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: 1167563
Sex: F
Age: 30
State: KS

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: None.

Symptom List: Dysphagia, Epiglottitis

Symptoms: The first night after my shot on Friday April 2nd 2021. I experienced extreme tiredness and pain at the injection site. On a second day Saturday April 3rd 2021. I experienced severe body aches muscles awareness in the injection site, and insomnia as well as nausea and a horrible headache. On the third day Sunday April 4th 2021. I had severe headaches arm was still sore and I was still experiencing nausea.

Other Meds: Metformin, Fluoxtine, woman's daily vitamins, prenatal, calcium supplement, iron supplements.

Current Illness: None

ID: 1167564
Sex: M
Age: 41
State: NY

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Patient experienced numbness in arm a few minutes following COVID vaccine. He was instructed by the pharmacist to sit for 30 minutes for monitoring instead of the usual 15 minutes. After about 30 minutes, he said he was experiencing difficulty breathing (he was alert and orientated and was able to talk but he said he was laboring to breathe). EMS was called. No treatment was given on site by EMS and the patient elected to be brought to the hosptial.

Other Meds:

Current Illness:

ID: 1167565
Sex: F
Age: 40
State: WV

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: N/A

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

Symptoms: After 1st dose - slight soreness at injection site, no other symptoms After 2nd dose - after 4 hours, extreme fatigue, whole body soreness, injection site soreness, after 12 hours, all of the above, after 24 hours, all plus injection site swelling and redness, 36 hours, only more injection site swelling and more redness, 48 hours, more swelling and redness, and now itchiness

Other Meds: N/A

Current Illness: N/A

ID: 1167566
Sex: F
Age: 28
State: PR

Vax Date: 03/12/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: SHELL FISH

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: SKIN RASH BENADRYL 25 MG 4 TIMES A DAY BENADRYL CREAM HC 1% DOCTOR APPOINTMENT 4/6/2021

Other Meds:

Current Illness:

ID: 1167567
Sex: F
Age: 71
State: AR

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

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

Lab Data:

Allergies: Aspirin, Zofran, morphine, wheat/gluten

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

Symptoms: Woke up Trembling & Palpitations so bad that I considered going to the ER. Took 1 Librax and went to bed. That helped.

Other Meds: Amlodipine 5mg Metoprol TAR 25 mg

Current Illness: None

ID: 1167568
Sex: F
Age: 36
State: PA

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: No

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

Symptoms: My armpit hurts a lot and I have a little swelling

Other Meds: None

Current Illness: No

ID: 1167569
Sex: M
Age: 40
State: TX

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Additional Details: PHARMACIST GAVE HIM INJECTION ,HE WAS DIZZI,NOT FEELING WELL ,CALLED 911 ,THEY CAME AND CHECKED HIM OUT ,BP WAS NORMAL, THEN HE WALK OUT FROM THE PHCY

Other Meds:

Current Illness:

ID: 1167570
Sex: M
Age: 52
State: IN

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

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: Headache Chills Fever Fatigue Slight dizziness Side effects lasted about 36 hours

Other Meds: N/A

Current Illness: N/A

ID: 1167571
Sex: M
Age: 36
State: MI

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Lipitor [Atorvastatin] PenicillinsNausea and Vomiting

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Reason for Call DIFFICULTY BREATHING and COVID-19 Vaccine The wife called initially. However, she was able to speak with pt directly Trying to get a nebulizer machine since Monday, pt is covid positive since 3/19/21 Nebulizer Machine at home broke on Saturday wants another machine Airway oxygen prescription was sent, and wrong information was given and was sent to store and also to pharmacy when needs to go to Airway Oxygen in per wife Needed a neb machine for chronic asthma Pt took Symbicort inhaler at 0200 am Ventolin inhaler used as rescue only and states have not used it today Pt had johnson and johnson covid vaccine yesterday 3/31/2021 pt had chills, body aches, and fever No fever today was 98 while on the phone triaging pt Pt wants work note for yesterday, today, and tomorrow Pt not wanting to be seen in office today states are just going to sleep and be home and is already feeling better as compared to yesterday and last night after receiving the covid vaccine spoke with wife about airway oxygen prescription for nebulizer machine and pt's work excuse notes for yesterday, today, and tomorrow instructed the wife to call the office back in 2 hours if has not heard from PCP office

Other Meds: albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG tablet budesonide/formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler diclofenac sodium (VOLTAREN) 75 MG delayed release tablet ipratropium-albuterol (DUO-NEB)

Current Illness: COVID-19; diarrhea of infectious nature

ID: 1167572
Sex: F
Age: 72
State: FL

Vax Date: 03/21/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: muscle fatigue, nausea, vomiting, chills, mild fever lasting for about twelve hours, extreme fatigue for two days (I assume this was a reaction since i have not been out or in contact with other people, but would side effects be that delayed?)

Other Meds: LOSARTAN 25 MG ATENOLOL 50 MG FLUOXATINE 10MG MULTIVITAMIN

Current Illness: none

ID: 1167573
Sex: M
Age: 64
State: NY

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Pain and swelling in right armpit

Other Meds: Valsartan Atorvastatin Amlodipine

Current Illness: None

ID: 1167574
Sex: F
Age: 64
State: NY

Vax Date: 03/12/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Sulfa drugs (severe anaphylaxis)

Symptom List: Rash, Urticaria

Symptoms: Trapezoidal raised rash on upper arm, 4 inches by 3 inches, 3 weeks after Moderns covid-19 vaccine

Other Meds: Vit D, Vit C, Biotin, Fenugreek, CoQ10, Centum Silver 50+ multi-vitamin

Current Illness:

ID: 1167575
Sex: F
Age: 38
State: NC

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Irregular heartbeats. Directly after dinner my heart started pounding viciously in my chest. I?ve never in my life experience this feeling. It would flutter rapidly daily with pounding feeling happening about once a day. One night I awoke from my sleep from my heart pounding in my chest.

Other Meds: Lamictal, Wellbutrin, Adderall

Current Illness: None

ID: 1167576
Sex: F
Age: 71
State: FL

Vax Date: 03/31/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Raspberry

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Pain, rash? and feels like being constantly stuck with pins. Burning and pain .

Other Meds: Vitamin D Aspirin 81mg Caltrate

Current Illness:

ID: 1167580
Sex: F
Age:
State: TN

Vax Date:
Onset Date:
Rec V Date: 04/05/2021
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: Fever; Heart Palpitations; Dizziness; Nausea; This case was reported by a consumer via call center representative and described the occurrence of fever in a 58-year-old female patient who received Hepatitis B vaccine for prophylaxis. On an unknown date, the patient received the 1st dose of Hepatitis B vaccine. On an unknown date, several days after receiving Hepatitis B vaccine, the patient experienced fever, palpitation, dizziness and nausea. On an unknown date, the outcome of the fever, palpitation, dizziness and nausea were recovered/resolved. It was unknown if the reporter considered the fever, palpitation, dizziness and nausea to be related to Hepatitis B vaccine. Additional details were provided as follows: The age at vaccination was not reported. The patient had received first dose of Hepatitis B vaccine about 5-6 years (2015 or 2016) ago. She experienced dizziness, fever, nausea, and heart palpitations after few days. The patient did not have any details about the vaccine, she got recovered. The reporter consented to follow up. For tolerance to 2nd dose, refer case US2021072888.; Sender's Comments: US-GLAXOSMITHKLINE-US2021072888:same gender, same country, same suspect

Other Meds:

Current Illness:

ID: 1167581
Sex: U
Age:
State:

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

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

Symptoms: suspected vaccination failure; I got the shots, so had them very light; This case was reported by a consumer and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. The patient received the shingles shots, so had shingles very light. This case was considered to be a suspected vaccination failure case, as the details regarding completion of primary vaccination schedule, laboratory confirmation for shingles and time to onset were unknown.

Other Meds:

Current Illness:

ID: 1167582
Sex: U
Age:
State:

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

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

Symptoms: Suspected vaccination failure; shingles; painful; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant), shingles and pain. On an unknown date, the outcome of the vaccination failure, shingles and pain were unknown. It was unknown if the reporter considered the vaccination failure, shingles and pain to be related to Shingles vaccine. Additional details were reported as follows: The age at vaccination was not reported. Years before the date of reporting, the patient received shingles shot at the drug store and had shingles. The patient stated that you do not want them as they are painful. The would not be able to afford one now. This case was considered to be a suspected vaccination failure case, as the details regarding completion of primary vaccination schedule, laboratory confirmation for shingles and time to onset were unknown.

Other Meds:

Current Illness:

ID: 1167583
Sex: U
Age:
State:

Vax Date: 12/01/2020
Onset Date: 12/29/2020
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: still dealing with pain in my arm / pain is awful / been hurting since December 29th,2020; This case was reported by consumer via interactive digital media and described the occurrence of pain in arm in a adult patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Previously administered products included Shingles vaccine (received 1 st dose on an unknown date). In December 2020, the patient received the 2nd dose of Shingles vaccine. On 29th December 2020, less than a month after receiving Shingles vaccine, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was not recovered/not resolved. It was unknown if the reporter considered the pain in arm to be related to Shingles vaccine. Additional details was reported as follows: The case was reported by patient herself. The age at vaccination was not reported. The age group was not reported but was captured as adult as per vaccine indication. The patient received 2nd dose and experienced pain in arm. The second shot did not work well for patient. The patient stated that he/she still dealing with pain arm just like he/she got vaccinated day before reporting. The reporter stated that the pain was awful and patient hoped it goes away. The case has been linked with the case US2021AMR073666, reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR073666:same reporter

Other Meds:

Current Illness:

ID: 1167584
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The most painful shots ever, but worth it.; This case was reported by a consumer via interactive digital media and described the occurrence of pain in a adult patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Previously administered products included Shingles vaccine with an associated reaction of pain (received 1st dose on an unknown date, refer case US2021AMR073665). On an unknown date, the patient received the 2nd dose of Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced pain. Rechallenge with Shingles vaccine was positive. On an unknown date, the outcome of the pain was unknown. It was unknown if the reporter considered the pain to be related to Shingles vaccine. Additional details were reported as follows: The case was reported by patient herself/himself. The age at vaccination was not reported. The age group was not reported but was captured as adult as per vaccine indication. The patient reported that her shingles shot was painful but was worth it. No other information was reported.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR073665:same reporter, 1st dose US-GLAXOSMITHKLINE-US2021AMR073665:same reporter, 2nd dose

Other Meds:

Current Illness:

ID: 1167585
Sex: M
Age: 11
State: AZ

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administered liquid Menveo portion; Administered liquid Menveo portion; This case was reported by a nurse via call center representative and described the occurrence of inappropriate preparation of medication in a 11-year-old male patient who received Men ACWY-CRM NVS (Menveo) (batch number AMVA398A, expiry date 31st August 2021) for prophylaxis. On 30th March 2021, the patient received Menveo. On 30th March 2021, unknown after receiving Menveo, the patient experienced inappropriate preparation of medication and inappropriate dose of vaccine administered. On an unknown date, the outcome of the inappropriate preparation of medication and inappropriate dose of vaccine administered were unknown. Additional details were reported as follows: The reported batch number was AMXA398A however captured AMVA398A as per latest sales data sheet. Nurse just administered liquid Menveo portion only to a patient which led to inappropriate preparation of medication and inappropriate dose of vaccine administered. Reporter/Nurse was looking for any guidance if just administered liquid Menveo portion only to a patient. Reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1167586
Sex: F
Age: 3
State: MI

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 04/05/2021
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:

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

Symptoms: An adult dose of Havrix was administered / to a pediatric patient.; An adult dose of Havrix was administered / to a pediatric patient; This case was reported by a other health professional via call center representative and described the occurrence of adult product administered to child in a 3-year-old female patient who received HAV (Havrix adult) (batch number G99R4, expiry date 20th May 2022) for prophylaxis. Co-suspect products included hepatitis A vaccine pre-filled syringe device (Havrix Pre-Filled Syringe Device) injection syringe for prophylaxis. On 9th March 2021, the patient received the 1st dose of Havrix adult and Havrix Pre-Filled Syringe Device. On 9th March 2021, unknown after receiving Havrix adult and Havrix Pre-Filled Syringe Device, the patient experienced adult product administered to child and overdose. On an unknown date, the outcome of the adult product administered to child and overdose were unknown. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were provided as follows: The medical assistant reported that an adult dose of Havrix was administered to a pediatric patient, which led to adult product administered to child and overdose. The reporter consented to follow-up.

Other Meds:

Current Illness:

ID: 1167588
Sex: M
Age: 54
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: received the first dose on Feb 2020 /April 1st 2021 he received second dose; This case was reported by a pharmacist via call center representative and described the occurrence of drug dose administration interval too long in a 54-year-old male patient who received HAB (Twinrix adult) (batch number 75C72, expiry date 13th June 2022) for prophylaxis. Co-suspect products included hepatitis A and hepatitis B vaccine pre-filled syringe device (Twinrix Pre-Filled Syringe Device) injection syringe for prophylaxis. Previously administered products included Twinrix adult (1st dose received on February 2020). On 1st April 2021, the patient received the 2nd dose of Twinrix adult and Twinrix Pre-Filled Syringe Device. On 1st April 2021, unknown after receiving Twinrix adult and Twinrix Pre-Filled Syringe Device, the patient experienced drug dose administration interval too long. On an unknown date, the outcome of the drug dose administration interval too long was unknown. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were provided as follows: The pharmacist was looking for guidance on Twinrix standard dosing because the patient received 2nd dose later then the recommended schedule, which led to lengthening of vaccination schedule. The reporter consented to follow up via fax.

Other Meds:

Current Illness:

ID: 1167589
Sex: F
Age:
State: FL

Vax Date: 10/02/2020
Onset Date: 10/02/2020
Rec V Date: 04/05/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: received the 2nd dose of Havrix 14 months after the 1st dose; This case was reported by a pharmacist via call center representative and described the occurrence of drug dose administration interval too long in a female patient who received HAV (Havrix) for prophylaxis. Co-suspect products included hepatitis A vaccine pre-filled syringe device (Havrix Pre-Filled Syringe Device) injection syringe for prophylaxis. Previously administered products included Havrix (1st dose received on 7th August 2019). On 2nd October 2020, the patient received the 2nd dose of Havrix and Havrix Pre-Filled Syringe Device. On 2nd October 2020, unknown after receiving Havrix and Havrix Pre-Filled Syringe Device, the patient experienced drug dose administration interval too long. On an unknown date, the outcome of the drug dose administration interval too long was unknown. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were provided as follows: The age at vaccination was not reported. The pharmacist reported that a patient received the 2nd dose of Havrix, 14 months after the 1st dose of vaccine. The patient received 2nd dose of Havrix, later than the recommended interval, which led to lengthening of vaccination schedule. The reporter consented to follow up via email.

Other Meds:

Current Illness:

ID: 1167590
Sex: M
Age:
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/05/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Stroke; A spontaneous report was received from a consumer concerning a male patient of unknown age who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a stroke. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 08 Mar 2021, prior to the onset of symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: unknown) via unknown route for prophylaxis of COVID-19 infection. On 16 Mar 2021, approximately 8 days after vaccination, the patient experienced a stroke. The event is life-threatening. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event a stroke was unknown.; Reporter's Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1167592
Sex: M
Age: 16
State: OH

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Systemic: Weakness-Medium, Additional Details: Patient felt like he was going to pass out, said he has never had a reaction to needles or shots. EMS evaluated the patient and determined he could go home.

Other Meds:

Current Illness:

ID: 1167593
Sex: F
Age: 39
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 04/05/2021
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: Hazelnuts, Alprazolam, Fresh Pineapple, Cephalaxin Drugs, Buspirone, Cephalasporins, Varenicline, Doxycycline, Sulfa Drugs, Sumatriptan, Armodafinil, Quinapril

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

Symptoms: Extreme itching, no rash, on face, ears, under chin, neck, chest, under and on the underside of both breasts, back of hands

Other Meds: Latuda, Singulair, Zoloft, Seroquel, Topomax, Zytec, Salagen, Fluticasone Salmeterol, Clonazepam, Fioricet, Ventin Inhaler, Desipramine, Nexplanon Implant, Baclofen, Stelara Injection, Clonidine, Furosimide, Esomeprazole, Aspirin, Atorvasta

Current Illness: Crohn's Disease, Gastroperesis, Reflux

ID: 1167594
Sex: F
Age: 62
State: TX

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: Report body aches, HA an flu-like symptoms day 1 post vaccination. Treatment: Tylenol. Outcome: Symptoms are improving. Does not interfere with ADLs.

Other Meds:

Current Illness:

ID: 1167595
Sex: M
Age: 35
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Shakiness-Severe, Additional Details: Patient was lightheaded and fainted post vaccine. He was non responsive for a few seconds. 911 was called and EMS treated patient on site. Patient denied hosptial visit.

Other Meds:

Current Illness:

ID: 1167596
Sex: M
Age: 35
State: GA

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: Zyrtec for seasonal allergies

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

Symptoms: Starting about 12 hours after the injection, I awoke with a fever of 101, body aches, and severe headaches. The symptoms progressed and my fever was over 102 most of the day and hit a max of 103.5 around 2:30pm. Nausea started around 4pm, which I alleviated by taking Zofran. I eventually went to bed and awoke on the second day around 4:30am with a fever at 101 still. Then around 7:30am, the fever broke with the most intense full body sweats. Later on that Friday, in the afternoon, I noticed a large red rash on my right arm at the injection side, it was slightly swollen and very hot. It got bigger over the next 12 hours or so and by Sunday afternoon the swelling had subsided and now appears and feels like a sunburn where the redness turns white if you press with a finger and then returns to red and it also itches now. I treated the itchiness with some hydrocoritizone cream.

Other Meds: Only taking a standard multi-vitamin

Current Illness: None

ID: 1167597
Sex: F
Age: 88
State: DE

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient potentially received higher than the recommended 0.3ml dose of the Pfizer vaccine. As of Sunday 4/4, patient only complaint is mild arm soreness.

Other Meds:

Current Illness:

ID: 1167598
Sex: F
Age: 51
State: VA

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain

Symptoms: Had a really bad migraine for 3 days straight, extreme aching in arm from neck to fingertips, felt extremely tired for 5 days and on the 6th day, woke up with my armpit extremely sore, swollen lymph nodes in armpit and collar bone, have not gone down yet

Other Meds: None

Current Illness: none

ID: 1167599
Sex: M
Age: 34
State: NY

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tachycardia-Mild, Additional Details: Patient complain of tachycardia, sweating, left neck soreness, dry mouth and numb tongue approximately 10 minutes after administration. Recovered after 30 minutes. Per patient possibly anxiety induced.

Other Meds:

Current Illness:

ID: 1167600
Sex: F
Age: 67
State: NY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: Sulfa

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

Symptoms: 3/31/2021 Moderate Pain /soreness at injection site almost immediately after vaccine. Used ice . 9p.m. Less pain. 2a.m, 4/1/2021-fever of 100.0 F, 640 mg Tylenol. 4/1-11a.m, Temp 99.0 F Continue with ice. 4/1/-5p.m. Temp 100.8,F, slight chills, moderate aches. Tylenol 640 mg .Injection site reddened, slightly itchy 9 pm Tylenol 640 mg 4/2- Fever did not return. Slight muscle aches, itchy at site..Soreness improving 4/3-4/4 Very minimal tenderness, itching,soreness 4/5- no symptoms

Other Meds: Simvastatin 20mg. Once a day Multivitamin Vit. C, D3,Omega 2,K2, Calcium

Current Illness: None

ID: 1167601
Sex: F
Age: 72
State: WI

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: Biaxin, Codeine

Symptom List: Tremor

Symptoms: Severe aching all over body, fever of 100.3, headache, overall ill feeling. Symptoms lasted from 5:00pm on 4/03/2021 to 6:00 pm on 4/04/2021

Other Meds: Levothyroxine, Pravastatin, Irbesartan/HCTZ, Potassium, Omerprazole, Metoprolol, Calcium

Current Illness: Inguinel hurniea - surgery scheduled for April 12, 2021

ID: 1167602
Sex: M
Age: 38
State: NY

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

Symptom List: Erythema, Pruritus

Symptoms: Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: Patient complaint of need to vomit and nausea approximately 5 to 10 minutes after administration. Patient recovered approximately 10 minutes later. Patient reported a history of reacting this to needle and injections.

Other Meds:

Current Illness:

ID: 1167603
Sex: M
Age: 39
State: IN

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

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

Symptoms: Headache, diarrhea, eggs and pains, lucid dreams, chills, tiredness, Shortness of breath

Other Meds:

Current Illness:

ID: 1167604
Sex: F
Age: 41
State: PA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: None.

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

Symptoms: My appointment time was 11:20 am on Thursday. I received the shot about 11:30 am on my upper left arm. By about 2 pm, I was feeling some soreness and stiffness in my arm. By about 6pm, the pain in the arm and increased and I was having some loss of range of motion. I use my computer mouse with my left arm (same as where I got the shot), and I was having trouble moving the mouse. By 9 pm on the day of the shot, I could not move my arm. It hung along my left side and would hardly move more than an inch. I never lost feeling in that arm, but it wouldn't move. It was as if I'd suffered a stroke. I had to pick up my left arm with my right arm in order to move it. For example, in order to undress so I could go to bed, I had to physically lift my left arm and prop it up on a shelf in my bathroom so I could get my sweater off over my head with my right arm. In addition to loss of all range of motion, I had intense, severe pain in my left arm. No position was comfortable. Even lying on my back in bed with my arm at my side made my arm throb horribly. I usually sleep under a weighted blanket, but I couldn't stand any weight whatsoever on the arm. The pain (even without the weighted blanket) ran the whole length of my arm, from my shoulder through my wrist into my fingers. I'd heard that you shouldn't take anything for pain for the first 24 hours after the shot because it might interfere with the immune reaction, so I didn't take anything. The next morning (Friday morning), my arm was still severely painful and unable to be moved. I couldn't drive because I couldn't lift my left arm enough to grip the steering wheel. Moving the arm with my right hand still caused horrible pain. I basically slept or read on the sofa for all of Friday. By that evening, about 32 hours after the shot, I began to be able to move my left arm a few inches vertically (like a hammer curl) and horizontally (out from my side). That night, I was able to bear the weight of my weighted blanket on my arm. By Saturday morning, the pain was drastically reduced. Saturday morning I could lift my arm to my waist. By Saturday evening, I could lift my arm to my shoulder. Sunday I was almost back to normal. I had only some stiffness and the occasionally twinge if I moved the arm too far too quickly. I could lift the arm over my head. Today (Monday), four days after my shot, I still have some mild stiffness, again if I move the arm too quickly.

Other Meds:

Current Illness: None.

ID: 1167605
Sex: F
Age: 35
State: MA

Vax Date: 03/28/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Left Arm swelling in muscle at injection site approximately 7 days post Moderna (mRNA-1273) injection; pain to touch and when lifting arm above head.

Other Meds: NA

Current Illness: NA

ID: 1167606
Sex: M
Age: 67
State: FL

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: Systemic: pt fell but was still coherant-Severe, Additional Details: pt fainted in lobby after recieving vaccine pt has chf, and dm with a recorded bp at the time of 102/70 event most likely caused by reduced bloodpressure leading to diziness

Other Meds:

Current Illness:

ID: 1167607
Sex: F
Age: 25
State: IN

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Debilitating headache and extreme shakes/shiver. I don't get many headaches, much less some that are equivalent to migraines. I've also never had shakes/shivers like that are equivalent to being out in 0 degree weather.

Other Meds: None - It doesn't ask but this did occur right before I turned in for the night and after I had some alcohol.

Current Illness: None

ID: 1167608
Sex: F
Age: 35
State: PA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: nausea, chills, body ache, dizziness Got shot in the afternoon, nausea, chills and aches set in that evening. Nausea and chills worsened overnight. Got dizziness overnight and passed out. The next morning, chills and aches had passed. Nausea and dizziness had worsened. I passed out in my kitchen and hit my head. Went to the ER for a broken nose, possible concussion, staples in my skull and stitches in my chin from the fall.

Other Meds: Lamictal, Tomapax, Cellcept, Mestinon, Vitaman D, Folic Acid

Current Illness: None

ID: 1167609
Sex: F
Age: 26
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: unknown

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Client received 1st dose and approx 15 min. later stated "I feel like I'm going to faint and feel hot." Client was kept for observation for 30 additional minutes. Vital signs taken 3 times and every time WNL. Client reported history of becoming faint with needles. Allergy to gluten. At 10:35am, client walked away unassisted. No medication or other treatment given.

Other Meds: unknown

Current Illness: unknown

ID: 1167610
Sex: F
Age: 36
State: PA

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Bananas Latex Flexeril Chlorhexidine Avocados Walnuts Trees Grasses Molds Cats Dogs Melons

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

Symptoms: Burning and numbness and tingling in entire right arm. It is bad enough to wake me.uo throughout the night. No issue previously on this side of the body.

Other Meds: Sertraline Doxapin Plaquenil Vit c Multivitamin Vit d

Current Illness: None

ID: 1167611
Sex: F
Age: 70
State: DE

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

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

Symptoms: Patient potentially received higher than the recommended 0.3ml dose of the Pfizer vaccine. As of Sunday 4/4, patient reports body aches and headache only slight worse than after receiving the 1st dose.

Other Meds:

Current Illness:

ID: 1167612
Sex: M
Age: 68
State: OH

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Levaquin, Reglan

Symptom List: Vomiting

Symptoms: Just like covid all over again. Fever, can't breathe, etc

Other Meds: Advair, albuterol, duoneb, omeprazole, Singulair, simvastatin

Current Illness: Cold? Asthma

ID: 1167613
Sex: M
Age: 26
State: PA

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

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Vomiting-Mild

Other Meds:

Current Illness:

ID: 1167614
Sex: F
Age: 64
State: MA

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: About 23 hours after vac started feeling fatigue, chills, all over body aches , sore arm and fever of 100.7 My usual temp is between 97.5 and 97.7. Took Tylenol went to sleep and by about 8 pm no fever, no chills, aches were not as severe and still fatigued and arm still sore. By next morning April 5 felt better but injection site still sore, and tender

Other Meds: None

Current Illness: None

ID: 1167615
Sex: F
Age: 60
State: DC

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Itchy hand, wrist and ankles, small lumps 50+ size of pea or smaller started 6 days after vaccination. Continued 4 more days (today) as they turned red, blistery, bubbled, popped, skin pealed on the larger areas (less than the size of a dime). Moved up to shoulders, and on legs up to thighs. Possible one on tongue. Antihistamine will take down the itchiness although initially adding Benadryl too.

Other Meds: none

Current Illness: none

ID: 1167616
Sex: M
Age: 53
State: CT

Vax Date: 03/20/2021
Onset Date: 03/26/2021
Rec V Date: 04/05/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: Pt developed acute pericarditis 6 days after receiving COVID 19 vaccination.

Other Meds: Lisinopril-HCTZ, allopurinol

Current Illness: none

ID: 1167617
Sex: M
Age: 21
State: AL

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

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

Symptoms: Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient passed out immediately after receiving vaccine. Woke up disoriented but became alert and aware within 2 minutes. Gave food and water and observed for 30 minutes.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm