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: 1334952
Sex: F
Age: 12
State: UT

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/20/2021
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: A patient received an expired vaccine, no AE; Initial information regarding an unsolicited valid non-serious case was received from other healthcare professional via Medical Information (Reference number- 00592591) and transmitted to Sanofi on 07-May-2021. This case involves a 12-year-old female patient who received an expired 0.5 mL dose of DIPHTHERIA-2/TETANUS/5 AC PERTUSSIS VACCINE [ADACEL] (lot C5577AA and expiry date: 20-Feb-2021) via an intramuscular route in the deltoid for prophylactic vaccination on 07-May-2021 (expired product administered). The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included MENINGOCOCCAL VACCINE A/C/Y/W CONJ (DIP TOX) (MENACTRA) for prophylactic vaccination and ALTHAEA OFFICINALIS ROOT, CINNAMOMUM CAMPHORA ESSENTIAL OIL, CITRUS AURANTIUM OIL, EUCALYPTUS GLOBULUS LEAF ESSENTIAL OIL, MENTHA X PIPERITA ESSENTIAL OIL (GARDISIL). The medical assistant (MA) would like to know the efficacy of ADACEL past the expiration date. This was a case of actual medication error due to expired vaccine used (latency same day). 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: MENACTRA; GARDISIL

Current Illness:

ID: 1334953
Sex: F
Age: 0
State: NY

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/20/2021
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: 07 month old female patient administered expired dose of Pentacel, no AE; Initial information received on 11-May-2021 regarding an unsolicited valid non-serious case received from a other health professional. This case involves a 7 months old female patient (reported that 7 months, 1 week, and 3 days) who was administered expired dose of DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] (expired product administered). Past vaccination included PEDIARIX. Medical history, medical treatment and family history were not provided. Concomitant medications included PNEUMOCOCCAL VACCINE CONJ 7V (CRM197) (PREVNAR) for Immunisation. On 04-May-2021, the patient received a 0.5 ml first dose of suspect DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE (lot UJ163AA and expiry date: 03-May-2021) (Frequency once) via an intramuscular route in the left thigh for prophylactic vaccination. It was a case of actual medication error due to expired vaccine used (latency on same day). It was also reported that the caller stated that PENTACEL was administered to a patient 1 day after the expiration date. The caller would like to know what the protocol is for this issue. Caller asking how to proceed if an expired Pentacel was given to a patient. 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 the 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: 1334954
Sex: F
Age: 2
State: VA

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/20/2021
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: A patient received an expired vaccine, no AE; Initial information regarding an unsolicited valid non-serious case was received from other healthcare professional via Medical Information (Reference number- 00596556) and transmitted to Sanofi on 11-May-2021. This case involves a two-year-old female patient who received an expired 0.5 mL dose of HIB (PRP/T) VACCINE [ACT-HIB] (lot UJ178AA and expiry date: 04-May-2021) via an intramuscular route in the left thigh for prophylactic vaccination on 11-May-2021 (expired product administered). The patient's medical history, past medical treatment(s), vaccination(s), concomitant medications and family history were not provided. This was a case of actual medication error due to expired vaccine used (latency same day). At the time of reporting, no adverse event was reported. The reporter requested guidance on how to proceed. 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: 1334955
Sex: U
Age:
State: IL

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/20/2021
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: patient inadvertently received an expired dose of MENACTRA, with no AE; Initial information received on 11-May-2021 regarding an unsolicited valid non-serious case from a pharmacist via Media Information (reference number ). This case involves a patient (unknown gender and age) who inadvertently received an expired dose of MENINGOCOCCAL A-C-Y-W135 (D CONJ) VACCINE (total, 1x, lot number not reported and expiration date: 23-Feb-2021) via unknown route in an unknown administration site for prophylactic vaccination on 04-May-2021 (expired product administered). The patient's past medical history, medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. It was an actual medication error due to expired vaccine used (same day latency). It was also reported that smart scripts was not completed as caller had limited data available to report. Caller was advised to call back to provide patient and vaccine data. Caller was with the question on the safety and efficacy of the expired dose. 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 the 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 batch number for this case.

Other Meds:

Current Illness:

ID: 1334956
Sex: M
Age:
State: IL

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 05/20/2021
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: DT went down to 31F and after going down the temperature was turned up for the refrigerator documented as being in range at 39 degrees F and at 35 degrees F but was then administered with no reported adverse event; Initial information received on 12-May-2021 regarding an unsolicited valid non-serious case from other health professional (Inquiry number: 00598066). It was reported that an unknown age male patient received DIPHTHERIA AND TETANUS TOXOIDS produced by unknown manufacturer (lot number: C5733AA, expiry date not reported) which went down to 31 Fahrenheit and after going down the temperature was turned up for the refrigerator documented as being in range at 39 degrees Fahrenheit and at 35 degrees Fahrenheit but was then administered on 09-Apr-2021 via an unknown route at an unknown administration site for prophylactic vaccination (product storage error temperature too low). It was a case of actual medication error due to product storage error temperature too low. At the time of report, no adverse event 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:

Current Illness:

ID: 1334957
Sex: F
Age: 1
State: OH

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/20/2021
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: the liquid portion was not used; the powder portion was mixed with sterile water; aside from the patient not receiving the DTaP-IPV portion with no AE; Initial information received on 12-May-2021 regarding an unsolicited valid non-serious case from other health professional (Inquiry number: 00598239). It was reported that a 20 month old female patient received DIPHTHERIA/TETANUS/5 HYBRID AC PERTUSSIS/IPV(MRC5)/HIB(PRP/T) VACCINE [PENTACEL] (lot number: lot UJ339AAA, expiry date: 07-May-2021) (Suspension For Injection) where the liquid portion was not used, the powder portion was mixed with sterile water; aside from the patient not receiving the dtap-ipv portion on 04-May-2021 via intramuscular route at an unknown administration site for prophylactic vaccination (product preparation issue). It was a case of actual medication error due to Inappropriate reconstitution technique. Concomitant medications included PNEUMOCOCCAL VACCINE CONJ 13V (CRM197) (PREVNAR 13) and MEASLES VACCINE, MUMPS VACCINE, RUBELLA VACCINE (MMR). At the time of report, no adverse event 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: PREVNAR 13; MMR

Current Illness:

ID: 1335949
Sex: U
Age:
State: MD

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 05/20/2021
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: No signs or symptoms reported.; temperature excursion on VARlVAX - VAQTA that was administered; Information has been received from a medical assistant reporting on a patient of unknown age and gender. There was no information about the patient's concurrent conditions, medical history or concomitant medication. On 22-APR-2021, the patient was vaccinated with an improperly stored varicella virus vaccine live (Oka/Merck) (VARIVAX) lot#T017687, expiration date 21-MAY-2022 (dose and route of administration were not reported) and with hepatitis A vaccine, inactivated (VAQTA) lot#T023913, expiration date 31-MAR-2022 (dose and route of administration were not reported). Both vaccines for prophylaxis. On an unknown date, varicella virus vaccine live (Oka/Merck) (VARIVAX) underwent a temperature excursion between 6 degrees Fahrenheit and 14 degrees Fahrenheit for 1 hour and 45 minutes; between 15 degrees Fahrenheit and 46 degrees Fahrenheit for 2 hours and 30 minutes. On an unknown date, hepatitis A vaccine, inactivated (VAQTA) underwent a temperature excursion above 47 degrees Fahrenheit for 2 hours. No previous temperature excursion. The call was not placed due to a digital data logger. This is one of several reports received from the same reporter. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability; Sender's Comments: US-009507513-2104USA007341: US-009507513-2105USA004334:

Other Meds: VAQTA SYRINGE (DEVICE)

Current Illness:

ID: 1335954
Sex: F
Age:
State: IL

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 05/20/2021
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: Loss of consciousness; Hyperhidrosis; Panic attack; Nausea; Vomiting; This case was received via FDA VAERS (Reference number: 1005525) on 11-May-2021 and was forwarded to Moderna on 11-May-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of LOSS OF CONSCIOUSNESS (Loss of consciousness) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 04-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Feb-2021, the patient experienced LOSS OF CONSCIOUSNESS (Loss of consciousness) (seriousness criterion medically significant), HYPERHIDROSIS (Hyperhidrosis), PANIC ATTACK (Panic attack), NAUSEA (Nausea) and VOMITING (Vomiting). At the time of the report, LOSS OF CONSCIOUSNESS (Loss of consciousness), HYPERHIDROSIS (Hyperhidrosis), PANIC ATTACK (Panic attack), NAUSEA (Nausea) and VOMITING (Vomiting) outcome was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided It was reported that the patient became nauseous and started vomiting approximately 20 minutes after the vaccine. She initially refused to go to the emergency room by ambulance. The vomiting continued and she then passed out and became diaphoretic. 911 was called and she was transported to the emergency room and tests were being ran. She said they did not feel it was vaccine related. Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded, although the events are likely related to the act of being injected rather than the vaccine itself

Other Meds:

Current Illness:

ID: 1335955
Sex: F
Age: 53
State: MO

Vax Date: 03/09/2021
Onset Date: 03/15/2021
Rec V Date: 05/20/2021
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: COVID-19; Myasthenia flare; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of COVID-19 (COVID-19) and MYASTHENIA GRAVIS (Myasthenia flare) in a 53-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036A21A) for COVID-19 vaccination. Concurrent medical conditions included Myasthenia gravis. Concomitant products included PREDNISONE, PYRIDOSTIGMINE BROMIDE (MESTINON) and MYCOPHENOLATE MOFETIL (CELLCEPT [MYCOPHENOLATE MOFETIL]) for an unknown indication. On 09-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Mar-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced COVID-19 (COVID-19) (seriousness criterion hospitalization). On an unknown date, the patient experienced MYASTHENIA GRAVIS (Myasthenia flare) (seriousness criterion medically significant). At the time of the report, COVID-19 (COVID-19) and MYASTHENIA GRAVIS (Myasthenia flare) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 14-Mar-2021, SARS-CoV-2 test: negative (Negative) Negative and positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Treatment information include patient received an antibody infusion from an antibody provider, Zpac and albuterol sulfate. Company Comment: A 53-year-old female patient who received mRNA-1273 experienced MYASTHENIA GRAVIS and COVID-19 6 days after the first dose of vaccine. No medical conditions were provided. Concomitant products included PREDNISONE,PYRIDOSTIGMINE and MYCOPHENOLATE. From the conmeds she is taking seems likely that the patient has a history of Myasthenia Gravis. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected. Most recent FOLLOW-UP information incorporated above includes: On 11-May-2021: Patient medical history, Lab investigations and hospital details; Sender's Comments: A 53-year-old female patient who received mRNA-1273 experienced MYASTHENIA GRAVIS and COVID-19 6 days after the first dose of vaccine. No medical conditions were provided.Concomitant products included PREDNISONE,PYRIDOSTIGMINE and MYCOPHENOLATE. From the conmeds she is taking seems likely that the patient has a history of Myasthenia Gravis. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected.

Other Meds: PREDNISONE; MESTINON; CELLCEPT [MYCOPHENOLATE MOFETIL]

Current Illness: Myasthenia gravis

ID: 1335956
Sex: U
Age:
State: IL

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 05/20/2021
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: generalized itching; This is a spontaneous report from a contactable consumer (patient) via . This 68-year-old patient of unspecified gender received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; lot number EN6207) via an unspecified route of administration in the right arm on 15Mar2021 at 16:30 (at the age of 68-years-old) as a single dose for COVID-19 immunisation. Medical history included penicillin allergy, obesity and hypertension, all from unknown dates and unknown if ongoing. Prior to vaccination the patient was not diagnosed with COVID-19. The patient had no concomitant medications and had not received any other vaccines in the four weeks prior to the COVID vaccine. The patient reported that 24 hours after injection they developed generalized itching; no hives just itching head to toe. The patient reported taking diphenhydramine hydrochloride (BENADRYL) every 6 hours. The patient reported receiving the second dose of BNT162B2 (lot number EN8731) on 12Apr2021.The clinical outcome of generalized itching was unknown. It was also reported that since vaccination, the patient had not been tested for COVID-19. No follow-up attempts are needed. No further information is expected.

Other Meds:

Current Illness:

ID: 1335957
Sex: F
Age:
State: IL

Vax Date: 03/27/2021
Onset Date:
Rec V Date: 05/20/2021
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: The patient reported that after her first dose, a little up her arm towards the back, not where they put the shot, she had a bump that hurt when she touched it. She further stated that it went away. The patient received the second dose on 17Apr2021. The clinical outcomes of a little up her arm towards the back she had a bump that hurt when she touched it were recovered on unspecified dates. No follow-up attempts are needed; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1335958
Sex: U
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 05/20/2021
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: Feeling itchy at the Injection site; This is a spontaneous report from contactable consumer via COVAES. A patient (reporter's cousin) of unspecified age and gender received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; lot number unknown) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. On an unspecified date the patient experienced feeling itchy at the injection site. The reporter stated that she had been feeling itchy at the injection site and it came and went and wasn't that serious and that her son and cousin also had this feeling, but it went away. The reporter stated they were scheduled for the next shot on 28Apr2021. The reporter stated they were hydrated all week before the vaccine and inquired if itching once in a while was normal. The clinical outcome of feeling itchy at the injection site was recovered on an unspecified date. No follow-up attempts are needed; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1335959
Sex: U
Age:
State:

Vax Date: 03/09/2021
Onset Date:
Rec V Date: 05/20/2021
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: Severe fatigue; This is a spontaneous report based on information received by Pfizer from Abbvie (manufacturer Control Number#: 21K-163-3856245-00). A contactable consumer (patient) reported a patient of unspecified age and gender received dose 1 of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) intramuscularly on 09Mar2021 as a single dose for COVID-19 immunization and tofacitinib citrate (XELJANZ; strength 5 mg) orally at an unspecified dosage from 2018 and orally at an unspecified dosage from 25Feb2021 for rheumatoid arthritis. Medical history and concomitant medications were not reported. In 2021, the patient experienced severe fatigue. Tofacitinib citrate and BNT162B2 were also considered suspect. The action taken with tofacitinib citrate in response to severe fatigue was dose not changed. The outcome of severe fatigue was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds: Xeljanz

Current Illness:

ID: 1335960
Sex: F
Age:
State: IN

Vax Date: 03/19/2021
Onset Date:
Rec V Date: 05/20/2021
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: extreme tiredness; headaches; body aches; This is a spontaneous report based on information received by Pfizer. A contactable consumer (patient) reported a 49-year-old female patient received dose 1 of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) via an unspecified route of administration around 19Mar2021 as a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. On an unspecified date the patient experienced extreme tiredness, headaches, and body aches that caused her not to be able to get out of bed. The outcomes of extreme tiredness, headaches, and body aches were unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1335961
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/20/2021
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: tingling in cheeks and nasolabial folds; This is a spontaneous report based on nformation received by Pfizer (manufacturer control number GL-040921-8926). A ncontactable consumer (patient) reported a female patient of unspecified age received dose 1 of COVID-19 vaccine (unspecified manufacturer) via an unspecified route of administration on an unspecified date as a single dose for COVID-19 immunization and hyaluronic acid, lidocaine (RESTYLANE L) at an unspecified dosage from an unknown date for an unknown indication. Medical history and concomitant medications were not reported. On an unspecified date after receiving one of the COVID-19 vaccines, the patient experienced tingling in cheeks and nasolabial folds. The action taken with hyaluronic acid, lidocaine in response to the event was unknown. The outcome of tingling was unknown. No follow-up attempts are possible; information about batch/lot number cannot be obtained.

Other Meds: RESTYLANE L

Current Illness:

ID: 1335962
Sex: U
Age:
State: LA

Vax Date:
Onset Date:
Rec V Date: 05/20/2021
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: I have swelling in my face; I had fast heartbeat; I had a rash over my body; allergic reaction; This is a spontaneous report received from a contactable consumer (patient). A 70-year old patient of unspecified gender received dose 2 of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) via an unspecified route of administration on an unspecified date (at the age of 70-years-old) as a single dose for COVID-19 immunization. Medical history included high blood pressure. Concomitant medications included aspirin from an unknown date for an unknown indication, rosuvastatin (CRESTOR) from an unknown date for cholesterol, vitamin D from an unknown date for an unknown indication, vitamin C from an unknown date for an unknown indication, and pantoprazole sodium sesquihydrate (PANTRO) from an unknown date for stomach medicine. The patient also took high blood pressure medicine. The patient previously received dose 1 of BNT162B2 (lot number EK5730) on 14Jan2021. On an unspecified date "maybe a week after her last shot 04Mar2021" the patient experienced swelling in the face, fast heartbeat, and rash over the body. The patient had been looking at the papers. The patient got both Pfizer shots and had "all of this." The patient visited a doctor several times and went to the emergency care and then primary doctor. The patient was diagnosed with allergic reaction. The patient kept breaking out. The patient broke out on the arm again. The patient received treatment for the events. The outcomes of swelling in the face, fast heartbeat, rash over the body, and kept breaking out were unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds: ASPIRIN [ACETYLSALICYLIC ACID]; CRESTOR; VITAMIN C [ASCORBIC ACID]; PANTRO

Current Illness:

ID: 1335963
Sex: F
Age:
State: CO

Vax Date: 02/01/2021
Onset Date: 02/12/2021
Rec V Date: 05/20/2021
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: I contracted COVID from my 2 year old son after long term exposure caring from him. My symptoms are very minimal and mild. I tested negative for 4 days but on day 5 of caring for him I contracted it.; I contracted COVID from my 2 year old son after long term exposure caring from him. My symptoms are very minimal and mild. I tested negative for 4 days but on day 5 of caring for him I contracted it.; pregnant at the time of the vaccination; This is a spontaneous report from a contactable other healthcare professional (hcp). A 34 year old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection), via an unspecified route of administration, administered in right arm on 12Feb2021 (Lot Number: EL9266, expiry date not reported) as first dose single (at the age of 33 years old); then via an unspecified route of administration, administered in right arm on Feb2021 (Lot Number: EN6199, expiry date not reported) as second dose, single; for covid-19 immunisation. Medical history included hypothyroid, PCOS and known allergies to bananas. The patient had no covid prior vaccination. Concomitant medications included levothyroxine and metoclopramide (REGLAN), both taken for an unspecified indication. The patient had no other vaccine in four weeks. Patient was pregnant at the time of the vaccination and event at 15 weeks gestation, with last menstrual date as 30Oct2020 and delivery date on 13Aug2021. Patient had contracted COVID from her 2 year old son after long term exposure caring from him. Her symptoms were very minimal and mild. On 02May2021, he was tested negative for 4 days but on day 5 (05May2021) of caring for him she contracted it (positive). No treatment received in response to the events reported. The outcome of the event contracted COVID from her 2 year old son after long term exposure caring from him was recovering.; Sender's Comments: Based on available information, a possible contributory role of the subject product, BNT162B2 vaccine, cannot be excluded for the reported events of COVID-19 and Vaccination failure. There is limited information provided in this report. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds: LEVOTHYROXINE; REGLAN [METOCLOPRAMIDE]

Current Illness:

ID: 1335964
Sex: M
Age:
State: MI

Vax Date: 03/01/2021
Onset Date:
Rec V Date: 05/20/2021
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: pain in his leg that felt like a clot; pain in his leg; This is a spontaneous report from a contactable consumer, the patient. A 45-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration in the right arm on Mar2021 at 11:15 (at the age of 45-years-old) as a single dose for COVID-19 immunization. Medical history included ongoing venous insufficiency since 2019. Concomitant medications were none. The patient did not receive any other vaccinations within 4 weeks of the vaccine. The patient stated that he received his first dose on 30Mar2021 or 31Mar2021. On an unspecified date, the next day after the first vaccination, the patient experienced pain in his leg that felt like a clot for the first week and a half to two weeks. Then, the patient got a little bit better, even though he had almost gone to the emergency room, but he got better after a couple weeks. The clinical outcome of "pain in his leg that felt like a clot " was resolved on Apr2021. Information on the lot/batch number has been requested.; Sender's Comments: Linked Report(s) : US-PFIZER INC-2021507016 Same patient/drug, different dose/event

Other Meds:

Current Illness: Venous insufficiency (Verbatim: Venous insufficiency)

ID: 1335965
Sex: F
Age:
State: MI

Vax Date: 01/17/2021
Onset Date: 02/01/2021
Rec V Date: 05/20/2021
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: felt achy; does not have the energy; sore inside my mouth; sound can hurt my ears; base of my left thumb hurts underneath the thumb where the thumb attaches to the hand; left hand cramp and tightness; Couldn't talk; could barely open her eyes / not be able to open her eyes; fell to the floor; food can taste extra, extra intense; ALT 71 (normal 7-52); sodium 131 (normal 136-144); MCH 34.20 (normal 26-34); MCV 100.30 (normal 80-98); i have a hard time seeing my computer screen; Headache; back pain; neck pain; shoulder pain; short term memory loss/memory problems; skin hurts; flustered; my body temperature, I can be freezing one minute and so hot; brain fog; can't find the words; I feel like I have ADD but on steroids; worked really hard to keep focus; not feeling well; itchy scalp that would be due to the Shingles; Muscle cramps; Muscle tightness; hard to walk; intense anxiety; big emotions, big anger, really really intense; big emotions, big anger, really really intense; exhausted/ fatigue; shingles; like the flu; staring into space; myoclonic jerks; hard time sleeping; stomach gas and bloating; stomach gas and bloating; This is a spontaneous report from a contactable consumer, the patient. A 64-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot: EJ1686), via an unspecified route of administration in the left arm on 17Jan2021 (at the age of 64-years-old) as a single dose for COVID-19 immunization. Medical history included ongoing preglaucoma diagnosed 3-4 years ago, ongoing anxiety and depression her whole life, bronchitis at age 5, sinus infections, ongoing sinus allergy "stuff" and allergies (now the patient managed the allergies and did not get sinus infections), "vagititis" over 10 years ago and just essentially being dry, menopause a long time ago, both big toes have some fungus for probably 3 years (toenails look ugly, discolored and thick), ongoing arthritis and bone spurs to C5 and C6 to the area of the neck for which the patient did physical therapy (PT) for about 2 years, low on b-12 when she had shingles last time in 2016, "because I dont want to get Covid" (prophylaxis therapy), nearsighted and wore bifocals. Concomitant medications included bupropion for anxiety and depression for 5 years or longer, loratadine for allergies, COLECALCIFEROL (VITAMIN D3) for depression for 10 (maybe 20) years or more, vitamin b complex (SUPER B COMPLEX) from 2016 and ongoing for "low on B-12", cyanocobalamin (VITAMIN B-12) from 2016 for low B12, latanoprost for preglaucoma, clonazepam from 2012 and ongoing for anxiety, ESTROGENS CONJUGATED (PREMARIN) vaginal cream for "vagititis" and just essentially being dry, ascorbic acid (VITAMIN C) for "because I dont want to get Covid" and an unspecified complete multivitamin for women 50 and older from 2020 "so I wouldn't get Covid". The patient previously got the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot: EK5730) in the left arm on 30Dec2020 (at the age of 64-years-old) for COVID-19 immunization. Around the middle of Feb2021, the patient had a hard time sleeping. She still napped during the day most days. Also around middle of Feb2021, the patient noticed muscle jerks, which came and went. It had gotten worse. The doctor said these were myoclonic jerks. The worst was on 28Mar2021. In the middle of the night, the patient called her on call doctor and asked if it might be a seizure. The physician said it was not a seizure. The weekend of 06Mar2021, the patient started to not feel well. She did not sleep well that Friday or Saturday night. She could not access her memory (short term memory loss) as of 07Mar2021, was flustered and it was clear that something was off as the day progressed. On 07Mar2021, the patient felt her skin hurt, like when you had a fever and the skin hurts. This came and went. Around 07Mar2021, the patient felt intense anxiety which branched out into other intense emotional reactions (big emotions, big anger). On an unspecified date, the patient had a sore inside the mouth. Around 07Mar2021, the patient felt freezing one minute and so hot the next. On 07Mar2021 at 03:00, the patient experienced a bad headache. It was like her neck and her back and her shoulders had intense pain, cramping pain and she had to soak in Epsom salt. The severe headache happened twice, lasted about 2-3 days, moved from the right side of the head, or top of the head. She stayed home from work on 08Mar2021 and 09Mar2021. The patient was exhausted and felt achy, like the flu. She had an appointment with the doctor on 15Mar2021. She was not feeling well at this point. The patient developed shingles (one spot on the right-hand side on back of head) sometime after 15Mar2021 and was diagnosed on 22Mar2021. The patient had an itchy scalp due to the shingles and claimed shingles caused memory issues and brain fog, since 07Mar2021, (it seemed like she got "COVID brain"). The patient was prescribed Valacyclovir 1 mg oral tablet every 8 hours, 30 tablets, for the shingles on 22Mar2021. The open spot on the scalp crusted over by 01Apr2021 when the patient saw the physician again. The patient stated that shingles has lasting effects: brain fog, can't find the words, short-term memory problems have been coming and going since 07Mar2021, felt liked she has attention deficit disorder (ADD) on steroids, worked really hard to keep focus. This has worsened, maybe manifested more so in the last 3-4 weeks or so. Sometimes when she got anxious, her prefrontal cortex did not function well. After being diagnosed with shingles, the patient began to take propranolol 40 mg in Mar2021 as needed (patient takes 1/8 or part of 1/8 of a tablet, just biting off a tiny piece). Initially when she had shingles, she had "some finger in the light socket, fight or flight internally"; the propranolol helped with this. She took it very regularly in Mar2021 and had taken once a week at most the last 2-3 weeks. The patient also took "Brain Goo" as of 22Mar2021 which caused the stinkiest gas in the universe, and the patient was bloated, (reported as from Feb2021) depending on what she ate, and because of that, the following week, the patient took an anti-gas pill, simethicone. She had muscle cramps (in the left upper thigh on the inside of the leg and outside of the leg) and tightness, in Mar2021, that made it hard to walk. The other area that tended to cramp up and cause problems were the arches, mostly the left arch. She reported it was probably 24Apr2021, she came downstairs in the afternoon or early evening and had such an intense cramp like a Charlie Horse and fell to the floor. Muscle cramps come and go, they shift around, it's in the left arch. It's not intensely sharp like it was that day. Right now, her left arch has a knot. The patient began taking tizanidine around 08Apr2021 at 4mg 1 tablet 3 times a day for muscle cramps and tightness, which can get painful, and tizanidine helps relax that. The patient experienced fatigue due to which the patient cannot go to the grocery store by herself very easily as she gets wiped out. The patient had to hang on to the cart because she does not have the energy. She described fatigue and stamina as she had energy for a while and then she crashed. She reported she had to carry protein with her because she can literally crash. She reported her left leg gave out and she had to grab onto the counter and she almost went to the floor. On 24Apr2021, the patient couldn't talk and could barely open her eyes. It felt like her body was shutting down. She couldn't get herself up off the couch to go to the bedroom. This had not happened again. She told her physician about it who was sending her to a neurologist. On 02May2021, her left hand knotted up- had a cramped muscle and tightness. The base of her thumb hurt (underneath the thumb where the thumb attaches to the hand). The patient felt that sound can hurt her ears, which came and went. The patient had a hard time seeing the computer screen, which started between 01Apr2021- 08Apr2021. The patient mentioned this to the physician. She was nearsighted and wore bifocals and wil

Other Meds: BUPROPION; LORATADINE; VITAMIN D3; SUPER B COMPLEX [VITAMIN B COMPLEX]; VITAMIN B-12; LATANOPROST; CLONAZEPAM; PREMARIN; VITAMIN C [ASCORBIC ACID]

Current Illness: Allergic sinusitis; Allergy; Anxiety (States all my life. Probably since before I was born.); Arthritis (To that area of my neck. I did PT for about 2 years); Bone spur (To that area of my neck. I did PT for about 2 years); Depression (States all my life. Probably since before I was born.); Preglaucoma, unspecified (Diagnosed 3-4 years ago)

ID: 1335966
Sex: F
Age: 37
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Shortly after administration of the Moderna #2 dose, patient experienced really dry throat. Her tongue felt weird but no swelling of throat, tongue, nor lips. She felt really dry, kept on drinking.. Said her throat was so dry that it felt like she couldn't swallow.

Other Meds: Unknown

Current Illness: Unknown

ID: 1335967
Sex: F
Age: 19
State: WI

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Noon

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

Symptoms: Dizziness, patient sat and lied on her back, she felt better and walked out of the pharmacy fine.

Other Meds: Advil, Birth Control

Current Illness: Noon

ID: 1335968
Sex: M
Age: 49
State: CA

Vax Date: 05/18/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Unevaluable event

Symptoms: Approx. 4.5 mm Red Spot on right eye, below pupil. No pain, no irritation... just the Red Spot on the eye.

Other Meds: NONE

Current Illness: NONE

ID: 1335969
Sex: F
Age: 60
State: CA

Vax Date: 04/22/2021
Onset Date: 05/12/2021
Rec V Date: 05/20/2021
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: Amoxcillin

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Sore Arm and shooting pains throughout my body. My lymphnode under my left arm where I got my shot swelled up 2 weeks from initial shot. 1 week prior to my 2nd vaccine my lymphnodes swelled up and my right lymphnode behind my right ear got really large. It has since gone down but all my lymphnodes are enlarged.

Other Meds: Claritin Redditabs

Current Illness: None

ID: 1335970
Sex: M
Age: 18
State: KY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NONE

Symptom List: Injection site pain, Pain

Symptoms: The customer , within 5-10 min post vaccination, felt light-headed, dizzy, and fell from the chair while was on a 15 minute waiting , seated on a chair post vaccination. A mild bruise seen on the forehead. As soon as, within few seconds, pharmacist was notified. The customer immediately responded to pharmacist's questions. Did not call 911 due to his response and alertness. Epipen was ready but was not required.

Other Meds: NONE

Current Illness: NO

ID: 1335971
Sex: F
Age: 55
State: LA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: light headed and shakes

Other Meds: unknown

Current Illness: unknown

ID: 1335972
Sex: M
Age: 61
State: NV

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/20/2021
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: None

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

Symptoms: Patient presented at the pharmacy on 05/20/2021 stating he has arm pain from the COVID vaccine he received 04/08/21. Patient states he has limited range of motion and the arm has pain radiating down. Patient received his second COVID vaccine in the left arm without incident.

Other Meds: Unknown

Current Illness: Unknown

ID: 1335973
Sex: F
Age: 25
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Penicillins

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient stated she needed the Pfizer COVID shot for her 2nd dose, but she actually received the Moderna COVID shot for her 1st dose. Patient was given the Pfizer shot for her 2nd dose when she should have received the Moderna shot.

Other Meds: N/A

Current Illness: N/A

ID: 1335974
Sex: U
Age:
State: NV

Vax Date:
Onset Date:
Rec V Date: 05/20/2021
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: None stated.

Other Meds: "For your protection, your session has expired after 20 minutes of inactivity, and no information was stored in your computer's memory" ******** I WAS ACTIVELY FILLING OUT THE FORM WHEN IT SUDDENLY DISAPPEARED AND THIS MESSAGE POPPED UP.

Current Illness:

ID: 1335975
Sex: M
Age: 30
State: NH

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: No

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

Symptoms: Patient experienced a minor seizure-like reaction that lasted for about 5 seconds. Patient was monitored for about 30 minutes. Blood pressure, heart rate and oxygen saturation were normal.

Other Meds: No

Current Illness: No

ID: 1335976
Sex: F
Age: 39
State: CA

Vax Date: 04/29/2021
Onset Date: 05/03/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Morfine

Symptom List: Nausea

Symptoms: Severe itchy throat,constant nose irritation & sneezing,severe eye itchiness with redness of the eye & pupil dilated,fatigue,jaw pain.

Other Meds: Metformin 500mg,Tazloc 40mg

Current Illness:

ID: 1335977
Sex: F
Age: 13
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: None indicated at time of vaccination

Symptom List: Injection site pain

Symptoms: Patient wa receiving their first Pfizer COVID vaccine. Student was well hydrated and had eaten a meal prior to vaccination. After administering vaccine, patient lost consciousness, slumped to her left side, and had seizure-like body jerk movements. She then regained consciousness, then lost consciousness again immediately after and proceeded to have whole body jerking movements. She then started sliding to the floor from her seat. Patient was lowered to ground with help from another RN. Vitals were taken, BP 102/82, HR 48 and RR 20. Dr. assessed patient and 911 was called for further assessment. Patient was not transported in ambulance and left clinic with parent recovered.

Other Meds: None indicated at time of vaccination

Current Illness: None indicated at time of vaccination

ID: 1335978
Sex: M
Age: 40
State:

Vax Date: 05/04/2021
Onset Date: 05/07/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Ritalin, cefaclor

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

Symptoms: Mild SOB with moderate intensity activity, similar sensation to asthma he had when he was younger. No wheezing. Improved after the first week.

Other Meds:

Current Illness:

ID: 1335979
Sex: M
Age: 42
State: GA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 05/20/2021
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: Azithromycin

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

Symptoms: Fever, tightness in chest, loss of energy, difficulty breathing

Other Meds: N/A

Current Illness: N/A

ID: 1335980
Sex: F
Age: 52
State: MD

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NO ALLERGIES

Symptom List: Tremor

Symptoms: VOMITING, DIZZINES AND SWEATING AFTER VACCINE. BLOOD PRESSURE TAKEN, AND PATIENT MONITORED FOR SIGNS OF ANAPHYLAXIS. STORE MANAGEMENT CALLED 911 FOR EMERGENGY, MEDIC ARRIVED AND TOOK OVER THE TREATMENT

Other Meds: VERAPAMIL 120MG, LISINOPRIL/HCTZ 20/12.5

Current Illness: PATIENT IS NOT SICK AT THE TIME OF VACCINATION

ID: 1335981
Sex: M
Age: 74
State: NY

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/20/2021
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: Patient called pharmacy to say he had developed a Rash and Hives the evening of his vaccine (vaccinated in the morning). Patient treating at home with hydrocortisone 1% and oral benadryl.

Other Meds: unknown

Current Illness: unknown

ID: 1335982
Sex: M
Age: 14
State: MT

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NONE

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

Symptoms: PATIENT PASSED OUT WHILE STANDING AND HIT HEAD. ELEVATED FEET AND PARAMEDICS CAME AND CHECKED ON HIM, BUT HE FELT FINE AND WENT HOME

Other Meds: NONE

Current Illness: NONE

ID: 1335983
Sex: M
Age: 29
State: VA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE KNOWN. NONE.

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

Symptoms: PATIENT FAINTED IN THE OBSERVATION CHAIR ABOUT 10 MINUTES AFTER RECEIVING THE J & J COVID -19 VACCINE. HE FELL OUT OF THE CHAIR BUT WAS NOT SERIOUSLY INJURED, HE MAY HAVE BUMPED HIS MOUTH. THE PHARMACY TECHNICIAN IMMEDIATELY HELPED HIM UP BACK TO HIS CHAIR AND GAVE HIM A BOTTLE OF WATER. SHE ALSO CHECKED HIS BLOOD PRESSURE (NOW AT 136/94). I CALLED 911 BUT HE DECLINED ANY ADDITIONAL ASSISTANCE SO I TOLD THEM TO CANCEL. WE ASKED HIM TO WAIT AN ADDITIONAL 5-10 MINUTES AND HE WAS FINE. HE LEFT ON HIM OWN ACCORD. I TOLD HIM THAT HE MAY RECEIVE A CALL FROM US AS A FOLLOW UP TO THE EVENT.

Other Meds: NONE KNOWN

Current Illness: NO

ID: 1335984
Sex: F
Age: 31
State: NH

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient fainted shortly after the administration of vaccine. She regained consciousness after approximately 10 seconds. 911 was called and patient was assessed by EMT's. After about 20 to 30 minutes the dizziness and sweating had concluded.

Other Meds: N/A

Current Illness: No

ID: 1335985
Sex: M
Age: 41
State: CO

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: hydrocodone and codeine

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

Symptoms: Patient had no previous issues with vaccines in the past. Patient went to the post-vaccination chairs and about 2 minutes after giving the Moderna COVID-19 vaccine, patient's wife informed me he was not feeling well. Patient was sweating profusely, shaking, light headedness, and difficulty breathing. Site of injection looked normal. I brought him back to the immunizing booth, laid him down, gave him something soft to lay his head on and cover- up with. His sweating and shaking seemed to get worse. He wanted to sit in the chair since the floor was cold. We sat him up, gave him an ice pack, and gave him some orange juice. We called 911 and instructed EMS where to find us and the patient's symptoms. While waiting on EMS, his symptoms improved slightly. They arrived quickly and assessed the patient's blood pressure, heart rate, and blood sugar. He did not feel as if he needed to go to the hospital. I had the patient wait in the immunization booth a bit longer. He felt better, and color came back into his face. He went home with his wife. I gave them the V-Safe info, so he can report any issues while at home.

Other Meds:

Current Illness: none

ID: 1335986
Sex: F
Age: 28
State: IN

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/20/2021
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: Bee stings- area gets really red and swollen.

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

Symptoms: Patient received Moderna COVID-19 vaccine on 5/8/2021 and developed redness at the site (the day of the injection). Area was very sensitive to the touch for the first 12 hours. Starting 5/9/2021, patient developed swelling at the site of injection, which extended from the site of injection all the way to the wrist area. This persisted for about 7 days. Reaction has now resolved.

Other Meds:

Current Illness:

ID: 1335987
Sex: F
Age: 38
State: ND

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Latex, penicilliums, mold

Symptom List: Pain in extremity

Symptoms: Tingly arm, down to finger tips. Had similar reaction with 1st COVID vaccine but it got better within 15 minutes. Arm still numb after 2 hours, fingers tingly. No feeling in arm. Capillary refill was good. Grip weaker on affected arm. Motor function is fine (she was typing on a keyboard). Called a day later to check on PT. Her whole arm is still numb, tingly feeling started coming back to her fingers about 6pm 5/20/21. Experienced other effects from the vaccine like fever, chills, shakes, and nausea.

Other Meds: None

Current Illness: None

ID: 1335988
Sex: M
Age: 15
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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 indicated at time of vaccination

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

Symptoms: Patient received first dose of Pfizer vaccine. Instantly became nauseous and Faint/pale. Assisted him to the floor elevated legs. No LOC. Pulse was 80, BP 138/80

Other Meds: None indicated at time of vaccination

Current Illness: None indicated at time of vaccination

ID: 1335989
Sex: F
Age: 35
State: MO

Vax Date: 04/21/2021
Onset Date: 05/14/2021
Rec V Date: 05/20/2021
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: A few weeks after the vaccine, I noticed a rash on my right lower back/side that was diagnosed as shingles at urgent care later that night. I was prescribed Valtrex, which I took for 7 days (3 times a day). Luckily, I caught the virus early enough that I did not have much pain. I had some itching once the rash was scabbing over. I also had a pins & needles feeling in my feet and right hand in the weeks leading up to my shingles diagnosis. I also had severe chills a few days before the shingles rash appeared.

Other Meds: Lexapro. Xanax. Tramadol. Ibuprofen. Had an iron infusion the day before vaccination.

Current Illness: Anemia. Endometriosis.

ID: 1335990
Sex: F
Age: 30
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: DOB: 3/21/1991. Received her second dose Pfizer (LOT#: EW0185 EXP: 8/2021) at 1441 on 5/18/21. Patient alerted EMT. Patient stated that she felt dizzy and had a severe headache. Patient stated it was an 8/10 on the pain scale. Patient stated she had lunch around 1200. EMT took patients vital signs at 1500. BP: 108/72 pulse: 86, O2: 99%. Patient was given water. Patient was asked to stay an extra 30 minutes for further observation. EMT reassessed and re-took vital signs at 1510. BP: 122/72, pulse: 82, O2: 97%. Patient stated she was feeling slightly better. Patient stated the pain from headache went down to 7/10. EMT reassessed and re-took vital signs at 1530. BP: 124/78, pulse: 74, O2: 96%. Patient stated she was feeling a lot better. Patient stated the pain from headache went down to 5/10. Patient was educated on worsening signs and symptoms of vaccine and when to seek EMS or urgent care. Patient verbalized understanding of education. Patient completed observation time. Patient left vaccination site at 1535. Patient left vaccination site unassisted and with a steady gait.

Other Meds:

Current Illness:

ID: 1335991
Sex: F
Age: 14
State: HI

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/20/2021
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: Unknown

Symptom List: Vomiting

Symptoms: Allergic reaction. Unable to breathe and face swelling. Required ER visit

Other Meds: Zofran

Current Illness: Gastrointestinal issues, weight loss, loss of appetite

ID: 1335992
Sex: M
Age: 15
State: ME

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/20/2021
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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Developed itching of scalp 2 hours post injection, spread to arms the next day. 3 days later developed hives over her wrist and knees. On day 4 hives worsened, and experienced brief (~1hr) period of chest heaviness that self resolved. Treated with Zyrtec which helped itch for a day. Benadryl not helpful. Day 5 woke with morbilliform rash over trunk and fever to 101.9, lasted a few hours, all symptoms resolved over the course of day 5.

Other Meds: Concerta, Malatonin, Adapalene gel

Current Illness:

ID: 1335993
Sex: F
Age: 38
State: IN

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: PATIENT BECAME DIZZY AND LIGHTHEADED THEN HAD NAUSEA 20 MINUTES AFTER SHOT. SHE WAS GIVEN WATER AND SOMETHING TO EAT SINCE I BELIEVE SHE MISSED EATING BREAKFAST. PATIENT SAT FOR 30 MORE MINUTES AND WAS FEELING ALITTLE BETTER AND LEFT TO GO LAY DOWN AT HOME

Other Meds: NAPROXEN 220 MG

Current Illness: NONE

ID: 1335994
Sex: F
Age: 11
State: AZ

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: A 11-year-old patient was inadvertently immunized with Pfizer-BioNTech COVID-19 vaccine which is approved for 12 years-old and older. Patient was observed for the recommended 15 minutes post-vaccination with no adverse events noted.

Other Meds:

Current Illness:

ID: 1335995
Sex: M
Age: 69
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 05/20/2021
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

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

Symptoms: 1st dose on 1/15/2021 I had only mild symptoms of arm soreness, tiredness and headache. 2nd dose on 2/12/2021 I had greater symptoms. Continued to have arm soreness and tiredness. However, strong headache persisted for several days. My family was concerned and almost sent me to the hospital on 2/21/2021 due to my flushed face and appearance of being ill. Most concerning, from that date, my diabetes blood sugar readings have become excessive for more than two months following. My doctor has had to add Jardiance to my other medications to try and control it. I am still not in the desired range to match where I was prior to my COVID vaccination.

Other Meds: Metformin; Glimepiride; Januvia; Ibesartan/Hydrochlorathiazide

Current Illness: None

ID: 1335996
Sex: M
Age: 40
State: TX

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NO

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

Symptoms: PATIENT FELT LIGHT HEADED, NAUSEOUS COUPLE MINUTES AFTER VACCINATION. WE GAVE HIM SOME WATER AND WET PAPER TOWEL. CHECKED HIS FOREARM BLOOD PRESSURE, IT WAS 78/47 HEART RATE 46. PATIENT SAID HE HAS NEEDLE PHOBIA, HE HADN'T EATEN SINCE 8 IN THE MORNING. HE WAS STILL ABLE TO TALK AND KEPT SAYING HE WAS FEELING MUCH BETTER, HE DIDN'T WANT US TO CALL 911 OR GET EXTRA MEDICAL HELP. WE GAVE HIM SOME GATORADE AND FOOD TO EAT. CHECKED HIS BLOOD PRESSURE AGAIN 30 MINUTES AFTER THE FIRST CHECK IT WAS 126/75 HEART RATE 77.

Other Meds:

Current Illness: NONE. PATIENT JUST SAID HE HAS NEEDLE PHOBIA

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm