VAERS 2021 Database www.vaers.hhs.gov

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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: 0943130
Sex: U
Age: 31
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: I received the Pfizef COVID-19 vaccine, second dose at 11:45am on Monday, 01/11/2021 and approximately 12 hours later I began to experience chills, fatigue, muscle aches, nausea, loss of appetite, as well as a headache that became worse with time. The fatigue, muscle aches and headache resolved after about 20 hours after I began taking 1000 mg of acetaminophen every 4 hours. All other symptoms resolved shortly thereafter as well.

Other Meds:

Current Illness:

ID: 0943137
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
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: one week later I was sick; got a flu shot; Initial information regarding an unsolicited valid non-serious case received from a consumer (patient) via social media on 26-Nov-2020. This case involves a patient of unknown demographics who experienced got a flu shot (influenza) and one week later patient was sick (illness), after receiving INFLUENZA VACCINE. The patient's medical history, past medical treatments, past vaccinations, family history and concomitant medications were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (batch number and expiration date not reported) via an unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient got a flu shot (influenza) and one week later patient was sick (illness), (non-serious event) (unknown latency) following the administration of INFLUENZA VACCINE. No laboratory data reported. It was not reported if the patient received a corrective treatment. At the time of report, the outcome was unknown for the event. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 0943138
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
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:

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

Symptoms: my daughter (a nurse) gets sick for 2-3 weeks every time she gets it; Initial information received on 27-Nov-2020 regarding an unsolicited valid non-serious case from a consumer (patient). This case involves a female patient of unknown age who (a nurse) gets sick for 2-3 weeks every time she gets it (Illness), while she received vaccine Influenza Vaccine. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medication was not reported. On an unknown date, the patient received influenza vaccine (Strength, formulation, dose, frequency, route, batch number and expiry date were unknown) for prophylactic vaccination. On an unknown date (unknown latency), after started therapy with suspect vaccine, the patient gots sick for 2-3 weeks every time she got it (Illness). Action taken with the suspect drug was not applicable. It was not reported if the patient received a corrective treatment. The event outcome was reported as unknown.

Other Meds:

Current Illness:

ID: 0943139
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: First flu shot I ever got like to killed me; Initial information received on 02-Dec-2020 regarding an unsolicited valid non-serious case from a consumer (patient). This case involves a patient of unknown demographics who reported he/she got first flu shot ever got like to killed me (feeling abnormal), while he/she received vaccine Influenza Vaccine. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medication was not reported. On an unknown date in 1969, the patient received influenza vaccine (Strength, formulation, dose, frequency, route, batch number and expiry date were unknown) for prophylactic vaccination. On an unknown date (unknown latency), after started therapy with suspect vaccine, the patient got first flu shot ever got like to killed him (feeling abnormal). The patient never had another flu shot since and never will. Action taken with the suspect drug was not applicable. It was not reported if the patient received a corrective treatment. The event outcome was reported as unknown.

Other Meds:

Current Illness:

ID: 0943140
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: sick everyvtime; Initial information received on 02-Dec-2020 regarding an unsolicited valid non-serious case received from a consumer via Social media. This case involves an unknown age female patient who experienced sick every time (illness), while she received INFLUENZA VACCINE [INFLUENZA VACCINE]. Medical history, medical treatment, vaccination and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number: not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, after started vaccine, the patient reported that was false yes do get sick (illness) took it every year and sick it would protect her no way would No laboratory data was provided. Final diagnosis was illness. It was not reported if the patient received a corrective treatment. The outcome was reported as Unknown for illness.

Other Meds:

Current Illness:

ID: 0943141
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Not Hasn't worked yet with no adverse event; Initial information received on 10-Dec-2020 regarding an unsolicited valid non-serious social media case received from a non-healthcare professional (patient). This case involved a patient of an unknown age and gender for whom not hasn't worked yet with no adverse event (Drug ineffective) was reported, after receiving INFLUENZA VACCINE. The patient's medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number, expiry date and other dosing details were not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, unknown latency, the patient reported that not hadn't worked yet (Drug ineffective). There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 0943142
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
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: patient got the flu shot once in whole life and patient got so deathly sick patient was laid out in bed for 3 days so not for patient; Initial information was received on 04-Jan-2021 regarding an unsolicited valid non-serious case from a consumer/non-health care professional (patient) via social media. This case involves a patient of unknown age who got the flu shot (INFLUENZA VACCINE) once in whole life and got so deathly sick patient was laid out in bed for 3 days (illness). Medical history, past medical treatment(s), vaccination(s), concomitant medications and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number, expiration date not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date, (latency: unknown), patient who got the flu shot once in whole life and got so deathly sick patient was laid out in bed for 3 days (illness). No laboratory data was provided. It was not reported if the patient received any corrective treatment. At the time of report, the outcome of event was unknown. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 0943143
Sex: M
Age:
State: TX

Vax Date: 11/19/2020
Onset Date: 11/19/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Pentacel was administered in error with no adverse event; Initial information regarding an unsolicited valid non-serious case was received from a other healthcare professional and transmitted to Sanofi on 30-Nov-2020. This case involved a 4 year old male patient for whom DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] was administered in error (product administration error). The patient's past vaccination(s) included ACTHIB. The patient's past medical history, medical treatment(s) and family history were not provided. Concomitant medications included VARICELLA ZOSTER VACCINE (VARICELLA VACCINE); MEASLES VACCINE, MUMPS VACCINE, RUBELLA VACCINE (MMR); and INFLUENZA VACCINE (INFLUENZA). On 19-Nov-2020, the health care professional stated DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV (MRC5)/HIB(PRP/T) VACCINE (Lot number UJ189AAA expiration date: 06-Apr-2021) via an unknown route in the right arm was administered in error (product administration error). Only the liquid was administered. It was reported that the child was behind on his immunizations and reporter did not have a complete record of what patient had received but knew patient was up to date with his ActHIB so even though he didn't get that part he didn't need it. At the time of this report, no adverse event was reported. 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: VARICELLA VACCINE; MMR; INFLUENZA

Current Illness:

ID: 0943144
Sex: M
Age: 1
State: IN

Vax Date: 11/30/2020
Onset Date: 11/30/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: administered ACTHIB to a patient but the diluent had expired 4 days prior/ no AE; Initial information received on 02-Dec-2020 regarding an unsolicited valid non-serious case received from the other health care professional (Medical assistant) via Medical Information (Reference number- 00378491). This case involves a 17 months old male patient who received a 0.5 ml dose of HIB (PRP/T) VACCINE [ACT-HIB] single-dose vial (lot: UJ175AAA, diluent expiry date: 26-Nov-2020, vaccine expiry date: 02-May-2021) via intramuscular route in the right outer thigh, on 30-Nov-2020 for prophylactic vaccination (expired product administered). The patient's medical history, medical treatments, vaccinations and family history were not provided. Concomitant medications included DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR, TETANUS VACCINE TOXOID (DTAP VACCINE) and INFLUENZA VACCINE (FLU) for prophylactic vaccination. It was a case of an actual medication error due to expired vaccine used (latency: same day). Medical Assistant (MA) reports that they administered ACT-HIB on Monday to a patient but the diluent had expired 4 days prior. MA requests to know if there no contraindication or side effects. They discarded the expired diluent. Patient received a dose of ACT-HIB on 30 Nov 2020 for which the diluent had expired on 26-Nov-2020, although the ACT-HIB vial itself did not expire until 05 Feb 2021. MD name and dose number in series not available. Medical assistant did not have the lot number for the diluent vial. Product used: Used. At the time of report no adverse event was reported. 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: DTAP VACCINE; FLU

Current Illness:

ID: 0943145
Sex: M
Age: 0
State: PA

Vax Date: 12/04/2020
Onset Date: 12/04/2020
Rec V Date: 01/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient was given only the DTaP/IPV portion of the PENTACEL. so the patient was just given the liquid with no AE; Initial information received on 08-Dec-2020 regarding an unsolicited valid non-serious case from an other health professional. This case involves a 3 months old male patient who received only the dtap/ipv portion of the pentacel, so the patient was just given the liquid (product preparation issue), of the vaccine DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL]. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included IMMUNOGLOBULIN ANTIHEPATITIS B (HEPATITIS B); and PNEUMOCOCCAL VACCINE CONJ 7V (CRM197) (PREVNAR). On 04-Dec-2020, the patient received 0.5 mL dose once a day via intramuscular route in the left thigh of suspect DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (lot number: U6395AA and expiry date unknown) for prophylactic vaccination. This was an actual medication error due to inappropriate reconstitution technique (PT: Product preparation issue) (latency was same day). No laboratory data reported. At the time of reporting, no adverse event was reported to the patient. 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: HEPATITIS B [IMMUNOGLOBULIN ANTIHEPATITIS B]; PREVNAR

Current Illness:

ID: 0943146
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: she gave the Pentacel part of the vaccine and missed the HIB part for the child with no AE; Initial information received on 10-Dec-2020 regarding an unsolicited valid non-serious case from an other health professional. This case involves child patient of an unknown age who received part of the vaccine and missed the hib (Haemophilus b) part (product preparation issue), while the patient received vaccine DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL]. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. No concomitant medication was reported. On an unknown date, the patient received 0.5 mL of dose once a day of suspect DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (lot number and expiry date unknown) via unknown route for prophylactic vaccination. This was an actual medication error due to inappropriate reconstitution technique (PT: product preparation issue) (latency unknown). No laboratory data reported. At the time of reporting, no adverse event was reported to the patient. 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. There would be no information regarding batch number for the case.

Other Meds:

Current Illness:

ID: 0943147
Sex: M
Age:
State: IN

Vax Date:
Onset Date:
Rec V Date: 01/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: 9 month-old child was supposed to receive a Pentacel vaccine, but the CMA administered only the DTaP/IPV portion, without reconstituting the Hib with no adverse event; Initial information regarding an unsolicited valid non-serious case received from a health care professional on 15-Dec-2020. This case involves a 9 month-old child who was supposed to receive a DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (PENTACEL) vaccine, but the CMA administered only the DTaP/IPV portion, without reconstituting the Hib (medication error). The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included pneumococcal vaccine conj 7v (crm197) (Prevnar). On an unknown date, the patient received DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE at a dose of 0.5 mL daily via intramuscular route right thigh (lot number: UJ390AA; Expiration date: 10-Dec-2021) for prophylactic vaccination. On an unknown date, it was reported that the 9 month-old child was supposed to receive a Pentacel vaccine, but the CMA administered only the DTaP/IPV portion, without reconstituting the Hib (medication error) (non-serious event) (unknown latency) following the administration of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE. No laboratory tests were reported. It was not reported if the patient received a corrective treatment. At the time of report, the outcome was not applicable for the event. Disclaimer: 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: PREVNAR

Current Illness:

ID: 0943148
Sex: U
Age:
State: NY

Vax Date: 11/18/2020
Onset Date: 12/15/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: who took the FLUZONE QUAD vaccination on Nov 18 2020. Patient is back in for 2nd dose of FLUZONE QUAD today on 12/15/2020 which is the 27 day instead of 28 days with no AE; Initial information received on 15-Dec-2020 regarding an unsolicited valid non-serious case received from a physician. This case involves a 9 month old infant patient who was on QUADRIVALENT INFLUENZA VACCINE (INFLUENZA QUADRIVAL A-B VACCINE) (FLUZONE QUADRIVALENT) (lot number and expiry date: not reported) for which who took the FLUZONE QUAD vaccination on Nov 18 2020 and was back in for the 2nd dose of FLUZONE QUAD today on 12/15/2020 which was the 27 day instead of 28 and wanted to know if it was acceptable to vaccinate on the 27th day (inappropriate schedule of product administration). This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holders 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:

Current Illness:

ID: 0943149
Sex: M
Age:
State: NC

Vax Date: 12/17/2020
Onset Date:
Rec V Date: 01/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: diluent was given today but not the medicine/no AE; This was dose was number two in the series for the patient,it should have been the third/no AE; Initial information regarding an unsolicited valid non-serious case was received from a other health professional via Medical Information (Reference number- 00397592) on 17-Dec-2020. This case involves a 6-month-old patient of unknown gender who was given second dose of diluent part of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] but not the medicine 0.5 ml once (5 dosage packs vial) (Pentacel lot number UJ337AAA and expiry date 05-Jul-2021) (ActHIB Lot UJ337AA, ActHIB Expiry. date: 05-Jul-2021), (DTaP-IPV Lot U6842BA, expiry date 05-Jul-2021) via intramuscular route on left thigh for prophylactic vaccination. (Product preparation error) (Incorrect dose administered). The patient's medical history, past medical treatment, vaccination and family history were not provided. Concomitant medications included PNEUMOCOCCAL VACCINE CONJ 13V (CRM197) (PREVENAR 13) and INFLUENZA VACCINE. It was an actual medication error case due to Active ingredient not added to diluent and Incorrect dose administered. (same day latency) It was reported that the patient had got diluent which was given on 17-Dec-2020 (reported as today) but not the medicine. It was asked if sterile water could be used as the diluent and they got one blue (DTaP-IPV component) and they thought that was the diluent so then another blue (DTaP-IPV component) mixed with the green (ActHIB component) was given and this was dose was number two in the series for the patient. It should have been the third. At the time of reporting, no adverse event was reported. 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: PREVENAR 13; INFLUENZA VACCINE

Current Illness:

ID: 0943150
Sex: U
Age:
State: NC

Vax Date: 12/29/2020
Onset Date:
Rec V Date: 01/14/2021
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: they only gave the liquid portion. She was referred to the Pentacel Reconstitution with no adverse event; Initial information regarding an unsolicited valid non-serious case received on 30-Dec-2020 from a other health professional. This case involves a patient (unknown demographics) who received the liquid portion of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL], while she was referred to the pentacel reconstitution (product preparation issue). Medical history, medical treatment, vaccination, family history and concomitant medications were not provided. On 29-Dec-2020 (reported as yesterday), the patient received a partial dose of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (lot number, expiry date and other dosing details were not reported] via unknown route at an unknown administration site for prophylactic vaccination as advised by nurse. It was reported that the vaccine DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) was only one of the 2 vials that came in the pack was given and they only gave the liquid portion (Product preparation issue). They wanted to know if they should re-administered the vaccine with the correct dose. At the time of report, no adverse event was reported. 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. There will be no information available on the batch number for this case.

Other Meds:

Current Illness:

ID: 0943151
Sex: M
Age: 4
State: NE

Vax Date: 12/07/2020
Onset Date: 12/07/2020
Rec V Date: 01/14/2021
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: IPOL and PEDIARIX were inadvertently administered to a 4 years old patient, with no AE; Initial information regarding an unsolicited valid non-serious case was received from the other health care professional via Medical Information (Reference number- 00414740) and transmitted to Sanofi on 04-Jan-2021. This case involves a 4 years old male patient who was inadvertently administered a 0.5 ml dose of IPV (VERO) [IPOL] Dosage form: multi dose vial lot R1F971M, expiration date: 03-OCT-2021 via intramuscular route in the left vastus lateralis and PEDIARIX not produced by Sanofi Pasteur lot number and expiration date not reported via unknown route in unknown administration site on 07-Dec-2020 for prophylactic vaccination. The patient's medical history, medical treatments, vaccinations and family history were not provided. Concomitant vaccinations included MEASLES VACCINE, MUMPS VACCINE, RUBELLA VACCINE (MMR VACCINE) and INFLUENZA VACCINE INACT SPLIT 3V (FLULAVAL) for prophylactic vaccination. This was an actual medication error case due to extra dose administered (latency same day). Caller with question regarding safety/ adverse effects following administration of extra dose of POLIOMYELITIS VACCINE (INACTIVATED) (IPV). Adverse event symptoms: None reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holders 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. There will be no information on the lot number of suspect vaccine PEDIARIX.

Other Meds: MMR VACCIN; FLULAVAL

Current Illness:

ID: 0943152
Sex: M
Age:
State: OR

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/14/2021
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: 11 year old patient was given DAPTACEL instead of ADACEL,with no AE; 11 year old patient was given DAPTACEL,with no AE; Initial information regarding an unsolicited valid non-serious case was received from a nurse via Medical Information (Reference number- 00416895) and transmitted to Sanofi on 05-Jan-2021. This case involves a 11 years old male patient who received a standard 0.5ml dose of DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE [DAPTACEL]. (lot number C5624AA, expiry date: 10-Jun-2021) once via intramuscular route in unknown administration site for prophylactic vaccination (Product administered to patient of inappropriate age) instead of DIPHTHERIA-2/TETANUS/5 AC PERTUSSIS VACCINE [ADACEL] (Wrong product administered) on 30-Dec-2020. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included HPV VACCINE (HPV VACCINE) and MENINGOCOCCAL VACCINE A/C/Y/W CONJ (DIP TOX) (MENACTRA) for prophylactic vaccination. This was an actual medication error case due to wrong vaccine administered and inappropriate age at vaccine administration (latency same day). Case detail: The reporter stated that a 11-year old male accidently received Daptacel and not the ordered Adacel. The reporter stated that the prescriber ordered the Adacel but the Medical Assistant in the office administered Daptacel and wanted to know if the patient was going to be ok. At the time of reporting, no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holders 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: HPV VACCINE; MENACTRA

Current Illness:

ID: 0943153
Sex: U
Age:
State: NJ

Vax Date: 10/08/2020
Onset Date:
Rec V Date: 01/14/2021
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: the patient complained of redness at the injection site after receiving the Flublok; Initial information regarding an unsolicited valid non-serious case received from the other health professional via phone at call center (Reference Number: US-SANOFI-00418826) received on 06-Jan-2021. This case involved a 68-year old patient complained of redness at the injection site (Injection site erythema) after receiving INFLUENZA QUADRIVALENT RECOMBINANT VACCINE (FLUBLOK QIV). Medical history, medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. On 08-Oct-2020, the patient received a dose of suspect INFLUENZA QUADRIVALENT RECOMBINANT VACCINE 0.5 mL (lot number: UJ455AA, expiry date: 17-Mar-2021) via an unknown route in the left deltoid for prophylactic vaccination. On an unknown date, unknown latency, the patient complained of redness at the injection site after receiving the Flublok (Injection site erythema). No relevant laboratory details were provided. It was not reported if the patient received a corrective treatment. Outcome was reported as unknown for the event of injection site erythema.

Other Meds:

Current Illness:

ID: 0943155
Sex: F
Age: 67
State: TX

Vax Date: 12/19/2020
Onset Date: 12/19/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rash to chest and neck area started around 6pm on 12/19/20 and it is current today 1/14/21 but fading

Other Meds: Benadryl and motrin after vaccine

Current Illness: DM and Hypertension

ID: 0943156
Sex: F
Age: 55
State: CO

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: possibly to penicillin?

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

Symptoms: I had the vaccine on 1/11 at 11:30AM. I only had a sore right arm on Tuesday. I noticed a full front and back body rash that afternoon. It started spreading up my neck and onto my forehead. No other symptoms. I took 25mg of Benadryl that evening. Woke up the next day with improving rash but still visible.

Other Meds: digestive enzyme, b complex, omega 3, hormone replacement therapy

Current Illness: none

ID: 0943157
Sex: F
Age: 38
State: MA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/14/2021
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: Papaya, Jackfruit

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

Symptoms: Had COVID vaccine and had reaction. Large welts at site of injection, warm to touch, very swollen and tender. Itchy around that area.

Other Meds:

Current Illness:

ID: 0943158
Sex: F
Age: 39
State: MA

Vax Date: 12/23/2020
Onset Date: 01/06/2021
Rec V Date: 01/14/2021
Hospital: Y

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

Lab Data:

Allergies: Monk Fish

Symptom List: Unevaluable event

Symptoms: Numbness tingling in feet, toes progressed to waist. ER Sunday hosp, pt was admitted inpatient, diagnosis transverse myelitis.

Other Meds: Sertraline 75 mg, Baby aspirin, Metoprolol 60 mg as needed

Current Illness: N/A

ID: 0943159
Sex: F
Age: 51
State: NY

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/14/2021
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: Reported headache, chills, greater than 6 loose stools overnight. Symptoms have resolved.

Other Meds:

Current Illness:

ID: 0943160
Sex: F
Age: 70
State: TX

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
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: Penicillin, shell fish, peanuts, soy, stinging insects, cod, flounder, grouper, haddock, pollens

Symptom List: Injection site pain, Pain

Symptoms: Chills started 5 hrs after injection. Headache, chills followed by hot flashes continued for 9 1/2 hrs. Light headed ness upon rising most of the day following the shot. Fatigue continued for 3 days.

Other Meds: Levothyroxine, pantoprazole

Current Illness:

ID: 0943161
Sex: M
Age: 33
State: PR

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: ,TIRED,HEADACHE,CHILLS,,NAUSIA,FEELING BAD,AND DIARREA.

Other Meds: INMODIUM AND TYLENOL

Current Illness: DIABETIC

ID: 0943162
Sex: F
Age: 37
State: NY

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: seasonal, parmesean cheese

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

Symptoms: sever emesis, chills

Other Meds: none

Current Illness: none

ID: 0943163
Sex: F
Age: 40
State: MI

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
Hospital: Y

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: KNDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Systemic: Dizzy, hyperventolation-Medium

Other Meds:

Current Illness:

ID: 0943164
Sex: F
Age: 35
State: CA

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Latex, Flagyl, and Codine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Nausea Vomiting Diarrhea Headache Dizziness (4 days)

Other Meds: N/A

Current Illness: N/A

ID: 0943165
Sex: M
Age: 49
State: AL

Vax Date: 12/21/2020
Onset Date: 12/26/2020
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Body Ache and fatigue began the afternoon of 12/26. Body ache intensity increased on 12/27. Loss of sense of smell became apparent on the afternoon of 12/27.

Other Meds:

Current Illness:

ID: 0943166
Sex: F
Age: 56
State: MD

Vax Date: 12/29/2020
Onset Date: 01/09/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Nausea

Symptoms: Sharp painful continuing headache, dizziness, hot/cold body sweats, joint aches, extreme tiredness

Other Meds: Iron , multi vitamin

Current Illness: NA

ID: 0943167
Sex: F
Age: 36
State: KY

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies

Symptom List: Injection site pain

Symptoms: Moderna COVID-19 Vaccine Extreme fatigue, headache, sore arm, and intense dizzy spells. This all occurred the afternoon / evening I received the vaccine. All side effects subsided by the next morning less a sore arm.

Other Meds: B12 Iron

Current Illness: None

ID: 0943168
Sex: F
Age: 38
State: SC

Vax Date: 01/05/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Moderna COVID-19 Vaccine EUA New pain/tenderness at injection site. Swelling and hardening of muscle. Large reddened area around site and very hot to touch.

Other Meds: Prestiq, multivitamin

Current Illness: none

ID: 0943169
Sex: F
Age: 44
State: OK

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Amoxicillin

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

Symptoms: Injection Site Reaction Day 2: Soreness in shoulder/arm Day 8: Small, itchy knot at injection site Day 9-11: Knot has swollen to approximately the size of a half dollar, and seems to be getting worse, not better.

Other Meds: Daily multivitamin

Current Illness: None

ID: 0943170
Sex: F
Age: 56
State: KY

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Vaccine administered at 10:41. Monitored in vaccine clinic before returning to work area in PACU. Upon return to PACU at 10:57, felt foggy and didn't feel right. Employee sat down. Left upper lip started to tingle, patient experienced palpitations and difficulty breathing, requiring surgical mask to be removed. Code EMA (code for non-patient called). Employee taken to emergency department for evaluation.

Other Meds:

Current Illness:

ID: 0943171
Sex: F
Age: 34
State: IL

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Erythema, Pruritus

Symptoms: 1/07@1920 INJECTION RECEIVED 1/8 @ 1100 CHILLS BEGAN @1130 102 FEVER RECORED; 1000MG ACETAMINOPHEN TAKEN @1300 MIGRAIN BEGAN @1700 NAUSEA BEGAN @1900 CHEST PAIN STARTED @2100 WENT TO THE ER

Other Meds: NONE

Current Illness: NONE

ID: 0943172
Sex: F
Age: 71
State: GA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/14/2021
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: No

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

Symptoms: 36 hours after injections uncontrollably chills for 2 hours, temp of 102.8. Continued temp of 102 for 2 days, no appetite severe fatigue ending up with severe dehydration resulting in urgent and ER visits. Received 2 liters of I V fluids. Continue also now with low grade temp in evening, nausea and diarrhea

Other Meds: Infernal, homologous, tricor,Crestor,dyazide,gabapentin,saxtenda,clonipin,lisinopril,fishoil,magnesium,vitamin d,synthroid

Current Illness: No

ID: 0943173
Sex: F
Age: 57
State: MI

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: cows hair and rye

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

Symptoms: fever, hot, cold, very tired

Other Meds: Omaperzole, baby aspirin, metformin, victozia, lisinopril, flonase, lexapro

Current Illness: none

ID: 0943174
Sex: F
Age: 18
State: IL

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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: Gluten Intolerance Citrus Intolerance

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Full body rash that was controlled with Benadryl and prednisone at an outpatient clinic 45 minutes after vaccination. Adverse rash and allergic reaction still present 48 hours later.

Other Meds: Zyrtec Nasacort Aurovela FE Levothyroxine

Current Illness: None

ID: 0943175
Sex: F
Age: 53
State: RI

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: sulfer milk gluten

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

Symptoms: stomach issues, migraines. body aches Fatigue

Other Meds: AMLODIPINE BESYLATE 2.5 ,atorvastatin 20 mg, levothyroxine 50 mcg, baclofen 10mg, Montelukast 10 mg, Omeprazole 20 mg, clonazepam 0.5 mg Symbicort

Current Illness:

ID: 0943176
Sex: F
Age: 60
State: FL

Vax Date: 01/05/2021
Onset Date: 01/08/2021
Rec V Date: 01/14/2021
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:

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

Symptoms: Fever and headache

Other Meds:

Current Illness:

ID: 0943177
Sex: F
Age: 35
State: MN

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Augmentin, Amoxicillin, Reglan

Symptom List: Pain in extremity

Symptoms: The evening I got the shot I felt my muscles starting to ache. The next morning when I woke up I was achy, but still went to work. Around 11:00 am on 1/13/21 I started to feel flushed and the chills. Took my temp and it was 100.3 F. I was achy all over and had a headache too.

Other Meds: Protonix, Prozac, Wellbutrin XL, Multivitamin, Omega 3, Vitamin D

Current Illness: Gastric ulcer

ID: 0943178
Sex: F
Age: 25
State: VA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Na

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

Symptoms: About 5 hours after injection, tenderness in arm appeared and then worsened. Kept me up in the night and would be very painful even with a light touch. Then the next morning I felt fatigued, slight headache, ears ringing and very light headed.

Other Meds: More a birth control

Current Illness: Na

ID: 0943179
Sex: F
Age: 58
State: MD

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: mold, cats, dogs, shellfish, oseltamivir phosphate, pollen, sulfa, sertraline, carvedilol

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

Symptoms: 310 pm after vaccine at 3 pm, itchy mouth, throat and lips. 12.5 mg benadryl at 330 and by 340 she was fine. 7 pm patient had systemic itchiness and took 25 mg benadryl and felt better. this am 1/14/2021 woke up at 6 amd and at 730 am she started itching . Called office at 920 am.

Other Meds: cozarr, astelin, optivar, buspar, nexium, prozac, flonase

Current Illness: none

ID: 0943180
Sex: F
Age: 33
State:

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
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: dicyclomine

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA nausea flush/heat chest

Other Meds: none

Current Illness: none

ID: 0943181
Sex: F
Age: 53
State: FL

Vax Date: 01/06/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Latex

Symptom List: Vomiting

Symptoms: Large, red rash on left arm with mild itching.

Other Meds: Daily: 5 mg Amlodipine and Vitamin D supplement.

Current Illness: None

ID: 0943182
Sex: F
Age: 48
State: WI

Vax Date: 12/27/2020
Onset Date: 12/27/2020
Rec V Date: 01/14/2021
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: shellfish

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: fatigue, body ache, headache, fever (101), injection site soreness

Other Meds: 20mg hydrochlorothiazide

Current Illness: none

ID: 0943183
Sex: M
Age: 17
State: MI

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early

Other Meds:

Current Illness:

ID: 0943184
Sex: M
Age: 68
State: NJ

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: gout flare in right foot in evening of vaccine -- took colchicine in am - waiting for improvement

Other Meds: metformin, jardiance, allopurinol, crestor

Current Illness:

ID: 0943185
Sex: F
Age: 45
State: MI

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: No known allergies to medications or food. Lots of contact allergies with adhesives, acrylates, fragrances, bee products, lanolin

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

Symptoms: Headache, nausea, fever of 103, chills, fatigue

Other Meds: Prevacid, Prozac, Wellbutrin, multivitamin

Current Illness: None

ID: 0943186
Sex: F
Age: 51
State: NH

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/14/2021
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: Penicillin

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

Symptoms: Cellulitis at injection site. Erythema, warm, painful. Small red bump noted day after vaccine. Cellulitis worsened over the week.

Other Meds: Lexapro, Albuterol

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm