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: 1303911
Sex: F
Age: 69
State: CT

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 05/10/2021
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: penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: I am experiencing pins and needles sensation in both feet which is continuing a month later. It seems to be worsening and affecting both leg shins as well. I need to seek medical advice as I thought this would be temporary and now that does not seem to be the case.

Other Meds: zolpiem tartrate generic fioricet

Current Illness: burninp chest pain

ID: 1303912
Sex: M
Age: 47
State: MA

Vax Date: 04/09/2021
Onset Date: 04/19/2021
Rec V Date: 05/10/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: shellfish, iodine contrast dye

Symptom List: Anxiety, Dyspnoea

Symptoms: Suffered an ischemic stroke in the pons region of the brain stem

Other Meds: nexium, valacyclovir, clonazepam, multivitimin

Current Illness: none

ID: 1303914
Sex: M
Age: 17
State: PA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: Vaccine was administered to a minor under the age of 18 years of age due to administration error. As of May 10th, 2021 the Moderna Covid vaccine is only indicated for adults aged 18 years and older. No adverse events were reported by the patient.

Other Meds: n/a

Current Illness: n/a

ID: 1303915
Sex: M
Age: 56
State: OR

Vax Date: 04/07/2021
Onset Date: 05/03/2021
Rec V Date: 05/10/2021
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: The patient is a 56 y.o. male who presents to the Emergency Department with cough and SOB for 2-3 days. The patient states he was vaccinated with the johnson and johnson COVID-19 vaccine two weeks ago. He denies any vomiting diarrhea, fevers, leg swelling, or chest pain. The patient additionally denies being around any sick contacts or any recent travel. The patient is a 56 y.o. male evaluated for cough and SOB for 2-3 days. Possibility of pneumonia. I have lower suspicion for PE, however his oxygen saturation is less than 94%, so we will obtain a D-dimer. I have lower suspicion for ACS. Will also check COVID swab to rule out COVID despite recent vaccination.

Other Meds:

Current Illness:

ID: 1303916
Sex: F
Age: 58
State: FL

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Swelling at injection site however swelling has moved and is currently way below the injection and is now in the upper arm a little above elbow. I have taken. Tylenol and applied heat to the area

Other Meds: Metformin Amlodipine Multivitamin

Current Illness: None

ID: 1303917
Sex: M
Age: 48
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 05/10/2021
Hospital: Y

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: n/a

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

Symptoms: Per pt's wife 1 hour within receiving the vaccine, pt got a fever, headache, and dizziness. She states he took ibuprofen at home . She states that on April 26,2021 pt's primary care physician - was contacted. She states that on April 28,2021 she heard back from him . She states hat on April 29,2021 he went to get lab work (WBC) that md ordered. she states that pt was contacted on May 1,2021 by primary care physician to go to the ER . She states that he was admitted to hospital from May 1,2021- May 4,2021 and diagnosed with Leukemia (CML)

Other Meds: Vitamin A, Vitamin D3, Vitamin K2, biotin, berberine

Current Illness: no

ID: 1303918
Sex: F
Age: 55
State: MN

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 05/10/2021
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: morphine codeine penicillin animals - horses, dogs, cats, dust mites pollen

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Back of throat started to get small pimple-like bumps. As time passed, the back of my throat started to swell. I took 2 benadryl capsules which seemed to stop the swelling. By the following morning, the symptoms resolved.

Other Meds: Levothyroxin Vitamin D Vitamin B complex allergy vaccinations prednsolone

Current Illness: N/A

ID: 1303919
Sex: M
Age: 74
State: HI

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Progressively worse headaches culminating in seizure, unconsciousness, and subdural hematoma requiring helicoptering to the ER and brain surgery to drain the hematoma.

Other Meds: NAC 600 mg 2x/day

Current Illness: none

ID: 1303936
Sex: U
Age:
State: NY

Vax Date: 01/01/2015
Onset Date:
Rec V Date: 05/10/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The pt. was treated for shingles and other zoster-related conditions; The pt. was treated for shingles and other zoster-related conditions; Information has been received from a lawyer regarding a case in litigation and refers to a patient (pt.) of unknown age and gender. No information was provided regarding medical history, concurrent conditions, or concomitant medications. On or about 01-JAN-2015, the pt. was inoculated by a health care provider (HCP) with zoster vaccine live (ZOSTAVAX) (lot#, expiration date, dose, dose# and route of administration was not specified) for the long-term prevention of shingles and zoster-related conditions. On an unknown date, (reported as subsequently after vaccination with zoster vaccine live (ZOSTAVAX)), the pt. was treated by a physician for shingles (herpes zoster) and zoster-related conditions (ill-defined disorder). As a direct and proximate result of pt's use of the zoster vaccine live (ZOSTAVAX) vaccine, the pt. had and would continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and will continue to suffer such losses, and damages in the future. The outcome of the events was not reported. The reporter considered the events to be related to zoster vaccine live (ZOSTAVAX).

Other Meds:

Current Illness:

ID: 1303938
Sex: M
Age:
State: MO

Vax Date:
Onset Date: 04/27/2021
Rec V Date: 05/10/2021
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: SUSPECTED CLINICAL VACCINATION FAILURE; METALLIC TASTE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 60 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included seasonal allergies, and the patient have no other health history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, Frequency: 1 total, batch number: 1808978 expiry: Unknown) dose was not reported, administered at left arm on 26-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the patient experienced suspected covid-19. On 01-MAY-2021, On the same day the patient underwent rapid swab test and tested positive for COVID-19 (suspected clinical vaccination failure, Stuffiness, Runny nose, Drainage, Congestion, Anosmia, Ageusia). It was reported that, the symptoms started about 4 days prior, but it was hard to discern due to allergies. On the same day, the patient went to gym for about 45 minutes and felt okay except for slight metallic taste in mouth. Later, he went home and tried smelling whiskey and realized he had lost his sense of smell and experienced loss of taste. The patient did not present with typical symptoms and had felt okay because he had been working out prior. It was reported that, the patient could smell firewood burning but nothing else. Later, all vitals checked at urgent care and all was normal. The patient's laboratory data revealed blood pressure was normal, Oxygen level on Oximeter 99%, Smell and Taste was 90-95% gone. At the time of this report, the patient had a tiny amount of fatigue and was in quarantine for the next ten days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from metallic taste, had not recovered from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0:20210504165-covid-19 vaccine ad26.cov2.s-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS

Other Meds:

Current Illness: Seasonal allergy

ID: 1303939
Sex: M
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a health care professional concerned a 67 year old male. The patient's weight, height, and medical history were not reported. The patient received COVID-19 VACCINE AD26.COV2.S (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 07-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. The patient did not show antibodies when he got tested using the serology IgG test on 31-MAR-2021. Laboratory data included: Serology Immunoglobulin G (NR: not provided) did not found Antibodies. Also he did not show antibodies when he got tested using SARS-COV2-Antibody IgG, spike ,semi quantitative on 20APR-2021 and 27-APR-2021 as well (confirmed immunological vaccine failure.) . Laboratory data included: COVID-19 antibody test (NR: not provided) did not found Antibodies. It was not known where he got vaccinated or his personal information. The action taken COVID-19 VACCINE AD26.COV2.S was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0: 20210509824- COVID-19 VACCINE AD26.COV2.S-Confirmed Immunological Vaccine Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.

Other Meds:

Current Illness:

ID: 1303940
Sex: M
Age:
State: NC

Vax Date:
Onset Date: 04/01/2021
Rec V Date: 05/10/2021
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: SUSPECTED SINUS INFECTION; TIGHTNESS OF NECK; BODY SPASMS; UNABLE TO SLEEP; SEVERE PRESSURE HEADACHE; DIFFICULTY CONCENTRATING; LIGHT HEADEDNESS; PAIN AROUND LEFT EYE; TIGHTNESS OF FACE; NUMBNESS OF FACE AND NECK; This spontaneous report received from a patient concerned a 37 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included seasonal allergies, and other pre-existing medical conditions included the patient had no known drug allergies.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, and batch number: 042A21A) dose was not reported, administered on 06-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On APR-2021, the subject experienced numbness of face and neck. On 12-APR-2021, the subject experienced severe pressure headache. On 12-APR-2021, the subject experienced difficulty concentrating. On 12-APR-2021, the subject experienced light headedness. On 12-APR-2021, the subject experienced pain around left eye. On 12-APR-2021, the subject experienced tightness of face. On 30-APR-2021, the subject experienced body spasms. On 30-APR-2021, the subject experienced unable to sleep. On 30-APR-2021, the subject experienced tightness of neck. On 04-MAY-2021, Laboratory data included: CT scan (NR: not provided) CLEAR. On an unspecified date, the subject experienced suspected sinus infection. Treatment medications (dates unspecified) included: amoxicillin trihydrate, naproxen, azithromycin, and paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from severe pressure headache, difficulty concentrating, light headedness, body spasms, unable to sleep, numbness of face and neck, tightness of neck, pain around left eye, and tightness of face, and the outcome of suspected sinus infection was not reported. This report was non-serious.

Other Meds:

Current Illness: Seasonal allergy

ID: 1303941
Sex: M
Age:
State: PA

Vax Date:
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
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: SHORTNESS OF BREATH; NUMBNESS TO BOTH HANDS; CHILLS; FEVER; HEADACHE; NAUSEA; This spontaneous report received from a parent concerned a 20 year old male. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805020, expiry: UNKNOWN) dose was not reported, administered on 05-MAY-2021 to right deltoid muscle for prophylactic vaccination. No concomitant medications were reported. On 05-MAY-2021, the subject experienced nausea. On an unspecified date, the subject experienced shortness of breath, numbness to both hands, chills, fever, and headache. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 105.0. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever, and chills, and the outcome of headache, nausea, numbness to both hands and shortness of breath was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303942
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: PSORIASIS LIKE FORMATIONS ALL OVER SKIN; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 2021, the subject experienced psoriasis like formations all over skin. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from psoriasis like formations all over skin. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303943
Sex: U
Age:
State: MA

Vax Date:
Onset Date: 04/23/2021
Rec V Date: 05/10/2021
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: MUFFLED HEARING IN BOTH EARS; FULLNESS ON BOTH EARS; WATER IN THE EARS; This spontaneous report received from a patient concerned a 24 year old of unspecified sex. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, expiry: UNKNOWN) dose was not reported, administered on 09-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-APR-2021, the subject experienced muffled hearing in both ears. On 23-APR-2021, the subject experienced fullness on both ears. On 23-APR-2021, the subject experienced water in the ears. Treatment medications (dates unspecified) included: prednisone. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from muffled hearing in both ears, fullness on both ears, and water in the ears. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303944
Sex: M
Age:
State: SC

Vax Date:
Onset Date: 04/01/2021
Rec V Date: 05/10/2021
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: UNSPECIFIED SIDE EFFECTS; This spontaneous report received from a patient concerned a male of unspecified age. The patient's weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 02-APR-2021 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On APR-2021, the subject experienced unspecified side effects. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of unspecified side effects was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303945
Sex: F
Age:
State: FL

Vax Date:
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
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: FEET AND ARMS BURNING; EYES BURNING; SWEATING; COULD NOT EAT; CHILLS; HEAD FELT IT WILL EXPLODE; EXTREME NAUSEA; FEVER; This spontaneous report received from a consumer concerned a 64 year old female. The patient's weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 05-MAY-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 05-MAY-2021, the subject experienced feet and arms burning. On 05-MAY-2021, the subject experienced eyes burning. On 05-MAY-2021, the subject experienced sweating. On 05-MAY-2021, the subject experienced could not eat. On 05-MAY-2021, the subject experienced chills. On 05-MAY-2021, the subject experienced head felt it will explode. On 05-MAY-2021, the subject experienced extreme nausea. On 05-MAY-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills, feet and arms burning, head felt it will explode, sweating, extreme nausea, fever, eyes burning, and could not eat. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303946
Sex: M
Age:
State: UT

Vax Date:
Onset Date: 04/01/2021
Rec V Date: 05/10/2021
Hospital: Y

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: BLOOD CLOTS IN LUNGS/BLOOD CLOTTING; VACCINE-INDUCED THROMBOTIC THROMBOCYTOPENIA; This spontaneous report received via company represenative, via a social media and concerned an adult male 'below 50'. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) unknown dose, in APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. In social media, it was reported that a third male has been treated for rare blood clotting that may have been caused by Johnson & Johnson vaccine. The patient first showed signs of vaccine-induced thrombotic thrombocytopenia around 10 days after receiving the vaccine in APR-2021. After a week of leg pain, he went to emergency room where he was placed on blood thinners (unspecified) and sent home. The patient returned next day with chest pain which led to a discovery of blood clots in his lungs. After a few days on blood thinners, the patient's platelet count was normal and was returned home where his condition continued to improve. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from blood clots in lungs/blood clotting and vaccine-induced thrombotic thrombocytopenia. This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0: This case reported in the media concerns an adult male under 50 years of age who experienced vaccine-induced thrombotic thrombocytopenia approximately 10 days after receiving the Janssen Covid-19 vaccine. After a week of leg pain, the patient went to the emergency room where he was placed on unspecified blood thinners for an unspecified indication and was sent home. The next day, the patient returned with chest pain which led to the discovery of blood clots in his lungs. After a few days on blood thinners, his platelet count was normal and he returned home where he is recovering. Additional information (e.g. height, weight, full medical history, social history, family history, concomitant medications, specific platelet levels, peripheral smear, D-dimer, fibrinogen, anti-platelet factor 4 antibodies, radiologic diagnostic test results such as ultrasound, CT, MRI, angiogram, or venogram) was not provided. Information is limited in this case. However, based on evolving knowledge of Thrombosis with Thrombocytopenia Syndrome (TTS, per definition) and considering the reportedly low platelet count and temporal relationship to vaccination (Criteria level 3), the events are assessed to have a plausible relationship with vaccination. Additional information will be requested if contact information becomes available.

Other Meds:

Current Illness:

ID: 1303947
Sex: F
Age:
State: CA

Vax Date:
Onset Date: 05/03/2021
Rec V Date: 05/10/2021
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: BACK ACHE; MUSCLE SPASM; HEAVY DARK CLOTTY PERIOD; PARALYSIS; PINS AND NEEDLES SENSATION; NUMBING; SWEATS; SORENESS; NAUSEA; This spontaneous report received from a consumer concerned a 26 year old female. The patient's height, and weight were not reported. The patient's concurrent conditions included birth control implanted in arm that is old and needs to be taken out, alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no drug allergies nor illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982, and batch number: 1808982 expiry: UNKNOWN) dose was not reported, 1 total, administered on 03-MAY-2021 at 09:00 on left arm for prophylactic vaccination. No concomitant medications were reported. On 3-May-2021 at 09:00, the patient was vaccinated. At 17:00, the patient had pain, nausea, sweats, and soreness. At 18:00, she had pins and needles sensation, numbing, and paralysis. Later, she had sweats. Paramedics had checked the patient blood pressure and heart rate and they were within normal limits. The patient was still experiencing backache, muscle spasm, pain and heavy dark clotty period which was unusual. The patient had birth control implanted in arm that was old and needed to be taken out. Laboratory data included: Blood pressure and Heart rate was found normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from soreness, back ache, muscle spasm, and heavy dark clotty period, and the outcome of nausea, sweats, pins and needles sensation, numbing and paralysis was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0 20210511206-COVID-19 VACCINE AD26.COV2.S- Paralysis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds:

Current Illness: Alcohol use (Occasioanl drinker.); Birth control; Non-smoker

ID: 1303948
Sex: U
Age:
State:

Vax Date:
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
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: CHILLS; FEVER; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On MAY-2021, the subject experienced chills. On MAY-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever and chills was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303949
Sex: F
Age:
State: MI

Vax Date:
Onset Date: 05/06/2021
Rec V Date: 05/10/2021
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: HEADACHES; HEART RATE INCREASED; FEELING HOT; SORE LEFT ARM AND LEGS ACHY; CHILLS; FEELING WEAK; This spontaneous report received from a patient concerned a 23 year old female. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A212A expiry: UNKNOWN) dose was not reported, administered on 05-MAY-2021 18:15 for prophylactic vaccination. No concomitant medications were reported. On 06-MAY-2021, the subject experienced heart rate increased. On 06-MAY-2021, the subject experienced feeling hot. On 06-MAY-2021, the subject experienced sore left arm and legs achy. On 06-MAY-2021, the subject experienced chills. On 06-MAY-2021, the subject experienced feeling weak. On 06-MAY-2021 04:00, the subject experienced headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from heart rate increased, had not recovered from feeling hot, headaches, sore left arm and legs achy, and feeling weak, and the outcome of chills was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303950
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: KNUCKLE SORENESS; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient's weight, height and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. On an unspecified date, the subject experienced knuckle soreness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of knuckle soreness was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303951
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: AGGRAVATED SHOULDER ARTHRITIS; CANNOT LIFT ARM WITHOUT PAIN; INTENSE PAIN IN RIGHT SHOULDER; This spontaneous report received from a pharmacist concerned a male of unspecified age. The patient's height, and weight were not reported. The patient's concurrent conditions included arthritis. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 16-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 2021, the subject experienced aggravated shoulder arthritis. On 2021, the subject experienced cannot lift arm without pain. On 2021, the subject experienced intense pain in right shoulder. Laboratory data included: X-ray (NR: not provided) arthritis in both shoulders. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from intense pain in right shoulder, and the outcome of aggravated shoulder arthritis and cannot lift arm without pain was not reported. This report was non-serious.

Other Meds:

Current Illness: Arthritis

ID: 1303952
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: FREEZING; LIGHT CHILLS; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On an unspecified date, the subject experienced freezing, and light chills. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from freezing, and light chills. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303953
Sex: F
Age:
State: MO

Vax Date:
Onset Date: 05/02/2021
Rec V Date: 05/10/2021
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: NAUSEA; FEVER; SLIGHT ARM PAIN; This spontaneous report received from a patient concerned a 63 year old female. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 180890 expiry: UNKNOWN) dose was not reported, administered on 02-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On MAY-2021, Laboratory data included: Body temperature (NR: not provided) 99.8. On 02-MAY-2021, the subject experienced slight arm pain. On 04-MAY-2021, the subject experienced nausea. On 04-MAY-2021, the subject experienced fever. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 97. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from slight arm pain on 02-MAY-2021, and had not recovered from nausea, and fever. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303954
Sex: F
Age:
State: AZ

Vax Date:
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
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:

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

Symptoms: VOMITING; ABDOMINAL CRAMPS; CANT SLEEP AT NIGHT, SLEEPY DURING THE DAY; HEADACHE; FEELING TIRED; This spontaneous report received from a patient concerned a female of unspecified age. The patient's height, and weight were not reported. The patient's concurrent conditions included type 1 diabetes, and other pre-existing medical conditions included the patient had unspecified allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On MAY-2021, the subject experienced vomiting. On MAY-2021, the subject experienced abdominal cramps. On MAY-2021, the subject experienced cant sleep at night, sleepy during the day. On MAY-2021, the subject experienced headache. On MAY-2021, the subject experienced feeling tired. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, abdominal cramps, cant sleep at night, sleepy during the day, and feeling tired, and the outcome of vomiting was not reported. This report was non-serious.

Other Meds:

Current Illness: Type 1 diabetes mellitus

ID: 1303955
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/10/2021
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: CHILLS; ARM PAIN; HEAD ACHE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 2021, the subject experienced chills. On 2021, the subject experienced arm pain. On 2021, the subject experienced head ache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills, and head ache on 2021, and had not recovered from arm pain. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303956
Sex: F
Age:
State: KY

Vax Date:
Onset Date: 05/06/2021
Rec V Date: 05/10/2021
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: TESTED POSITIVE FOR COVID-19; This spontaneous report received from a patient concerned a female of unspecified age. The patient's weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, and batch number: 1808609 expiry: 09/JUN/2021) dose was not reported, administered on 06-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-MAY-2021, the subject experienced tested positive for covid-19. Laboratory data included: COVID-19 virus test (NR: not provided) positive for covid (units unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of tested positive for covid-19 was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1303957
Sex: M
Age:
State: SC

Vax Date:
Onset Date: 04/09/2021
Rec V Date: 05/10/2021
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: FLARE UP OF RA; This spontaneous report received from a health care professional via concerned a 38 year old male. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, frequency once total, administered on 01-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 09-APR-2021, the patient experienced flare up of Rheumatoid Arthritis (RA). Patient stated that physician told that flare up of RA caused by COVID vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of flare up of RA was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0: 20210512871-covid-19 vaccine ad26.cov2.s-Flare up of rheumatoid arthritis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds:

Current Illness:

ID: 1303958
Sex: M
Age:
State: CA

Vax Date:
Onset Date: 05/05/2021
Rec V Date: 05/10/2021
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: SWOLLEN TESTICLES TO 3 TIMES THEIR NORMAL SIZE; SWEATS; CHILLS OR TEETH CHATTERING; FEVER; This spontaneous report received from a health care professional concerned a 30 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included non-smoker, and other pre-existing medical conditions included the patient did not have known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978 expiry: 13-JUN-2021) dose was not reported, administered on 05-MAY-2021 11:38 for prophylactic vaccination. Concomitant medications included testosterone. On 05-MAY-2021, the subject experienced sweats. On 05-MAY-2021, the subject experienced chills or teeth chattering. On 05-MAY-2021, the subject experienced fever. On 06-MAY-2021, the subject experienced swollen testicles to 3 times their normal size. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills or teeth chattering, fever, sweats, and swollen testicles to 3 times their normal size. This report was non-serious.

Other Meds: TESTOSTERONE

Current Illness: Non-smoker

ID: 1304092
Sex: F
Age: 43
State:

Vax Date: 02/16/2021
Onset Date: 04/28/2021
Rec V Date: 05/10/2021
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: Injection site pain

Symptoms: CHEST PAIN Other pulmonary embolism without acute cor pulmonale

Other Meds:

Current Illness:

ID: 1304093
Sex: F
Age: 66
State: NY

Vax Date: 03/02/2021
Onset Date: 03/12/2021
Rec V Date: 05/10/2021
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: Developed popular rash on inner right arm ten days after vaccination

Other Meds:

Current Illness:

ID: 1304094
Sex: M
Age: 19
State: NY

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/10/2021
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:

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

Symptoms: WITHIN 5 MINUTES OF RECEIVNG FIRST DOSE OF COVID19 PFIZER VACCINE, PATIENT RETURNED TO PHARMACY STATING HE WAS FEELING DIZZY, AND COLLAPSED INTO COUNTER. MANAGER WAS ABLE TO HELP HIM TO A CHAIR SO HE DID NOT FALL, PATIENT CAUGHT HIMSELF WITH THE SHIELD/COUNTER. CALLED 911 AND EMS ARRIVED WITHIN A FEW MINUTES. ASKED PATIENT TO DESCRIBE SYMPTOMS, PATIENT RELAYED FEELING DIZZY, TROUBLE SEEING, VERY WARM, SWEATY. PATIENTS VITALS WERE CHECKED BY EMS, PARENTS AND PATIENT CHOSE NOT TO TRANSPORT AFTER ABOUT 30 MINUTES PATIENT WAS CLEAR OF ALL SYMPTOMS.

Other Meds:

Current Illness:

ID: 1304095
Sex: F
Age: 33
State: IN

Vax Date: 04/23/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: none

Symptom List: Tremor

Symptoms: Almost two weeks later I developed a rash that was later confirmed as shingles.

Other Meds: Elix Cycle Balance herbal remedies

Current Illness: none

ID: 1304097
Sex: F
Age: 22
State: OH

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: The patient was given expired J&J vaccine doses. The vial was punctured at 9:40AM and expired correspondingly at 3:40PM. The respective time the shot was given outside this window was 4:51 PM.

Other Meds: N/A or unknown

Current Illness: None

ID: 1304099
Sex: F
Age: 49
State: ID

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: Vaccine vial remained in freezer one day longer than reccommended per manufacturer. Should have been pulled from freezer and refrigerated before 3pm Thursday 5/6/2021 but was not; Administered Friday 05/07/2021 after removal from freezer that morning. "USE BY DATE" on "FREEZER" sticker on original container was noticed Friday afternoon after injection had been admistered.

Other Meds:

Current Illness:

ID: 1304100
Sex: M
Age: 55
State: NY

Vax Date: 03/07/2021
Onset Date: 03/10/2021
Rec V Date: 05/10/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Starting on 3rd day after the first vaccine shot, I felt sharp pain on my left chest and left back, two days later, rashes appeared, diagnosed as Shingles. Treated with antiviral medication. As today, rashes almost gone, but part of my chest is still sensitive to touch, temperature. The injection site of my left arm still feel mild pain and weak.

Other Meds:

Current Illness:

ID: 1304101
Sex: F
Age: 55
State: VA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/10/2021
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: Allergic to septocaine. Allergic to oranges, almonds, dust, mold, tree pollen

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: My appointment was on time, 4pm on 4/3 at the Pharmacy. The young girl that gave me the shot told me she was certified, and she gave me the shot in the presence of her manager. I have given myself shots for years with diabetes, plus many flu shots, and have never felt pain like that. I expressed this to her, how painful it was, and she just said "I know, I know..." as if it was normal for the shot to be so painful. I knew instantly something was wrong. They were more worried, it seemed, about a potential adverse reaction such as an allergy shock, since I'm allergic to a few things, but I did not experience that. I waited 15 minutes, my arm hurting the whole time, and they suggested I go buy Tylenol for the pain, which I did. My left arm has hurt since then. I got a horrible bruise from this shot (will send picture) that took weeks to heal. Since then I've continued to feel pain and don't have full mobility of my left arm. I can type, but not lifting anything heavy and have to go easy with anything on the left side. I thought at first it might be what people were calling "covid arm" but I discovered that was more about soreness, not pain. I tried ibuprofin, but after three weeks I'd had enough and made a doctors appointment. Since I was also noticing my left shoulder was very tense and tight, and I was starting to get neck stiffness in same area, I started googling before my appointment. When I entered my symptoms, SIRVA kept popping up, so I wondered if that was what I now had because of the improper vaccine administration. I asked my doctor for an MRI order to find out, but she said we needed to do an Xray first (which only showed mild issues related to osteo). She offered a prescription of taking Advil 400 mg three times and day and to use a muscle relaxer when I needed it, such as at night (Cyclobenzaprine). She said to try that for a week, and if it wasn't better, that another Dr could order MRI. Since then I've also added a pain spot under my left shoulder blade. Insurance called and said the order was "under review" so that's where things stand now. If they don't approve, I guess I will go next to an orthopedist for guidance? This has cost me health, due to lack of sleep also - I wake up with pain in the middle of the night, even when I take the meds. Praying for a diagnosis, and solution, soon.

Other Meds: Just my traditional meds: Lantus and Novolog for Diabetes; Losartin for kidney protection; 24-hour Zyrtec

Current Illness: n/a

ID: 1304102
Sex: F
Age: 35
State: FL

Vax Date: 01/04/2021
Onset Date: 02/09/2021
Rec V Date: 05/10/2021
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: N/a

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

Symptoms: Initial dose 1/4/2021 second 1/29/2021. I was a little over 8 weeks pregnant when I had a miscarriage on or around 2/09. I was not aware that the baby did not have a heart beat at that time but learned at an ultrasound on 3/9. I had an d and c. The baby was due on 9/23/2021.

Other Meds: Wellbutrin and prenatal vitamins

Current Illness: N/a

ID: 1304103
Sex: F
Age: 28
State: UT

Vax Date: 12/18/2020
Onset Date: 12/22/2020
Rec V Date: 05/10/2021
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: Shortness of breath 5 days after the vaccine that persisted 2 weeks, limiting the ability to talk, eat a full plate of food, or walk to the bathroom without stopping to catch my breath. Shortness of breath still comes and goes at this time currently in my daily life.

Other Meds: Prenatal vitamin, probiotic, vitamin b12

Current Illness: None

ID: 1304105
Sex: F
Age: 75
State:

Vax Date: 03/10/2021
Onset Date: 04/18/2021
Rec V Date: 05/10/2021
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:

Symptom List: Pain in extremity

Symptoms: CEREBROVASCULAR ACCIDENT R29.810 - Facial weakness

Other Meds:

Current Illness:

ID: 1304106
Sex: F
Age: 64
State: OH

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: The patient was given expired J&J vaccine doses. The vial was punctured at 9:40AM and expired correspondingly at 3:40PM.The respective time the shot was given outside this window was 4:54 PM.

Other Meds: N/A patient did not fill prescriptions at this pharmacy

Current Illness: Diabetes

ID: 1304107
Sex: F
Age: 60
State: NY

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fatigue next day and severe outbreak of herpes simplex on lips inside and out; nares

Other Meds:

Current Illness:

ID: 1304108
Sex: F
Age: 76
State:

Vax Date: 01/28/2021
Onset Date: 02/24/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Stroke-like symptoms Other cerebral infarction due to occlusion or stenosis of small artery

Other Meds:

Current Illness:

ID: 1304110
Sex: F
Age: 17
State: NM

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 05/10/2021
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:

Symptom List: Vomiting

Symptoms: Administered Janssen COVID-19 vaccine to a 17 year old but the minimum age is 18 years old.

Other Meds:

Current Illness:

ID: 1304111
Sex: F
Age: 39
State: IL

Vax Date: 04/09/2021
Onset Date: 04/28/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Janssen COVID-19 Vaccine EUA Bilateral Bell?s Palsy April 28th- I lost taste and my tongue felt burnt and had a coating on it. April 29th- Morning, I noticed my top lip was off-center. Later that evening, I felt numbness around my lip and mouth. April 30th- Lost muscle function on left side of face, including around left eye. Went to Urgent Care, they diagnosed as Bell?s Palsy and prescribed a high dose steroid and antiviral medication. May 2nd- Called doctor because right eye was twitching and muscles were feeling very tight. They thought it was my eye over compensating May 4th- Lost muscle function on right side of face. Went to Urgent Care to be re-evaluated. They suggested I go to the ER. Went to ER, bloodwork, CT scan and MRI all came back normal. They believe it is bilateral Bell?s Palsy

Other Meds: None

Current Illness: None

ID: 1304112
Sex: F
Age: 39
State: MO

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 05/10/2021
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: That night, besides having serious chills for about a half hour (which WAS an expected side effect) and chattering teeth, I vomited my dinner, and was vomiting throughout the early morning, and even some dry heaving into the day. It occurred over the course of about 12 - 14 hours. I at least returned to the toilet to vomit four times. I had to keep a bag by my bed. So far, I'm the only one of several people I know who have had either the Moderna or Pfizer vaccine and had vomiting.

Other Meds: Trintellix, 20 mg Calcium and Vitamin D daily vitamin supplement

Current Illness: none

ID: 1304113
Sex: M
Age: 17
State: PA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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: Patient is 17 years old, we will call his PCP for follow up

Other Meds: n/a

Current Illness: none

ID: 1304114
Sex: M
Age: 56
State: OH

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None that aware.

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

Symptoms: First dose 3/23/21; second dose 4/24/21. First dose I had face numbness within an hour of injection, symptoms subsided by next day however would return intermittently for the next 2-3 weeks. After second dose once again returned and have been on going ever since, I advised PHCP and he advised it was a side affect and there was nothing that he could do. Overall feeling is a numbness from cheek bones down to mouth, lower lip tingles at times, face feels swollen but not visually noticeable, feels restrictive when I smile,

Other Meds: Lansoprozole 30mg, Echinacea 400mg, milk thistle combination 410mg, red yeast rice 1140mg, multi vitamin, saw palmetto 160mg, everflex joint supplement 1800mg, D3 4000iu, zinc 50mg, super beta prostate

Current Illness: None

ID: 1304115
Sex: F
Age: 35
State: IN

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: Maroviz (dizziness)prednisone (muscle soreness)

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

Symptoms: On 5/10/21 the patient received her second vaccine. After receiving the second dose the patient reported that her face and lip felt numb. After 15 minutes the patient reported that she was felling better. While driving home the patient stated that her throat started to close and it throat was itchy. The patient drove to the ER were she recieved epinephrine. The patient was later trasported the Hospital were is still receiving treatment. The patient reported that she is feeling better.

Other Meds: None

Current Illness: No

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm