VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0936808
Sex: F
Age: 40
State: NC

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Fluoroquinolones

Symptoms: Sore injection site. Injection was given via tuberculin syringe and did not penetrate the muscle, it was subcutaneous. My dose was a waste and I may not have immunity due to operator error.

Other Meds: Multivitamin

Current Illness: No

ID: 0936810
Sex: M
Age: 45
State: MN

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: PCN, Keflex, Latex, Kiwi

Symptoms: Fever, chills, body aches approximately 12 hours after vaccination.

Other Meds: Prilosec, Vit D, Claritin, Multi Vit

Current Illness:

ID: 0936811
Sex: F
Age: 30
State: FL

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: 12 hours after vaccination: Uncontrollable Rigors, muscle contractions, fever, chills, hyperesthesia, abdominal pain, nausea, headache, back pain

Other Meds: Vyvanse, Sertraline, Trazodone

Current Illness: None

ID: 0936812
Sex: F
Age: 44
State:

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever 100-101degrees x 24hrs, Chills. Sweats, lethargy, headache

Other Meds:

Current Illness:

ID: 0936813
Sex: F
Age: 37
State: IL

Vax Date: 12/31/2020
Onset Date: 01/08/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Nka

Symptoms: Day 7/8 post first dose of vaccine developed redness, itching, swelling in left upper arm. Pain and tenderness in arm and lymph nodes in underarm

Other Meds: None

Current Illness: None

ID: 0936814
Sex: F
Age: 58
State: IL

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: N/A - Didn't go to Doctor

Allergies: No Known Allergies

Symptoms: I had severe chills all night 8 Jan, was unable to get warm. Then I had fatigue, headache and body ache on 9 Jan. Felt better on 10 Jan and each day I feel a little better. I did not got to doctor.

Other Meds: Synthroid, Losartan, Hctz, Meloxicam, Pantoprazole, Gabapentin, Atorvastatin, Mutli Vitamin, Zinc, Vitamin B, C, D

Current Illness: N/A

ID: 0936815
Sex: M
Age: 63
State: NY

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Seasonal outdoor allergies

Symptoms: Chills, body aches, sweating, mildly sore right arm

Other Meds: Amlodipine, Bupropion ER, Atorvastatin, Fluticasone nasal spray, Calcium, Vit B12

Current Illness: None

ID: 0936816
Sex: F
Age: 45
State: KS

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: n/a

Allergies: NKDA

Symptoms: Chest tightness, dizziness, chills. No reported treatment and symptoms resolved.

Other Meds: none reported

Current Illness: None reported

ID: 0936817
Sex: F
Age: 34
State: NC

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: SULFA DRUGS

Symptoms: I had a delayed injection site reaction that began on day 8 distal to injection site, with redness, induration and mild itching. It did not bother me so I paid little attention it. But on day 13 I looked down on my arm and it was a lot larger, more erythema, more indurated, raised, warm- still not painful, only mildly pruritic. The area measures approximately (irregular shape) 16.5 cm at the largest diameter. Mow much improved after taking antihistamines. I'm reporting because of the extent. Not sure if there's any recommendation as far as premedication prior to second dose.

Other Meds: SYNTHROID 25MCG, DAILY MULTIVITAMIN

Current Illness: NONE

ID: 0936818
Sex: F
Age: 66
State: FL

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: no

Symptoms: facial swelling in areas where I previously had facial fillers mostly in the temple and eyes. greater swelling in the right eye

Other Meds: paxil bio -identical hormones antiobiotic - Nitrofurantoin

Current Illness: urinary tract infection

ID: 0936819
Sex: F
Age: 33
State: PA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: The next day I had a sore arm which was expected. I also started with chills, extreme fatigue, headaches, and muscle soreness since receiving the vaccine and the symptoms still ongoing with today being 1/12/21.

Other Meds: Sertraline, Sprintec, Daily Multi-Vitamin, D3, Tumeric, B12

Current Illness: None

ID: 0936820
Sex: F
Age: 35
State: NC

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Fever of 101, chills, muscle aches, headache about 13 hours after injection. All of those side effects are gone but I still have a red, itchy hot spot on arm where injection given.

Other Meds: None

Current Illness: None

ID: 0936821
Sex: F
Age: 38
State: IN

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: CT scan and blood work

Allergies: None

Symptoms: Facial cellulitis, eye swelling, headache, nausea

Other Meds: Synthroid

Current Illness: None

ID: 0936822
Sex: F
Age: 25
State: OH

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: PCN

Symptoms: Extreme chills, tachycardia at rest (130s), fever 101.5, shortness of breath at rest, tachypnea, headache, extreme weakness, sore throat, swollen throat, numbness in extremities. Treatment- rest, benadryl, excedrin migraine

Other Meds: Trazadone, birth control, Effexor, protonix

Current Illness: None

ID: 0936823
Sex: M
Age: 61
State: NC

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: Awakened 0300 the next day, Saturday the 9th with chills, fever 2 degrees above normal, headache and left arm pain from deltoid to elbow. Went to work in ICU at 0638, feeling like i had been ran over by a truck. Fatigue and general malaise throughout day. Sunday, i had no problems. Monday morning awakened with diarrhea, I never have diarrhea! I felt bad most of Monday. Tuesday today, i feel fine!

Other Meds: Dovato 1 daily; Montelukast 10 mg at bedtime; Lansoprazole 30 mg daily; Magnesium Malate 1350mg at bedtime; Belbuca 600mcg twice daily; Vitamin C 1000mg daily; Zinc 100 mg daily; Tylenol 1000mg daily; Advair 2 puffs two times a day; Albuter

Current Illness: none

ID: 0936824
Sex: F
Age: 47
State: TX

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: N/A

Allergies: None

Symptoms: Very sore at the injection site, light nausea, fatigue, low grade fever, chills, lethargy, body aches. All symptoms resolved within 24 hours of onset except for sore injection site and fatigue. I am still having sore injection site and fatigue 48 hours after receiving the immunization.

Other Meds: Escitalopram 10 mg bupropion 300 mg

Current Illness: 3 days post-quarantine from Covid-19

ID: 0936825
Sex: M
Age: 40
State: VA

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: severe muscle aches and fatigue. felt feverish

Other Meds: none

Current Illness: none

ID: 0936826
Sex: F
Age: 61
State: PA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: N/A

Allergies: sulfa, tape, Neosporin, Mupirocin

Symptoms: Started about 3pm with soreness in left arm on 1/11/2021. By midnight, the left arm was very sore and heaviness/numbness down to fingers. On 1/12/2021 (today), I could hardly raise my left arm over my head. I took 2 Ibuprofen and plan to ensure I do range of motion stretches and basically just use the left arm. I do not have a fever, and plan to drink plenty of water today.

Other Meds: Cosopt, Latanoprost, Flexeril, Hydrochlorothiazide, Allegra, Vit C, Multi-vitamin, Viactiv Ca++ chew

Current Illness: COVID-19 virus 12/1/2020, treated at home/no hospitalization

ID: 0936827
Sex: F
Age: 42
State: NC

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Localized itching, swelling, hardness, tenderness, redness and heat on day 8 after vaccine was given

Other Meds: ACIPHEX, PROZAC, WELLBUTRIN, ADDERALL

Current Illness:

ID: 0936828
Sex: F
Age: 51
State: CT

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: I received the shot at 8:10 am and felt nothing. As the morning progressed, I developed a sore arm, similar to a flut shot. However, it was worse, and I also felt achy in my neck. I drove home from work around noon, and I couldn't even use my arm on the steering wheel. These symptoms continued and I finally took Tylenol in the middle of the afternoon, and evening going to bed. I slept horribly and woke up feeling like a train wreck. I took my temperature. It was 102! I started taking the Tylenol again. I couldn't even raise my arm, either. My arm didn't hurt if it was just still, but it would hurt if it was touched, and I could not raise it for 3 days. Despite taking the Tylenol, I felt awful all day and really had to stay bedridden. I was also very thirsty both the day of the vaccine and this second day. Saturday morning I woke up feeling better, but as the day wore on, the aches and fever came back. Sunday was the same as Saturday. Monday was similar, but better overall. Today is Tuesday. My arm still feels a little weird and I cannot completely raise it. I did have the COVID-19 back in March and have antibodies, as far as I know as I have donated to Red Cross 4 times.

Other Meds: vitamin C

Current Illness: none

ID: 0936829
Sex: F
Age: 66
State: IN

Vax Date: 01/04/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: Took claritan and atarax

Allergies: Sulpha

Symptoms: 5 days later started itching, 6 days spread to trunk of body and neck,7days big welts wherever I scratched. Still here at 8 days

Other Meds: Lotrel ,cymbalta,atorvastatin,metforman,lantus,coreg,wellbutrin,ezetimbe, Invokana. Meletonan..centrim silver womens

Current Illness: 0

ID: 0936830
Sex: M
Age: 73
State: NY

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 12 HOURS AFTER VACCINATION EXPERIENCED HOT FLASH LASTING OVER 15 MINUTES WITH DRYNESS OF MOUTH

Other Meds: doxacin, low dosage asperin, lipitor

Current Illness:

ID: 0936831
Sex: F
Age: 58
State: IL

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: Amoxicillin - hives

Symptoms: Approximately 25-30 minutes post first Moderna vaccine (after pt was discharged from clinic with no issues) patient started experiencing feeling of throat thick and eyes heavy. Called 911. Patient transported via EMS to ER where she presented with feeling of thickness in her throat and tongue, swollen eyes and redness in the forehead. Pt received dexamethasone 10 mg IV x 1 and epinephrine 0.3 mg IM x 1. Pt was prescribed prednisone 10 mg tab: 4 po x 1 dose tonight, 3 po in am, 2 po qd x 1 day, 1 po qd x 1 day (total 10 tabs) upon discharge to home. Provider recommended no second COVID dose.

Other Meds: Chlordiazepoxide 25 mg PO QID Meloxicam 15 mg tab PO QD Carbamazepine 200 mg PO TID Naltrexone 75 mg tab PO QD Oxybutynin 5 mg tab PO TID Fluoxetine 20 mg cap PO QD Trazodone 100 mg PO QD Levothyroxine 75 mcg tab PO QD Calcium carbonate 600

Current Illness:

ID: 0936832
Sex: F
Age: 51
State: PA

Vax Date: 01/04/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: denies

Symptoms: patient states that she received covid vaccine on 1/4/2021 to left arm and developed left arm redness and swelling on 1/10/2021. Pt. states that she took motrin and it is helping. Pt. states that left arm is tennis ball size, lightly red

Other Meds: cod oil, vitamin d, synthroid, losartan, nexium, metformin, multivitamin

Current Illness: denies

ID: 0936833
Sex: F
Age: 35
State: MD

Vax Date: 12/23/2020
Onset Date: 01/01/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: Epi Pen prescribed, PA Consulted.

Allergies: NKDA

Symptoms: 12/23/2020-Had left arm ache and chills. Lasted approximately 3 days then resolved. 1/1/2021-In the morning noted hives/rash/itching/obvious line of demarcation to the injection site in my left shoulder. Through the morning noted the hives spread up my neck and angioedema noted to both sides of my neck, lymph nodes swelling on both sides and the injection site became more swollen and turned very hard to the touch. No difficulty breathing at baseline, but it becamer difficult to take a full breath and chest tightness with exertion. Benadryl 50 mg was taken 4-6 times a day for 3 days. PA consulted, who stated to stay with Benadryl regimen, steroids not currently recommended, call 911 if symptom worsen.

Other Meds: Adderaall

Current Illness: No

ID: 0936834
Sex: F
Age: 42
State: FL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: EKG and labs done in ED on 1/5/21.

Allergies: NKA

Symptoms: Approximately 10 minutes after receiving the vaccine she became anxious. She stated, " I am nervous about the unknown. I wanted to get it." " I always get like this." 8:50am she was placed on vs monitor, BP 138/82, HR 115, O2sat 100%. 8:55am HR up to 124. She was tearful and trembling. 8:58am 133/92, HR 149, O2sat 100%, R 24. Code green was called. 9:05am She was taken by stretcher to ED for evaluation. BP 131/94, HR 132, O2 sat 100% when leaving the vaccine clinic area. She remained awake and alert throughout. 1/7/21 Followed up with her via phone conversation. She states she was discharged from ED yesterday. She was at work. She had a slight headache today, but had taken Advil and it was improving. Stated that last night the headache was worse. No other complaints today.

Other Meds: Vitamins

Current Illness: None

ID: 0936835
Sex: F
Age: 35
State: SC

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data: na

Allergies: in 2010 I had an allergic reaction to hummus that caused my entire face and throat to swell requiring Benadryl. I have since eaten hummus and have had no reaction.

Symptoms: 30 minutes after administration, my tongue and mouth became tingly and "fuzzy" causing me to have to continually clear my throat. My neck then began to itch and I broke out into a rash around the front of my neck.

Other Meds: na

Current Illness: na

ID: 0936836
Sex: F
Age: 26
State: PA

Vax Date: 01/04/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: N/A

Allergies: N/A

Symptoms: New redness, swelling, tenderness that began 6 days after vaccine (4 days after previous redness/soreness ended and many days without symptoms). Frequent to constant itching at injection site. Increasing in size/severity over the past 2 days.

Other Meds: Zyrtec, Escitalopram, Wellbutrin, Xanax, birth control, Albuterol

Current Illness: N/A

ID: 0936837
Sex: M
Age: 30
State: MA

Vax Date: 01/07/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: NKA

Symptoms: The evening of 1/10 I spontaneously developed diffuse urticaria of my trunk and face, associated with itching, mild abdominal discomfort, and facial flushing. Symptoms somewhat improved with cetirizine. The evening of 1/11 developed recurrent spontaneous diffuse urticaria, mostly in the face. Having persistent intermittent sweats and significant fatigue. Per Patient, He have had urticaria rarely in the past, associated with shellfish. I have never had anaphylaxis before.

Other Meds: ISOtretinoin (ACCUTANE;CLARAVIS;MYORISAN) 30 mg capsule tacrolimus (PROTOPIC) 0.1 % ointment

Current Illness:

ID: 0936838
Sex: M
Age: 38
State: OK

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: Ethanol, Mint

Symptoms: Brain fog/cotton head and difficulty concentrating started around 1400. Later, around 1700, nausea requiring me to lie down but no vomiting. No medications taken. Resolved after a few hours of sleep.

Other Meds: Cetirizine 10mg PO daily, Fluticasone nasal spray 1 spray in each nostril daily, Hydrochlorothiazide 25mg PO daily

Current Illness: None

ID: 0936839
Sex: F
Age: 43
State: KY

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Prednisone, Sulfamethoxazole, Trimethprim

Symptoms: She took the vaccine on 12/28/2020. She reports she was sick that day and 3 days after with headache, nausea, chills and extreme fatigue. She took Tylenol for her symptoms. Did not seek medical treatment. Symptoms have resolved except for fatigue. She noticed that her right arm was still sore on 1/10/2021 and she reports a red area that is very hot to touch.

Other Meds: Iron OTC (Ferrous Gluconate), Multivitamin Gummies, Clonidine, Tylenol

Current Illness: None.

ID: 0936840
Sex: F
Age: 59
State: IL

Vax Date: 01/06/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: n/a

Allergies: nka

Symptoms: 2nd Injection received approx. 11:05 AM on Wednesday 1/6/2021. First symptoms of reaction seen between 8-10pm on Saturday, 1/9/2021 which included hives around neck and covering chest torso and arms. Treated with topical Benadryl. Rash/hives continued to persist spread to entire body, head, neck, face, torso, arms, legs, feet. On early Monday, 1/11/2021 - Contact with Employee Health Nurse and PCP Dr. and advised to take Benadryl as the only symptom was the rash/hives - no facial swelling or shortness of breath. Tuesday, 1/12/2021 after taking advice of Employee Health Nurse and PCP symptoms are nearly fully resolved.

Other Meds: Plavix 75mg 1x daily in AM Aspirin 81mg -1x daily in AM Allegra 180 mg - 1x daily in AM Tart Cherry Supplement in AM Multi-Vitamin (Women over 50 ) in AM Calcium in AM Cinnamon w/Chromium in AM Crestor 20mg 1x daily PM Montelukast Sodium 1

Current Illness: none

ID: 0936841
Sex: M
Age: 57
State: NM

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Severe systemic illness for 1 week

Other Meds: Lisinopril

Current Illness: None

ID: 0936842
Sex: M
Age: 26
State: MA

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Reglan - restlessness

Symptoms: Employee stated he did not feel well felt flush dizzy. Employee skin was diaphoretic. Walked employee to EMT station, he was able to walk without assistance. Rested on stretcher, stated he was feeling better and left the facility on his own at 1450

Other Meds:

Current Illness:

ID: 0936843
Sex: M
Age: 33
State: PR

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient refers rash in the right side of the body.

Other Meds:

Current Illness:

ID: 0936844
Sex: M
Age: 31
State: IN

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: resting

Allergies: NKA

Symptoms: Headache started overnight. Debilitating to the point of unable to think clearly without great effort. Aching headache felt on top of head and seems to radiate down to behind the eyes and to the sides of jaws.

Other Meds: lexapro 20mg generic zyrtec

Current Illness: none

ID: 0936845
Sex: M
Age: 37
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Employee reported significant pain and decreased ROM after Moderna COIVD vaccine, stated vaccine was administered "higher on my shoulder than I have experienced with other vaccines". Treated with OTC pain relief and email f/u with pcp who recommended continuing OTC analgesia and exercise of arm.

Other Meds:

Current Illness:

ID: 0936846
Sex: F
Age: 50
State: FL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Paprika, Horse, cockroaches and dust

Symptoms: On Jan. 4th at 7am I had no immediate reaction. At 2pm that day got extremely nauseated, local injection site red and warm, muscle aches through out body experienced. No other symptoms at that time. Arm redness started to fade and go away over the next three days. On January 11 at 9pm, Injection site became red, itchy and warm to touch, Heart rate fluctuated in the 102 to 120 range intermittently. Normal heartrate is 85. Notified Employee Health and supervisor and made appointment with primary doctor for Wednesday Jan. 13th at 2pm. Applied cool compress to site all throughout the reactions.

Other Meds: Levothyroxine, metformin, zoloft

Current Illness: None

ID: 0936847
Sex: F
Age: 38
State: NH

Vax Date: 01/07/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: N/A

Allergies: all "cillins"

Symptoms: Raised red rash that lasted 8 hours on hips, stomach. chest and thighs. Not bothersome .No treatment needed.

Other Meds: tri-sprintec tablets

Current Illness: N/A

ID: 0936851
Sex: U
Age:
State: MD

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No other AE reported; has been administered since the temperature excursion; This spontaneous report was received from an agency referring to a patient of unknown age and gender. Information on pertinent medical history, concomitant medication and drug allergies/reactions was not reported. On 23-DEC-2020 the patient was vaccinated with a temperature excursion of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) (lot # S010729 with expiration date 01-DEC-2021; lot# 1637648 with expiration date 19-JUN-2022; dose and route were not reported) for prophylaxis (product storage error). The administered doses of the vaccine experienced a temperature excursion 32.9 Fahrenheit (F) and 34 F for 24 minutes and 16 hours time frame. Whether there was previous temperature excursion was not applicable. The digital data logger was involved. No product to retrieve. Device was not available for evaluation (obtain was false). No other AE was reported. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: S010729; expirationdate: 01-DEC-2021; deviceage and unit: 0 ; malfunction: Unknown; productavailableforevaluation: No; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability

Other Meds: GARDASIL 9 SYRINGE (DEVICE)

Current Illness: Prophylaxis

ID: 0936852
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: HPV; This spontaneous report was received from a consumer via company representative referring to a female patient around 28 years old. The patient's concomitant medication, pertinent medical history and drug allergies and reactions were not reported. On an unknown date, the patient was vaccinated with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) or quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, exact dose, injection site, route of administration, lot # and expiration date were not reported) for prophylaxis (she was unsure which vaccine was given). On an unknown date, the patient had human papillomavirus (HPV) which was not covered by the vaccine. The outcome of HPV was unknown. The causality assessment between the event and suspect vaccines was not provided by the reporter. This is one of the three cases received from the same reporter.; Sender's Comments: US-009507513-2101USA003845: US-009507513-2011USA010820:

Other Meds:

Current Illness:

ID: 0936853
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: HPV; This spontaneous report was received from a consumer via company representative referring to a female patient around 28 year old. The patient's concomitant medication, pertinent medical history and drug allergies and reactions were not reported. On an unknown date, the patient was vaccinated with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) or quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, exact dose, injection site, route of administration, lot # and expiration date were not reported) for prophylaxis (she was unsure which vaccine was given). On an unknown date, the patient had human papillomavirus (HPV) strain Wart strain which was not covered by the vaccine. The outcome of HPV was unknown. The causality assessment between the event and suspect vaccines was not provided by the reporter. This is one of the three cases received from the same reporter.; Sender's Comments: US-009507513-2011USA010820: US-009507513-2101USA003844:

Other Meds:

Current Illness:

ID: 0936854
Sex: F
Age: 69
State: ME

Vax Date: 11/17/2020
Onset Date: 11/01/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Pain at the injected site; Pain at the injected site / makes it difficult for her to lift her left arm; Buzzing in her head; Cannot sleep; Earache in both the ears; Tip of her tongue is tingling; Feels heat in the inside of both her arms from the elbow to the palms/hands; Joint pain all over her body; Having difficulty focusing; This case was reported by a consumer via call center representative and described the occurrence of injection site pain in a 69-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. The patient's past medical history included shingles (had a history of shingles on gabapentin for neuralgia states). Previously administered products included Shingrix with an associated reaction of injection site pain (1st dose received in right arm on 29th July 2020). Concomitant products included gabapentin. On 17th November 2020, the patient received the 2nd dose of Shingrix. In November 2020, less than a week after receiving Shingrix, the patient experienced injection site pain, injected limb mobility decreased, noises in head, sleeplessness, ear pain, tingling tongue, feeling hot, generalized joint pain and mental concentration difficult. On an unknown date, the outcome of the injection site pain, injected limb mobility decreased, noises in head, sleeplessness, ear pain, tingling tongue, feeling hot, generalized joint pain and mental concentration difficult were unknown. It was unknown if the reporter considered the injection site pain, injected limb mobility decreased, noises in head, sleeplessness, ear pain, tingling tongue, feeling hot, generalized joint pain and mental concentration difficult to be related to Shingrix. Additional details were provided as follows: The patient received 2nd dose in left arm. The reporter stated that, after vaccination the patient had pain at the injected site which makes it difficult for her to lift her left arm, buzzing in head, because of which cannot sleep, earache in both the ears, tongue was tingling, felts heat in the inside of both her arms from the elbow to the palms or hands and had joint pain all over body and difficulty focusing. The reporter consented to follow up. ; Sender's Comments: US-GLAXOSMITHKLINE-US2020231823:Same reporter. 1st dose

Other Meds: GABAPENTIN

Current Illness:

ID: 0936855
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: nauseated; fever; aches; headache; diarrhea; vomiting; This case was reported by a nurse and described the occurrence of nausea in a adult female patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, less than a day after receiving Shingrix, the patient experienced nausea, fever, pain, headache, diarrhea and vomiting. On an unknown date, the outcome of the nausea, fever, pain, headache, diarrhea and vomiting were recovered/resolved. The reporter considered the nausea, fever, pain, headache, diarrhea and vomiting to be related to Shingrix. Additional information was provided as follows: The age at vaccination was not reported. The patient received a dose of Shingrix vaccine and on the same day at 11 pm, the p atient experienced nausea, fever, pain, headache, diarrhea and vomiting. The reporter mentioned that, the events were resolved in 2 days. The reporter also mentioned that, the events had occurred because of the vaccine. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 0936856
Sex: F
Age: 52
State: VA

Vax Date: 11/06/2020
Onset Date: 11/07/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: swelling; itching/ large red circle associated with pain and itching; pain/ large red circle associated with pain and itching; large red circle that progressively got bigger/ the mark is there faded; This case was reported by a physician and described the occurrence of swelling in a 52-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. Concurrent medical conditions included drug allergy (allergies to other medications like prednisone pack, valtrex, antivirals). On 6th November 2020, the patient received the 1st dose of Shingrix. On 7th November 2020, 1 days after receiving Shingrix, the patient experienced swelling, localized itching, pain localized and localized erythema. On 23rd November 2020, the outcome of the swelling, localized itching, pain localized and localized erythema were recovered/resolved. It was unknown if the reporter considered the swelling, localized itching, pain localized and localized erythema to be related to Shingrix. Additional details were provided as follows: The patient had allergies to other medications like prednisone pack, Valtrex, antivirals. The reporter did not know the route of administration or the lot and expiry details of Shingrix as the vaccine was administered at a local pharmacy. The patient experienced some pain, itching and swelling. The reporter upon escalation stated patient described it that it started the next day as large red circle that progressively got bigger a few days later and was associated with pain and itching. It was still there, the mark was there faded. The pain, itching and swelling had resolved. None of the other symptoms had persisted. The symptoms lasted a day before reporting for about 17 days. The reporter consented to follow up. This case has been linked with US2020AMR234423 reported for the same patient by same reporter. There was discrepancy in the reported duration for the events. The reporter stated the event stated the next day until a day before reporting that was 16 days, however he stated that the events lasted for about 17 days.; Sender's Comments: US-GLAXOSMITHKLINE-US2020AMR234423:Same patient, Valtrex case

Other Meds:

Current Illness: Drug allergy (allergies to other medications like prednisone pack, valtrex, antivirals)

ID: 0936857
Sex: M
Age: 16
State: MI

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies:

Symptoms: FLUBLOK was administered to 16 years old patient with no adverse event; Initial information regarding an unsolicited valid non-serious case was received from a nurse via Medical Information (Reference number- 00414283) and transmitted to Sanofi on 04-Jan-2021. This case was linked with 2021SA002156, 2021SA002607, 2021SA002631, 2021SA002726, 2021SA002799, 2021SA002850, 2021SA003080, 2021SA003127, 2021SA003182, 2021SA002085 (same reporter) This case involves a 16 year old male patient who was administered with a standard 0.5ml dose of INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] (prefilled syringe, lot UJ509AA, expiration date 10 May 2021) once via intramuscular route at the left deltoid for prophylactic vaccination on 30-Dec-2021 (Product administered to patient of inappropriate age). Medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included MENINGOCOCCAL VACCINE A/C/Y/W CONJ (DIP TOX) (MENACTRA) for prophylactic vaccination. It was a case of actual medication error due to inappropriate age at vaccine administration (latency-same day). Reporter stated that FLUBLOK had been administered to 11 pediatric patients and would like to know if patients were covered for influenza vaccination for the season At the time of reporting, no adverse event reported (reported as none). This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds: MENACTRA

Current Illness:

ID: 0936865
Sex: F
Age: 38
State: NY

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: Peanuts, pecans, almonds

Symptoms: Mother; approximately 12 hrs after fever, chills for about 8 hours. Diarrhea 3 days. Mother is pumping breastmilk. Injection was Friday. 11 month old infant had Fridays milk on Sat, Sat milk on Sunday. Infant fatigued and fussy with loose stools Sunday. Infant had diarrhea, vomited and spiked 102.2 fever Monday evening 1/11. Fever broke Tuesday morning 7 am. Infant still fussy and loose stools. Vomiting ceased.

Other Meds: Sertraline 100mg daily, 1 prenatal daily

Current Illness: stomach bug 2 weeks prior breast feed infant side effects onset started Sunday 1/10/21 in the morning, fever spike 102.2 with ibuprophen 1/11/21 at 5pm infant is 11 months on 1/12./21

ID: 0936866
Sex: F
Age: 26
State: IN

Vax Date: 01/10/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Tachycardia- occurred about 14 hours after the vaccine, and lasted for about 12 hours. Resting heart rate is usually 70 and was 100. Any activity it would climb to the 120-130s.

Other Meds: Zoloft, Allegra, multivitamin

Current Illness: None

ID: 0936867
Sex: M
Age: 28
State: MI

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Fever/chills/night sweats for 1 day, body aches, injection site pain, nausea for 3 days, headache for 3 days, all resolved. Two doses of 1000 mg acetaminophen needed to resolve fever.

Other Meds: Vitamin D

Current Illness: None

ID: 0936868
Sex: F
Age: 22
State: IN

Vax Date: 01/10/2021
Onset Date: 01/11/2021
Rec V Date: 01/12/2021
Hospital:

Lab Data: None

Allergies: Doxycycline

Symptoms: Fever from 3:00 am to 6:40 pm (99.7 - 101.4) treated with extra strength acetaminophen. Temperature is now 99.5 Fatigue for 1/11 and 1/12 Intermittent muscle aches on arms and calves

Other Meds: Trazodone; amitriptyline; dicyclomine Nexaplon arm implant

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm