist via call center representative and described the occurrence of shingles in a 72-year-old female patient who received Herpes zoster (Shingrix) (batch number EZ4TD, expiry date 4th November 2022) for prophylaxis. On 22nd January 2021, the patient received the 1st dose of Shingrix. On an unknown date, less than 2 months after receiving Shingrix, the patient experienced shingles and pain. On an unknown date, the outcome of the shingles was recovered/resolved and the outcome of the pain was recovering/resolving. It was unknown if the reporter considered the shingles and pain to be related to Shingrix. Additional details were provided as follows: The patient experienced an active case of Shingles after receiving Shingrix. The patient had a pain for 3 days, but she was better and there were no active shingles at the time of reporting. The reporter inquired if they could give the 2nd dose to the patient. The consent to follow up was provided. The batch number of Shingrix was reported as E24TD, which was corrected to EZ4TD as per sales data sheet.

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Current Illness:

ID: 1136586
Sex: F
Age:
State: NC

Vax Date: 11/05/2020
Onset Date:
Rec V Date: 03/26/2021
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Symptoms: First dose / 11/5/2020 / she developed shingles and has had it for 2 weeks; This case was reported by a consumer via call center representative and described the occurrence of shingles in a adult female patient who received Herpes zoster (Shingrix) for prophylaxis. On 5th November 2020, the patient received the 1st dose of Shingrix. On an unknown date, less than 5 months after receiving Shingrix, the patient experienced shingles. On an unknown date, the outcome of the shingles was recovered/resolved. It was unknown if the reporter considered the shingles to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported, but was selected adult as per vaccine indication. The patient had received first dose of shingrix on 5th November 2020 and experienced shingles for 2 weeks. Patient was scheduled for second dose in March 2021, but now she will confirm with HCP, when she can get it. No other information was reported. The reporter did not consented to follow up.

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Current Illness:

ID: 1136587
Sex: M
Age: 33
State: KY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 03/26/2021
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Symptoms: Passed away; Asthma attack; Tightness in chest; Couldn't breathe; Felt like a panic attack; Resting HR was 145 bpm; Shortness of breath/ winded going up and down stairs; Fever of 100.2 F; Headache came in waves; Extremelynumb mouth and tongue; Felt very dehydrated; Body aches and pains; A spontaneous report was received from a consumer, concerning himself, a 33 years old male patient who received Moderna's Covid-19 Vaccine (mRNA-1273) and experienced extremely numb mouth and tongue, felt very dehydrated, body aches and pains, asthma attack, tightness in chest, couldn't breathe, felt like a panic attack, resting heart rate was 145 bpm, shortness of breath/ winded going up and down stairs, passed away, headache came in waves, fever of 100.2 f. The patient's medical history reported included asthma in child. Concomitant medications were not reported. On 06 Jan 2021 at 11:50 AM, the patient received their first dose of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly in the left upper arm for prophylaxis of COVID-19 infection. On 06 Jan 2021 (Wednesday), in less than 12 hours after vaccination, patient had an extremely numb tongue and mouth, felt very dehydrated with body aches and pains and also headache that came in waves. On 07 Jan 2020, he had what he would call an asthma attack (he had asthma as a child). He had tightness in his chest and felt he couldn't breathe while he was trying to fix his pants belt prior to going to work. It felt almost like a panic attack and then passed before going to work. The event passed away was assessed as serious based on EMA IME list. He also had shortness of breath throughout (when he went up and down stairs), he was winded. When he went to the doctor on 07 Jan 2021, his resting HR was 145bpm (his normal HR was 80bpm). Hence, his physician tested him for COVID-19 by both RAPID and standard testing and both showed negative. The evening of 07 Jan 2021, he had a fever of 100.2 F which subsided overnight. Treatment for the event includes paracetamol and diphenhydramine. Action taken with mRNA-1273 in response to the events were not reported. The outcome of events asthma attack, tightness in chest, couldn't breathe, felt like a panic attack, felt like a panic attack and passed away, was resolved on 07 Jan 2021. The outcome of event fever of 100.2 F was resolved on 08 Jan 2021. The outcome of events extremely numb mouth and tongue, felt very dehydrated, body aches and pains, resting heart rate was 145 bpm, shortness of breath/ winded going up and down stairs, headache came in waves was resolved on 10 Jan 2021.; Reporter's Comments: This case concerns a 33 Y/O M with NS unexpected Loss of consciousness, pain, panic attack, heart rate increased, chest discomfort, asthma attack, dyspnea, hypoesthesia oral, dehydration and NS expected headache, fever. Event onset was Day 2 after first dose mRNA-1273. Treated with paracetamol and diphenhydramine. Events resolved. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded.

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Current Illness:

ID: 1136588
Sex: F
Age: 65
State: NY

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 03/26/2021
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Symptoms: annoying choking all day long; extremely hot to the touch; red patch on my arm; chills; The arm was extremely sore, not the usual pain; A spontaneous report was received from a consumer concerning a female patient of 65 year old, who was received Moderna's COVID-19 vaccine(Mrna-1273) and experienced redness, pain and hotness in arm, chills and choking. The patients medical history included high cholesterol and blood pressure. Concomitant medications reported included Lipitor, Hydrochlorothiazide, baby aspirin and vitamins. On 05 Feb 2021,prior to the onset of events, the Patient received their first of two planned dose of mRNA-1273(Lot number: 030M20A ) vaccine intramuscularly in the left non-dominant arm for prophylaxis of COVID-19 infection. On 05 Feb 2021, couple of hours later patient experienced soreness in arm. On an unknown date, six days after the vaccination, patient experienced redness in arm and extremely hot to the touch. On an unknown date, 1 to 2 days later after vaccination, patient started choking all day long and patient also got the chills. Treatment for the event included Advil once or twice. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for unknown for redness and pain, recovered for feeling hot, not recovered for chills and choking.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: ATORVASTATIN; HYDROCHLOROTHIAZIDE; BABY ASPIRIN; VITAMINS [ASCORBIC ACID;ERGOCALCIFEROL;NICOTINAMIDE;RETINOL;RIBOFLAVIN;THIAMINE HYDROCHLORIDE]

Current Illness: Blood pressure high; High cholesterol

ID: 1136589
Sex: U
Age:
State: MO

Vax Date: 01/28/2021
Onset Date: 02/16/2021
Rec V Date: 03/26/2021
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Symptoms: second dose of Moderna on day 19; A spontaneous report was received from a pharmacist concerning a patient of unknown age and gender, who received second dose of Moderna's COVID-19 vaccine (mRNA-1273) on day 19 from their first dose. The patient's medical history and products known to have been used by the patient were not reported. The patient received their first of two planned doses of mRNA-1273 (Batch number: Batch number not provided) on 28 Jan 2021, and after 19 days from the first dose on 16 Feb 2021 patient received their second of two planned doses of mRNA-1273 (Batch number: Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. No treatment information was provided. No relevant laboratory details were included. Action taken with the drug in response to the events was not applicaple. The event was considered as recovered/resolved.; Reporter's Comments: This case concerns a patient of unknown gender and age who received their third dose of mRNA-1273 (Lot unknown), reporting Inappropriate schedule of product administration without any associated adverse events.

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Current Illness:

ID: 1136590
Sex: F
Age:
State: MA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/26/2021
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Symptoms: felt like passes out; face turned bright red; sweating; shivering; A spontaneous report was received from a consumer concerning a 63-years-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced events, face turned bright red/erythema, sweating/ hyperhidrosis, shivering/shivering, felt like she would pass out/loss of consciousness, blood pressure was 88/66/ hypotension. The patient's medical history was not provided. Concomitant medications reported was valsartan. On 4 Mar 2021, prior to the onset of the events the patient received their first of two planned doses of mRNA-1273 (lot/batch: 010AZIA) in the left arm intramuscularly for prophylaxis of COVID-19 infection. On 4 Mar 2021, the patient after she received mRNA-1273, she waited for 30 minutes and was okay. She drove about half an hour, and her face turned bright red, sweating, shivering, felt like she would pass out. The event felt like she would pass out was assessed as serious as per IME list. She pulled to the side of the highway to wait, it got worse. She called 911 and they transported her to the hospital. She went to the ER from 2:30 to 5:30pm. They did a lot of tests; blood test, heart test, EKG, everything was normal. They put her on saline bags. When the ambulance first got there her blood pressure was 88/66, when she left the hospital it was back to normal. Action taken with mRNA-1273 in response to the events was not reported. The outcome of events face turned bright red, sweating, shivering, felt like she would pass out/loss of consciousness was not reported whereas event blood pressure was 88/66 was resolved on 4 Mar 2021.; Reporter's Comments: This case concerns a 63-year-old female who had a serious unexpected event of loss of consciousness along with nonserious unexpected hypotension, erythema, hyperhidrosis, and expected chills. Event onset occurred the same day as the first dose of mRNA-1273. Treatment not reported. Events resolved. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: VALSARTAN

Current Illness:

ID: 1136591
Sex: M
Age: 63
State: MT

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/26/2021
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Symptoms: rash in his throat; boils in his tongue; swelling in his face and throat; swelling in his face and throat; headache; joint pain; A Spontaneous report was received from a consumer(patient) concerning himself a 63 year old male patient, who received dose of Moderna's COVID-19 vaccine (mRNA-1273) and experienced headache, joint pain/arthralgia, swelling in face and throat, rash in the throat/oropharyngeal blister and boils in tongue/tongue blistering. The patient's medical history was not provided. Concomitant medications included blood thinner and meloxicam. On 25 Feb 2021 prior to the onset of events the patients received first dose of their two planned doses of mRNA-1273 (Batch N0:001A21A) intramuscularly in the left arm for prophylaxis of covid 19 infection. On 25 Feb 2021, within the first 24 hours he had a headache and joint pain. Then, a couple of days after he experienced swelling in his face and throat, a rash in his throat, and boils on his tongue. Rash in the throat/oropharyngeal blister was considered medically significant and serious. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events, headache, joint pain/arthralgia, swelling in face and throat, rash in the throat/oropharyngeal blister were unknown. The outcome of the event boils in tongue/tongue blistering was not resolved.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: MELOXICAM

Current Illness:

ID: 1136592
Sex: M
Age: 73
State: AZ

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/26/2021
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Symptoms: Atrial Fibrillation (AFib) episode that lasted about 3 hours; A spontaneous report was received from a consumer who was also a 73-year old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced atrial fibrillation (Atrial Fibrillation). The patient's medical history included acid reflux, atrial fibrillation and high cholesterol. Products known to have been used by patient with in last two weeks included omeprazole, simvastatin, amlodipine, apixaban, famotidine, multivitamin, and probiotics. On 04 Feb 2021, patient received his first of the two planned vaccine doses of mRNA-1273 (Lot number: 10N20A) intramuscularly. On 08 Mar 2021, approximately one day prior to the event, the patient received his second of two planned doses of mRNA-1273 (Lot number: 032N20A) intramuscularly for prophylaxis of COVID-19 infection. On 09 Mar 2021, the patient experienced the event atrial fibrillation episode that lasted about 3 hours and heart rate reached 160 BPM at rest, and continued to fluctuate up and down. It was reported that the patient had cardiac conditions that periodically caused him to experience Afibs, but those usually only last for about 2 minutes. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the event, atrial fibrillation, was considered resolved on 10 Mar 2021.; Reporter's Comments: Based on the current available information and the subject's underlying history of recurrent Afib, the event was assessed as Unlikely Related to study drug. The case is confounded by the subject's underlying history of Afib, which was reported to occur periodically and subsiding on its own.

Other Meds: OMEPRAZOLE; SIMVASTATIN; AMLODIPINE; ELIQUIS; FAMOTIDINE; MULTIVITAMIN [VITAMINS NOS]; PROBIOTICS NOS

Current Illness: AFib; GERD (acid reflux/GERD); High cholesterol

ID: 1136593
Sex: F
Age: 81
State: FL

Vax Date: 02/04/2021
Onset Date: 03/08/2021
Rec V Date: 03/26/2021
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Symptoms: Headache; Serious convulsion; Slight tenderness at the injection site; A spontaneous report was received from a consumer concerning an 81-years old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced serious convulsion/seizure, slight tenderness at the injection site/vaccination site pain and headache. The patient's medical history included blood pressure high, diabetes and rheumatoid arthritis. Concomitant medications included methotrexate. The patient received their first of two planned doses of mRNA-1273 (lot/batch number: unknown) on 04 Feb 2021. On 08 Mar 2021, prior to the onset of the event, the patient received the second of two planned doses of mRNA-1273 (batch number: 027A21A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 08 Mar 2021, the patient experienced slight tenderness at the injection site. On 09 Mar 2021, at 12.30 and 1.30 AM the patient experienced medically significant event of serious convulsion with no previous history of seizures. Since patient has a disabled husband, she didn't call ER (emergency room) and went to the neurologist next morning who told her to report it. On 10 Mar 2021, the patient experienced headache attributed to migraines. Treatment for the event headache included paracetamol. Treatment information for the events serious convulsion and slight tenderness at the injection site was not reported. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the drug in response to the events was not applicable. The outcome of the event slight tenderness at the injection site was resolved on 08 Mar 2021. The outcome of the event serious convulsion was resolved on 09 Mar 2021. The outcome of the event headache was resolved on 10 Mar 2021.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: METHOTREXATE

Current Illness: Blood pressure high; Diabetes; Rheumatoid arthritis

ID: 1136594
Sex: F
Age:
State: CO

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Rec V Date: 03/26/2021
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Symptoms: Bell's Palsy; A spontaneous report was received from a female patient of unspecified age who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced Bell's Palsy. The patient's medical history and concomitant medications were not provided. On an unknown date, the patient received a dose of mRNA-1273 (lot/batch: unknown) intramuscularly for prophylaxis of COVID-19 infection. On an unknown date after receiving the Moderna's COVID-19 vaccine, the patient experienced Bell's Palsy. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded

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Current Illness:

ID: 1136595
Sex: F
Age: 78
State: SC

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 03/26/2021
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Symptoms: Stroke following administration; A spontaneous report was received from a consumer concerning a 78 year old ,female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a stroke/cerebrovascular accident. The patient's medical history was reported as previous stroke two years ago. Concomitant medications taken by the patient included losartan, glipizide, lintas, metformin, blood thinners, hydrochlorothiazide. On 26 Feb 2021, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number: 023M20A) intramuscularly for prophylaxis of COVID-19 infection. On 28 Feb 2021, the patient experienced a stroke which needed emergency treatment. She received treatment for this condition and was back at home at the time of reporting and at that point she had no other side effects. Treatment activities for event was received but not provided. Action taken with mRNA-1273 in response to the events was unknown. The outcome of event, stroke was recovered.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the onset date of the event, a causal relationship cannot be excluded. However, patient's elderly age along with prior history of stroke are considered significant risk factors.

Other Meds: LOSARTAN; GLIPIZIDE; METFORMIN; HYDROCHLOROTHIAZIDE

Current Illness: Stroke (Had a previous stroke two years ago)

ID: 1136596
Sex: M
Age: 42
State: MA

Vax Date: 02/13/2021
Onset Date: 02/01/2021
Rec V Date: 03/26/2021
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Symptoms: splashing some of the vaccine into his eyes; COVID-19; A spontaneous report was received from a pharmacist concerning himself (male patient of 42 years age) who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced COVID-19 in that week of vaccination and splashed some of the vaccine into his eyes. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 13 Feb 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. The patient was diagnosed with COVID-19 by COVID-19 test performed on an unknown date in Feb 2021 within the week of first dose Covid vaccination. The patient splashed some of the vaccine into his eyes on 13 Feb 2021. Treatment information was not provided. Action taken with mRNA-1273 in response to the event(s) was unknown. The events COVID-19 was recovered on unknown date and outcome of event splashing some of the vaccine into his eyes was unknown.; Reporter's Comments: This report refers to a case of Exposure via eye contact and for mRNA-1273, lot # unknown with Event of COVID-19 positive. Based on mechanism of action of mRNA -1273 vaccine, the event COVID-19 is assessed as unlikely related to mRNA-1273.

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Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm