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

Incidents per State

State Total
88,334
AK1,815
AL6,133
AR3,993
AS45
AZ14,539
CA64,759
CO12,159
CT8,719
DC1,747
DE1,868
FL41,499
FM3
GA16,132
GU92
HI2,477
IA4,739
ID2,763
IL21,496
IN23,655
KS4,844
KY8,414
LA5,328
MA15,281
MD13,105
ME3,277
MH8
MI20,143
MN12,873
MO10,275
MP30
MS3,073
MT2,392
NC17,450
ND1,440
NE3,023
NH3,124
NJ19,456
NM4,089
NV4,600
NY36,525
OH20,140
OK6,525
OR8,918
PA24,920
PR2,483
QM2
RI2,092
SC6,952
SD1,243
TN10,038
TX38,745
UT4,482
VA15,477
VI62
VT1,780
WA15,487
WI11,573
WV2,461
WY894
XB5
XL1
XV2

ID: 1440182
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 11-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006064: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498:

Other Meds:

Current Illness:

ID: 1440183
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 11-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source. ; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006064: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440184
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 11-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source. ; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006064: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440185
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 11-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006064: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440186
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 21-JUN-2021, the patient was vaccinated with a dose of varicella virus vaccine live (Oka/Merck) (VARIVAX) (lot # T029533 exp date 01-SEP-2022) (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006064: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440187
Sex: U
Age:
State: WA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 11-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006064: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440188
Sex: U
Age:
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 10-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006064: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440189
Sex: U
Age:
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 10-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006064: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440190
Sex: U
Age:
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 10-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006064: US-009507513-2106USA006497: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440191
Sex: U
Age:
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 07/01/2021
Hospital:

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Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 10-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006064: US-009507513-2106USA006498: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440192
Sex: U
Age:
State: WA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Allergies:

Symptom List:

Symptoms: PROQUAD underwent a temperature excursion and was administered; This spontaneous report as received from a licensed practical nurse refers to a patient of unknown age and gender. On 10-JUN-2021, the patient was vaccinated with a dose of Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (lot # T036562 exp date 26-APR-2022) rHA (dose and route not reported) that underwent a temperature excursion. Previous temperature of excursion was 6?F to 14?F (14F) for 2 hours, 14?F to 46?F (45.5F) 1 hour and 30 minutes and 6?F t o14?F (14.4F) for 2 hours. This is one of several reports received from the same source.; Sender's Comments: US-009507513-2106USA006475: US-009507513-2106USA006476: US-009507513-2106USA006477: US-009507513-2106USA006478: US-009507513-2106USA006479: US-009507513-2106USA006480: US-009507513-2106USA006481: US-009507513-2106USA006482: US-009507513-2106USA006483: US-009507513-2106USA006484: US-009507513-2106USA006485: US-009507513-2106USA006486: US-009507513-2106USA006487: US-009507513-2106USA006488: US-009507513-2106USA006489: US-009507513-2106USA006490: US-009507513-2106USA006491: US-009507513-2106USA006492: US-009507513-2106USA006493: US-009507513-2106USA006494: US-009507513-2106USA006495: US-009507513-2106USA006496: US-009507513-2106USA006497: US-009507513-2106USA006064: US-009507513-2106USA006458: US-009507513-2106USA006459: US-009507513-2106USA006460: US-009507513-2106USA006461: US-009507513-2106USA006462: US-009507513-2106USA006463: US-009507513-2106USA006464: US-009507513-2106USA006465: US-009507513-2106USA006466: US-009507513-2106USA006467: US-009507513-2106USA006468: US-009507513-2106USA006469: US-009507513-2106USA006470: US-009507513-2106USA006471: US-009507513-2106USA006472: US-009507513-2106USA006473: US-009507513-2106USA006474:

Other Meds:

Current Illness:

ID: 1440193
Sex: U
Age:
State:

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

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Symptoms: I got the shingles shot twice. Both times I got the shingles.; This case was reported by a consumer via interactive digital media and described the occurrence of shingles in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced shingles. On an unknown date, the outcome of the shingles was recovered/resolved. It was unknown if the reporter considered the shingles to be related to Shingles vaccine. Additional details were provided as follows: The case was reported by the patient. The age at vaccination was not reported. The patient got the shingles shot and got the shingles. The reporter stated that, shingles were one of the many side effets from the covid shot and this was the reason why the patient's doctor advised not to take the covid shot. For tolerance to the 2nd dose of shingles vaccine refer linked case US2021AMR139344, reported by same reporter.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR139344:Same reporter

Other Meds:

Current Illness:

ID: 1440194
Sex: F
Age:
State:

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

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Symptoms: I let my daughter get 2 of the 3 shots; This case was reported by a consumer via interactive digital media and described the occurrence of incomplete course of vaccination in a female patient who received HPV 16-18 (HPV vaccine) for prophylaxis. Previously administered products included HPV vaccine (received 2 doses of HPV vaccine on an unknown date). On an unknown date, the patient received the 3rd dose of HPV vaccine. On an unknown date, unknown after receiving HPV vaccine, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were provided as follows: This patient was reporter's daughter. The age at vaccination was not applicable for this report. Till the time of reporting the patient had taken 2 doses of HPV vaccine and not taken the 3rd dose, which led to incomplete course of vaccination. This case has been linked with US2021AMR139467, reported by same reporter; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR139467:Same reporter

Other Meds:

Current Illness:

ID: 1440195
Sex: U
Age:
State:

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

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Symptoms: I made mistake and took Shingrix series 2 times; This case was reported by a consumer via interactive digital media and described the occurrence of extra dose administered in a patient who received Herpes zoster (Shingrix) for prophylaxis. Co-suspect products included Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 3rd dose of Shingrix and the 4th dose of Shingrix. On an unknown date, unknown after receiving Shingrix and Shingrix, the patient experienced extra dose administered. On an unknown date, the outcome of the extra dose administered was unknown. Additional details were provided as follows: The patient reported the case for herself/himself. The age at vaccination was not reported. The patient mistakenly took Shingrix series 2 times, which led to extra dose administered. The reporter asked if he/she was ok.

Other Meds:

Current Illness:

ID: 1440196
Sex: U
Age:
State: FL

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

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Symptoms: I received my first shot / in 2018 but never got the second; This case was reported by a consumer via call center representative and described the occurrence of incomplete course of vaccination in a 80-year-old patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (received first shot of Shingrix in 2018). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were reported as follows: This case was reported by patient for herself/himself. Till the time of reporting, patient did not received 2nd dose of Shingrix, which led to incomplete course of vaccination. The reporter asked he/she needs to start all over and get two shots at proper interval or just get a second shot. The patient was 80 years old and also received two shots of the Moderna vaccine in March and April of this year.

Other Meds:

Current Illness:

ID: 1440197
Sex: F
Age: 11
State: FL

Vax Date: 06/22/2021
Onset Date: 06/01/2021
Rec V Date: 07/01/2021
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Symptoms: administered a 11 yr old a 3rd dose / on 6/22, (already got 2 doses of havrix ); got a rash after the 3rd dose, patient developed a flat red rash; This case was reported by a nurse via call center representative and described the occurrence of red rash in a 11-year-old female patient who received HAV (Havrix) (batch number YR532, expiry date 9th September 2022) for prophylaxis. Co-suspect products included hepatitis A vaccine pre-filled syringe device (Havrix Pre-Filled Syringe Device) injection syringe for prophylaxis. Previously administered products included Havrix with an associated reaction of no adverse event (first dose received on 7th April 2011) and Havrix with an associated reaction of no adverse event (2nd dose received on 13th October 2011). On 22nd June 2021, the patient received the 3rd dose of Havrix and Havrix Pre-Filled Syringe Device. In June 2021, less than a week after receiving Havrix and Havrix Pre-Filled Syringe Device, the patient experienced red rash. On 22nd June 2021, the patient experienced extra dose administered. On an unknown date, the outcome of the red rash and extra dose administered were unknown. It was unknown if the reporter considered the red rash to be related to Havrix and Havrix Pre-Filled Syringe Device. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details were reported as follows: This case was reported by a Nurse. Nurse reported a medical assistant administered a 3rd dose of Havrix, which led to extra dose administered. The patient developed a flat red rash. No other complication. Consented to follow up.

Other Meds:

Current Illness:

ID: 1440198
Sex: U
Age:
State: MI

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

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Symptoms: late for their second dose / within the last year most likely due to COVID but didn't have any further details; This case was reported by a pharmacist via call center representative and described the occurrence of social problem in a patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (1st dose received on an unknown date). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced social problem. On an unknown date, the outcome of the social problem was unknown. Additional details were provided as follows: The age at vaccination was not applicable for this report. The reporter stated that, patient was might be two months late for their second dose of Shingrix within the last year most likely due to COVID, which led to social problem. The reporter stated that, did not have any further details. The reporter did not consent to follow up.

Other Meds:

Current Illness:

ID: 1440199
Sex: M
Age:
State: TX

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

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Symptoms: been 2 years since the 1st dose; This case was reported by a pharmacist via call center representative and described the occurrence of incomplete course of vaccination in a 61-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (1st dose received on an unknown date ). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were provided as follows: The age at vaccination was not applicable for this report. The reporter stated that, it had been 2 years since the 1st dose of Shingrix. Till the time of reporting, the patient did not receive 2nd dose of Shingrix, wchich led to incomplete course of vaccination. No reactions reported. The reporter did not consent to follow up.

Other Meds:

Current Illness:

ID: 1440200
Sex: F
Age: 62
State: CO

Vax Date: 06/21/2021
Onset Date:
Rec V Date: 07/01/2021
Hospital:

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Symptoms: administered / shingrix on 6/21/2021 / was left outside at room temperature for a week; This case was reported by a other health professional via call center representative and described the occurrence of incorrect storage of drug in a female patient who received Herpes zoster (Shingrix) (batch number NR55Z, expiry date 22nd October 2022) for prophylaxis. On 21st June 2021, the patient received the 1st dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incorrect storage of drug. On an unknown date, the outcome of the incorrect storage of drug was unknown. Additional details were provided as follows: The reporter stated that, patient was administered a first dose of shingrix that was left outside at room temperature for a week, which led to incorrect storage of drug. The reporter consented to follow up. The batch number of Shingrix was updated from NR55V to NR55Z as per sales data sheet.

Other Meds:

Current Illness:

ID: 1440201
Sex: U
Age:
State: CO

Vax Date: 06/20/2021
Onset Date:
Rec V Date: 07/01/2021
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Symptoms: placing two and a half boxes of the Shingrix vaccines/ by mistake/Shingrix placed in the freezer; This case was reported by a physician via call center representative and described the occurrence of incorrect storage of drug in a patient who received Herpes zoster (Shingrix) (batch number E9C7K, expiry date 14th October 2022) and (batch number 393C7, expiry date 25th October 2022) for prophylaxis. On 20th June 2021, the patient received Shingrix. On 20th June 2021, the dose was an unknown dose. On an unknown date, unknown after receiving Shingrix, the patient experienced incorrect storage of drug. On an unknown date, the outcome of the incorrect storage of drug was unknown. Additional details were provided as follows: The age at vaccination was not reported. The reporter stated that, placing two and a half boxes of the Shingrix vaccines by mistake. No further events were reported. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1440202
Sex: M
Age:
State: FL

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

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Symptoms: received dose one / on 07Sep2019 and forgot to return for dose two; This case was reported by a pharmacist via call center representative and described the occurrence of incomplete course of vaccination in a male patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (1st dose received on 7th September 2019). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were provided as follows: The age at vaccination was not applicable for this report. The reporter stated that, the patient forgot to return for dose two. Till the time of reporting the patient did not receive 2nd dose of Shingrix, which led to incomplete course of vaccination. No further details provided on the call. Specialist forgot to ask whether pharmacist granted permission for follow up from safety.

Other Meds:

Current Illness:

ID: 1440203
Sex: F
Age: 52
State: CA

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 07/01/2021
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Symptoms: given just the Shingrix adjuvant only (unreconstituted Shingrix); given just the Shingrix adjuvant only (unreconstituted Shingrix); This case was reported by a pharmacist via call center representative and described the occurrence of inappropriate preparation of medication in a 52-year-old female patient who received Herpes zoster (Shingrix) (batch number 44DX9, expiry date 28th October 2022) for prophylaxis. On 12th June 2021, the patient received the 1st dose of Shingrix. On 12th June 2021, unknown after receiving Shingrix, the patient experienced inappropriate preparation of medication and inappropriate dose of vaccine administered. On an unknown date, the outcome of the inappropriate preparation of medication and inappropriate dose of vaccine administered were unknown. Additional details were provided as follows: The pharmacist reported that a female patient was given just the Shingrix adjuvant only, which led to inappropriate preparation of medication and inappropriate dose of vaccine administered. No symptoms reported. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1440204
Sex: F
Age:
State: CA

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

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Symptoms: received the 1 dose / in October 2020 / should have gotten the 2nd dose in April 2021, but she didn't; This case was reported by a nurse via call center representative and described the occurrence of incomplete course of vaccination in a female patient who received Herpes zoster (Shingrix) for prophylaxis. Previously administered products included Shingrix (1st dose received in October 2020). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced incomplete course of vaccination. On an unknown date, the outcome of the incomplete course of vaccination was unknown. Additional details were provided as follows: The age at vaccination was not aplicable for this report. The reporter stated that, the patient should have gotten the 2nd dose in April 2021, but she did not, so she was more than 60 days late for it. Till the time of reporting, the patient did not receive 2nd dose of Shingrix, which led to incomplete course of vaccination. No further details were provided at the time of the call. The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1440207
Sex: U
Age:
State:

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

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Symptoms: MYOCARDIAL INFARCTION/ TROPONIN INCREASED; This spontaneous report received via social media from a consumer concerned multiple patients of unspecified age, sex, race and ethnic origin. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patients 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. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients experienced myocardial infarction/ troponin increased. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of myocardial infarction/ troponin increased was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0: 20210647168-covid-19 vaccine ad26.cov2.s-Myocardial infarction/ troponin increased. This event(s) is considered unassessable. The event(s) has an unknown/unclear 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: 1440208
Sex: F
Age:
State: NY

Vax Date:
Onset Date: 03/01/2021
Rec V Date: 07/01/2021
Hospital: Y

Vax Type:
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Allergies:

Symptom List:

Symptoms: COULD NOT SPEAK A FULL SENTENCE; VERY PAINFUL INFLAMMATION OF CHEST, INFLAMED CHEST WALLS; CRAZY RIDICULOUS VAGINAL BLEEDING; ANEMIC; ALMOST DIED; FAINTING AFTER BLOODWORK; CRYING FOR NO REASON; DOING REGULAR THINGS AT A SLOWER PACE; SLOWLY DYING; This spontaneous report received from a patient concerned a 47 year old, female. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805018, and expiry: UNKNOWN) dose was not reported, 1 total administered on 21-MAR-2021 for prophylactic vaccination. Concomitant medications included iron for anemia. On 21-MAR-2021, shortly after vaccination patient became very tired and felt like getting sick and felt like as it was the expected. Patient stayed on couch next day. On 23-MAR-2021, bleeding was started which was not normal bleeding. Patient knew that she had to see hematologist as oxygenated blood was leaving her body. Patient experienced very heavy vaginal bleeding. Patient called gynecologist and was advised to go to emergency room, if patient bleed more than a pad an hour. Patient went to doctor shortly because patient felt this was not normal and something else was going on. When doctor took patient's blood, she fainted. Patient was healthy before shot and never had this before. Patient had intravenous (IV) so that patient could drive home. Patient was doing regular things at slower pace. Some weird things happened at 17.00 daily, patient cried for no reason. Blood test was received with something low. Patient went to the emergency room where they gave her blood, which patient never needed before in her life. Patient needed 2 units of bloods. Patient was slowing dying but did not know it. Patient was now anemic and needed 4 iron infusions and maybe needed 5th also. Patient had been told to follow-up in august. Patient was not sure that her body was making her own blood again. Patient felt almost died. Patient could not speak a full sentence even after the emergency room visit. Patient was still bleeding. Patient also experienced inflammation in chest which was very painful. Patient started birth control on 14-MAY-2021 and 15-MAY-2021 and stayed on until 24-MAY-2021. Patient started bleeding again on 25-MAY-2021 which continued till 29-MAY-2021. Patient had a lot of shortness of breath and thought may be a blood clot but on 20-MAY-2021, X-ray showed no clots. Cardiologist said this was most likely from the COVID Shot and likely inflammation. Patient chest was still painful to touch and it was better than before. Patient was on iron pills but stopped after the 3rd infusion of iron and patient's anemia levels was improved. On 23-MAR-2021. Laboratory data included: Blood test (NR: not provided) showed low hematocrit and hemoglobin. Laboratory data (dates unspecified) included: Gynecological examination (NR: not provided) fine, and Physical examination (NR: not provided) fine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from crazy ridiculous vaginal bleeding on 29-MAY-2021, fainting after bloodwork on 09-APR-2021, and crying for no reason on 13-JUN-2021, was recovering from anemic, and could not speak a full sentence, had not recovered from very painful inflammation of chest, inflamed chest walls, and the outcome of almost died, slowly dying and doing regular things at a slower pace was not reported. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender's Comments: V0: 20210651060- JANSSEN COVID-19 VACCINE Ad26.COV2.S ?Fainting, Almost died, Vaginal bleeding, Anemia, Could not speak, Chest wall pain. 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: IRON ORAL

Current Illness:

ID: 1440210
Sex: M
Age:
State:

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

Vax Type:
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Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: PALE FOR ABOUT A DAY AND HALF; COLD SWEAT; CHILLS; This spontaneous report received from a consumer via a company representative concerned a male of unspecified age. The patient's height, and weight were not reported. No past medical history or concurrent conditions were 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. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the subject experienced pale for about a day and half, cold sweat, and chills. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from pale for about a day and half, cold sweat, and chills. This report was non-serious. This case, from the same reporter is linked to 20210662161.

Other Meds:

Current Illness:

ID: 1440211
Sex: M
Age:
State: CT

Vax Date:
Onset Date: 04/01/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: VERTIGO; CAN NOT OPEN JAW; BODY ACHE; FEELING REALLY TIRED; LACK OF FOCUS; EYE DISORDER; EAR DISORDER; This spontaneous report received from a parent concerned a 45 year old male. The patient's height, and weight were not reported. The patient's past medical history included defibrillator, and concurrent conditions included muscular dystrophy, atrial fibrillation, and cardio myopathy. The patient experienced drug allergy when treated with fentanyl, and meclozine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, and expiry: UNKNOWN) dose was not reported, administered on 31-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On APR-2021, the subject experienced lack of focus. On APR-2021, the subject experienced eye disorder. On APR-2021, the subject experienced ear disorder. On 01-APR-2021, the subject experienced body ache. On 01-APR-2021, the subject experienced feeling really tired. On 02-APR-2021, the subject experienced vertigo. On 02-APR-2021, the subject experienced can not open jaw. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body ache, and feeling really tired on 04-APR-2021, was recovering from can not open jaw, had not recovered from vertigo, and the outcome of lack of focus, eye disorder and ear disorder was not reported. This report was non-serious.; Sender's Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.

Other Meds:

Current Illness: Atrial fibrillation; Cardiomyopathy; Muscular dystrophy

ID: 1440212
Sex: U
Age:
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: FELT DIZZY; COLD; MILD FEVER; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient's height, and weight were not reported. No past medical history or concurrent conditions were 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. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the subject experienced felt dizzy, cold, and mild fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from felt dizzy, cold, and mild fever. This report was non-serious.

Other Meds:

Current Illness:

ID: 1440213
Sex: F
Age:
State:

Vax Date:
Onset Date: 04/01/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: PASSING OUT; LIGHT HEADED; BLOOD PRESSURE STARTED DROPPING WITHIN 10 MINUTES; STARTING TO VOMIT; This spontaneous report received from social media and a patient via a company representative concerned a female of unspecified age and of unknown race and ethnicity. The patient's height, and weight were not reported. No past medical history or concurrent conditions were 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, 1 total administered on APR-2021 for prophylactic vaccination. No concomitant medications were reported. 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 in APR-2021, the patient's felt light-headed, then patient's blood pressure started dropping within 10 minutes of getting the vaccine. The patient remembered when sitting in the car and was passing out she started to vomit. The patient was taken to hospital by ambulance. Laboratory data included: Blood pressure (NR: not provided) Decreased. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the light headed, blood pressure started dropping within 10 minutes, passing out and starting to vomit was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210667007.; Sender's Comments: V0:20210666416-COVID-19 VACCINE AD26.COV2.S-Passing out. 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: 1440214
Sex: U
Age:
State:

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a consumer via social media and company representative concerned a patient of unspecified sex, age, unknown race and ethnicity. The patient's height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, 1 total, 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 patient experienced suspected clinical vaccination failure, and suspected covid-19 infection. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0:20210666714-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has an unknown/unclear 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: 1440215
Sex: F
Age: 59
State: MN

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies:

Symptom List:

Symptoms: I have been in and out of hospital because of being dehydrated after vaccine.; Diarrhea; I had watery diarrhea and couldn't eat anything because this continued happened; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea) and DEHYDRATION (I have been in and out of hospital because of being dehydrated after vaccine.) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033821A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Irritable bowel syndrome. Concurrent medical conditions included Sleep disorder. On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Mar-2021, the patient experienced DECREASED APPETITE (I had watery diarrhea and couldn't eat anything because this continued happened). On 21-Mar-2021, the patient experienced DIARRHOEA (Diarrhea) (seriousness criterion medically significant). On an unknown date, the patient experienced DEHYDRATION (I have been in and out of hospital because of being dehydrated after vaccine.) (seriousness criterion medically significant). The patient was treated with LOPERAMIDE HYDROCHLORIDE (IMODIUM) for Diarrhea, at an unspecified dose and frequency. At the time of the report, DIARRHOEA (Diarrhea), DEHYDRATION (I have been in and out of hospital because of being dehydrated after vaccine.) and DECREASED APPETITE (I had watery diarrhea and couldn't eat anything because this continued happened) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment medication also included unspecified IV fluids and fodmap diet. Concomitant medication included unspecified medicine to sleep at night Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested. This case was linked to MOD-2021-225401 (Patient Link).; Sender's Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1440216
Sex: M
Age: 34
State: NC

Vax Date: 05/10/2021
Onset Date: 06/03/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
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Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe headache in upper right side of head with light and sound sensitivity followed by a shingles outbreak on right side of face and head.

Other Meds: None

Current Illness: None

ID: 1440217
Sex: M
Age: 40
State: TX

Vax Date: 06/27/2021
Onset Date: 06/28/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
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Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: sore throat, fatigue, upset stomach

Other Meds: none

Current Illness: none

ID: 1440218
Sex: M
Age: 43
State: NY

Vax Date: 06/01/2021
Onset Date: 06/08/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Almost about 1 week after getting second shot of covid-19 vaccine I started feeling weird on right side of my body. Swollen right side of my body specially facial area, which got worse over the period of time. Now main symptoms i am having are tender facial muscles , hoarseness, loss of voice and blurry vision on right side. Symptoms got worse last week.

Other Meds:

Current Illness:

ID: 1440219
Sex: M
Age: 41
State: FL

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Booster Given Too Late-

Other Meds:

Current Illness:

ID: 1440220
Sex: M
Age: 23
State: SC

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient experienced syncopal episode within 5 minutes of administration of second dosage of Moderna Covid-19 vaccination, patient was unconscious less than 30 seconds, spontaneously awoken, and was fully recovered within 15 minutes.

Other Meds:

Current Illness:

ID: 1440221
Sex: M
Age: 19
State: CA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
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Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Seizure-Mild, Additional Details: Patient received vaccine (2nd dose) on left arm, felt dizzy while waiting in the observation area. Suddenly peed himself, and walked away. When we talked to him afterwards, he reports he thinks he might have had a seizure. Patient did not fall, said he had no history of seizure in the past. Patient declined to be sent to the ER or urgent care. Unsure exactly if it was a seizure or not. He said he did not have any reaction when he got his first dose.

Other Meds:

Current Illness:

ID: 1440222
Sex: F
Age: 55
State: MA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1440223
Sex: F
Age: 24
State: NV

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
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Lot:
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Lab Data:

Allergies: None.

Symptom List:

Symptoms: Headache, body ache, cold sweats, fatigue. ACNE!! Two days after my second dose I got a bunch of small pimples on my left cheek. Ever since April 9th, the acne has only gotten worse. It started as small closed bumps on my cheeks and forehead and spread to my neck, chest, and back. I?ve gone to the dermatologist and allergist to see what I am allergic to, only to find out that I?m allergic to a few things but nothing in any products I use or come into contact daily. The acne had progressed from small bumps, looking like almost clogged pores, to full acne. It is getting worse and not going away. I am going to be scheduled a biopsy with my dermatologist to send to a pathologist to see exactly what type of acne/cells it is and also go to a gynecologist to check my hormones.

Other Meds: N/A

Current Illness: None.

ID: 1440224
Sex: F
Age: 44
State: CA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Site: Itching at Injection Site-Mild, Additional Details: pt had s few rash and was itchy on both arms

Other Meds:

Current Illness:

ID: 1440225
Sex: F
Age: 19
State: PA

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1440226
Sex: F
Age: 54
State: TX

Vax Date: 06/16/2021
Onset Date: 06/17/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
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Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: See details below-Medium, Additional Details: Patient stated she is continueously having sore throat, allergy symptoms and, swellings on hands, fingers, and feet since next day of the vaccine administration. She tried several OTCs including Claritin, Benadryl, Tylenol, Aleve, sore throat spray, and Halls lozenges. None of those helps. She also takes HCTZ and will have PCP appt on 07/01/21. In the meantime, suggested her to discuss with PCP and withold the second dose until adverse reactions are being resolved.

Other Meds:

Current Illness:

ID: 1440227
Sex: M
Age: 20
State: CA

Vax Date: 06/19/2021
Onset Date: 06/20/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Lymph Node Swelling-Medium, Systemic: Tachycardia-Mild, Additional Details: pt mom called 4 days post vaccination. i recommended going to urgent care or er. she said chest and armpit swollen with pain and pt thought heart was beating faster than normal.

Other Meds:

Current Illness:

ID: 1440228
Sex: M
Age: 43
State: IN

Vax Date: 06/29/2021
Onset Date: 06/29/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Severe Cold chills, headache, shortness of breath, joint an body aches an pain, fatigue. Used ibuprofen and albuterol, only lasted a day

Other Meds: None

Current Illness: None

ID: 1440229
Sex: F
Age: 65
State: FL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash Generalized-Medium

Other Meds:

Current Illness:

ID: 1440230
Sex: M
Age: 37
State: CT

Vax Date: 06/30/2021
Onset Date: 06/30/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa-meds

Symptom List:

Symptoms: Pain/Soreness at injection site.

Other Meds: Omeprazole; Humira

Current Illness: None

ID: 1440231
Sex: M
Age: 13
State: PA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: pt passed out for less than 1 min after administration. mother was advised to report to md office for follow up and to recieve 2nd dose

Other Meds:

Current Illness:

ID: 1440232
Sex: M
Age: 51
State: NJ

Vax Date: 06/02/2021
Onset Date: 06/09/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Pain in deltoid muscle around point of injection starting about a week after injection and persisting.

Other Meds: Nexium

Current Illness: None

ID: 1440233
Sex: F
Age: 23
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Additional Details: pt stayed 20 minutes and parents picked up patient and pt was okay leaving the pharmacy.

Other Meds:

Current Illness:

ID: 1440234
Sex: M
Age: 57
State: NY

Vax Date: 03/11/2021
Onset Date: 03/24/2021
Rec V Date: 07/01/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: nkda

Symptom List:

Symptoms: Initially inability to move the left arm to put it into the jacket. Then bouts of labile hypertension, inability to find his word and then slurred speech and global problems moving his limbs and fine motor issues

Other Meds: carvedilol loratadine lisinopril

Current Illness: hypertension hyperlipidemia prediabetes

Total 2021 VAERS Injuries: 679,999

Page last modified: 03 October 2021 5:28pm