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
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 0960766
Sex: F
Age: 54
State: NJ

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Lab Data:

Allergies: shellfish rocephin pcn tagamet plaquenil levaquin phenylephrine duramorph bactrim ds pyridium

Symptom List:

Symptoms: 1. severe headache began 2.5-3 hours after vaccination that lasted over 16 hours 2. soreness at injection site

Other Meds: multi vitamin baby aspirin calcium with zinc vit. c

Current Illness:

ID: 0960767
Sex: F
Age: 38
State: NC

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Exacerbation of Eczema

Other Meds: Vitamin D3 Oral tablet

Current Illness: N/A

ID: 0960768
Sex: F
Age: 44
State: NJ

Vax Date: 01/13/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Lab Data:

Allergies: none

Symptom List:

Symptoms: Delayed response at the injection site. Initial muscles soreness at the injection site in the first 24 hours but then no other immediate side effects. Day 7 some let arm swelling and heat at the injection site appear. Contacted my primary care and was informed what to look for and if it gets worse contact again or if it last more than 2 weeks post vaccine.

Other Meds: Vitamin D, Biotin

Current Illness: none

ID: 0960769
Sex: F
Age: 71
State: FL

Vax Date: 01/14/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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Symptoms: On the early morning hours of Monday was woken up out my sleep. I had serve diarrhea for 5 hours and then it stopped. Has been fine every chance. **believes that Moderna vaccine has Polyethylene Gylcol in it and wants a warning added that if you take Miralax daily to not take before/after receiving vaccine.

Other Meds: Miralax daily, Nexium every 2 days, Vitamin D every 2 days, Pravastatin twice a week,

Current Illness:

ID: 0960770
Sex: M
Age: 41
State: FL

Vax Date: 01/08/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Allergies: none

Symptom List:

Symptoms: Mild rash at area of injection site

Other Meds: Spiriva; Symbicort; Montelukast; Zxyal

Current Illness: none

ID: 0960771
Sex: M
Age: 55
State: SC

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
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Lab Data:

Allergies: Codeine - Causes stomach pain

Symptom List:

Symptoms: Started with fatigue about 4.5-5 hours after injection then low grade fever. (99 deg) Fever reduced with ibuprofen. About 12 hours after injection fever spiked to 100.7 deg with chills and body aches. Took ibuprofen but didn't reduce fever so an hour later took tylenol and then temp came down. Following day had low grade fever about 99 deg controlled with aspirin as needed and third day low grade fever in the morning only. Symptoms completely gone after that.

Other Meds: Ramipril 20 mg daily HCTZ 25 mg daily Amlodipine 5mg daily Levothyroxine 25mcg daily Famotidine 20 mg daily Men's One-A-Day 1 daily Krill-omega 3 350mg daily CoQ10 200 mg daily Vitamin D3 2000 iu daily Zinc 50 mg daily

Current Illness: None

ID: 0960772
Sex: F
Age: 38
State: NY

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: allergies:environmental NKDA

Symptom List:

Symptoms: fever 101-102 chills headache sore neck sore left arm fogginess

Other Meds: Lo loestrin 21 (birth control)

Current Illness: none

ID: 0960774
Sex: M
Age: 59
State: IN

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: Keflex

Symptom List:

Symptoms: Had first injection in the upper left arm and now arm is still extremely sore and makes for restless sleep. Second injection done in right arm and know soreness except slight at injection site if touching it.

Other Meds: Daily vitamin, fish oil , zinc , vitamin C , Atorvastatin 40 mg, , glucosamine

Current Illness: none

ID: 0960775
Sex: F
Age: 65
State: AL

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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Allergies: NKDA

Symptom List:

Symptoms: In less than 60 seconds, I became Diaphoretic, had substernal chest pain radiating to back, nausea and eventual vomiting. This lasted for a long period of time, I asked to go to ER because I was so alarmed. I felt great all day prior to injection. I had been at work as a nurse with Mobile County Public School System, until I came to get vaccination .

Other Meds: Lasix 40mg QD Valsartan 80mg QD Coreg BID Calexa 40 mg QD Nortriptyline 50mg QHS Potassium 20meq BID Magnesium BID Zetia 10mg BID

Current Illness: NONE

ID: 0960776
Sex: F
Age: 38
State: OH

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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Symptom List:

Symptoms: 6 hours after receiving dose s#1 Moderna , employee also my patient started having voluminous diarrhea with cramping lasting ~ 2 days.

Other Meds:

Current Illness:

ID: 0960777
Sex: M
Age: 31
State: FL

Vax Date: 12/23/2020
Onset Date: 12/25/2020
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: NONE

Symptom List:

Symptoms: Patient developed COVID infection 48hrs after vaccination. Lost sense of smell/taste and this progressed to cough, fever, chest congestion, fatigue, body aches, headaches.

Other Meds: Flonase, Allegra

Current Illness: NONE

ID: 0960778
Sex: F
Age: 40
State: PR

Vax Date: 01/01/2021
Onset Date: 01/17/2021
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: None

Symptom List:

Symptoms: Vertigo, dizziness nausea

Other Meds: None

Current Illness: None

ID: 0960779
Sex: F
Age: 52
State: AZ

Vax Date: 01/14/2021
Onset Date: 01/17/2021
Rec V Date: 01/21/2021
Hospital:

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Lab Data:

Allergies: allergic to Prednosone

Symptom List:

Symptoms: I received the vaccine on Thursday 1-14-21, on Saturday I started feeling very thirsty and then severe dry mouth and cold on Sunday and Monday. I just made sure to stay hydrated. On Tuesday I felt better but when I got up on Wednesday morning, I felt dizzy. It progressed into the day and became worse. I had to go home from work and was unable to drive. Today, I feel slightly better but still dizzy if I get up quickly.

Other Meds: ND Thyroid, Zypan, Zymex, Iron, probiotics.

Current Illness:

ID: 0960796
Sex: M
Age: 60
State: TN

Vax Date: 03/07/2015
Onset Date: 03/01/2015
Rec V Date: 01/21/2021
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Symptoms: Loss of concentration; small shingles outbreak/ persistent painful blistering rash on top of his head in his hair, on his face and in his ear/ diagnosed as herpes zoster; ears started "feeling funny"/ persistent painful blistering rash on top of his head in his hair, on his face and in his ear; The vaccine did not prevent shingles, but rather caused patient to contract a persistent strain of herpes zoster; persistent painful blistering rash on top of his head in his hair, on his face and in his ear/ diagnosed as postherpetic neuralgia; This spontaneous report was received from a patient's wife and pharmacist and refers to 60-year-old (also reported as 56-year-old, conflicting information) male patient. The patient's concurrent condition included unspecified heart disease. The patient had no drug reactions or allergies. The patient's medical history and concomitant medications were not reported. On 07-MAR-2015 (also reported as on Saturday), the patient was vaccinated with zoster vaccine live (ZOSTAVAX) vial 19400 plaque-forming unit (PFU), lot # K016326, expiry date 24-DEC-2015 (dose, route of administration, application site were not reported) for the prevention of shingles/ vaccination/ to prevent shingles. On 08-MAR-2015 (reported as the day after getting zoster vaccine live (ZOSTAVAX), also reported as by Sunday afternoon), his ears started "feeling funny". On the same day, he also experienced headache and shooting pains accompanied by a burning sensation, all of which occurred on his face without rash and redness. The patient had shooting pains, tingling and numbness on the left side of his face and had. The pharmacist believed it was a small shingles outbreak. The patient's wife reported that he developed shingles in the left side of his face. The patient contacted pharmacist due to the event. It was reported that he went to his physician and was given an unspecified steroid shot and a dose of steroids in pills due to shingles. The patient stated that he felt that the vaccine gave him shingles. There was no treatment given for the events. The outcome of shingles was reported as not recovered. The outcome of remaining events was not reported. The patient considered the shingles to be related to zoster vaccine live (ZOSTAVAX). The relatedness between ears started "feeling funny" and zoster vaccine live (ZOSTAVAX) was not provided. Follow up information has been received on 18-OCT-2019 from a lawyer, regarding a case in litigation and refers to a male patient. On an unknown date, the patient was inoculated with zoster vaccine live (ZOSTAVAX) for routine health maintenance and for the prevention of shingles. The vaccine did not prevent shingles, but rather caused patient to contract a persistent strain of herpes zoster accompanied by pain. On an unknown date (reported as shortly after receiving vaccine), the patient developed a persistent painful blistering rash on top of his head in his hair, on his face and in his ear. In response to these symptoms, he presented to a physician, where he was diagnosed with herpes zoster and postherpetic neuralgia and remained under their care. As a result, the patient had suffered and would continue to suffer significant medical expenses, pain and suffering, and other damages. The outcome of the events was considered to be not recovered. The reporter considered the events to be related to zoster vaccine live (ZOSTAVAX). Follow up information has been received on 18-JAN-2021 from a lawyer via a Plaintiff Fact Sheet, regarding a case in litigation and refers to a 60-year-old male patient (pt). The pt never smoked or used tobacco products. He was diagnosed with chickenpox in approximately 1964, at the age of approximately 9 or 10 years old. He was never vaccinated with chickenpox vaccine. On 07-MAR-2015, the pt was vaccinated with zoster vaccine live (ZOSTAVAX) in left arm, by a pharmacist at a pharmacy. The pt claimed to suffer following physical injuries caused by zoster vaccine live (ZOSTAVAX): shingles (herpes zoster) and postherpetic neuralgia (PHN). The pt suffered from pain which led to loss of concentration, loss of work. He had severe pain on the side of his face, head, neck and in his ear. The pt first became aware of the injuries as initially he noticed the pain at night of 07-MAR-2015, but the following day 08-MAR-2015 it got much worse. He first became aware of the injuries as within hours he began to experience pain in his hair, face and ear. It was painful to touch. The following day he broke out in bumps and sores in his hair, side of his face and ear. He was diagnosed with shingles and postherpetic neuralgia (PHN) by a physician in approximately March 2015. On an unknown date in March 2015, he was prescribed unspecified medication for nerve pain by a physician (could not recall name of medication). On an unknown date in March 2015, he communicated with a physician about whether the injuries were related to or caused by zoster vaccine live (ZOSTAVAX). He reported that he saw provider for shingles treatment and discussed injury. He stated that he did not know if any test to determine if the rash following vaccination with zoster vaccine live (ZOSTAVAX) was wild type or vaccine strain varicella zoster virus was ever performed by a healthcare provider. He was never told by any healthcare provider that he had vaccine strain varicella zoster virus. The pt claimed that zoster vaccine live (ZOSTAVAX) did not cause or aggravate any psychiatric/ psychological conditions other than pain, suffering and emotional distress, for which treatment was sought from a healthcare provider. The pt filed for social security due to retirement in 2019, which was granted. In the 7 years preceding his zoster vaccine live (ZOSTAVAX) vaccination to the present, the pt received inpatient or outpatient care from his primary care physician (PCP) (2005 to present). In the 7 years preceding zoster vaccine live (ZOSTAVAX) to the present, the pt required hospitalization or recurrent medical care and treatment or medication due to high cholesterol (2005 to present) and high blood pressure (2010 to present). In the 7 years preceding zoster vaccine live (ZOSTAVAX) to the present, the pt's prescription medications taken on a regular basis included: rosuvastatin for high cholesterol (2005 to present) and metoprolol for high blood pressure (2010 to present). The outcome of the events was not provided. The reporter considered the events to be related to zoster vaccine live (ZOSTAVAX). Follow up information has been received on 18-JAN-2021 from pharmacy records, regarding case in litigation. On 07-MAR-2015, the pt was dispensed zoster vaccine live (ZOSTAVAX) 19400 PFU injection, quantity 1. Upon internal review, the event of herpes zoster in his ear was considered to be medically significant. It has been determined that cases # US-009507513-1503USA005428 and US-009507513-1503USA012042 are a duplicate case of case # US-009507513-1503USA004588. Therefore cases # US-009507513-1503USA005428 and US-009507513-1503USA012042 are being deleted from our files and the cases are consolidated into case # US-009507513-1503USA004588.

Other Meds: rosuvastatin; metoprolol

Current Illness: Blood pressure high (dates of care: 2010 to present); Cardiac disorder; Cholesterol high (dates of care: 2005 to present); Non-tobacco user; Routine health maintenance

ID: 0960799
Sex: U
Age:
State: NE

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

Vax Type:
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Symptoms: 1st and 2nd dose of Shingrix at less than recommended interval; This case was reported by a pharmacist via call center representative and described the occurrence of drug dose administration interval too short in a adult patient who received Herpes zoster (Shingrix) for prophylaxis. Concomitant products included Herpes zoster (Shingrix). On an unknown date, the patient received the 2nd dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced drug dose administration interval too short. On an unknown date, the outcome of the drug dose administration interval too short was unknown. Additional details were provided as follows: The age at vaccination was not reported. The age group was not provided but selected as adult as per vaccine indication. The patient received 1st and 2nd dose of Shingrix at less than recommended interval, which led to shortening of vaccination schedule. The reporter wanted to know how to proceed further. The reporter consented to follow up. No details from patient or vaccination and no further details were provided.

Other Meds: Shingrix

Current Illness:

ID: 0960801
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type:
Manufacturer:
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Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960814
Sex: F
Age: 34
State: TX

Vax Date: 12/23/2020
Onset Date: 12/17/2020
Rec V Date: 01/21/2021
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Symptom List:

Symptoms: Second dose Moderna COVID-19 Vaccine administered 7 days after first dose; First dose received Pfizer COVID-19 Vaccine; A spontaneous report was received from a healthcare professional concerning a 34-years old, female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced inappropriate schedule of product administration and product use issue. The patient's medical history and relevant concomitant medications were not reported. On 17 Dec 2020, the patient had received their first dose of the Pfizer COVID-19 vaccine. On 23 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection and experienced inappropriate schedule of product administration and product use issue. No side effects were observed, and no treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event, inappropriate schedule of product administration, was resolved on 23 Dec 2020, and the outcome of the event, product use issue, was resolved on 17 Dec 2020.; Reporter's Comments: This case concerns a 34 year old, female patient. The patient's medical history is not provided. The event occurred on 23 Dec 2020 when the patient received the first dose of the mRNA-1273. This report refers to a case of wrong product administered and out of specification product use where mRNA-1273 has been administered to the patient, who had received the first dose of Pfizer COVID-19 vaccine. There was no reported adverse reaction associated with this case.

Other Meds:

Current Illness:

ID: 0960815
Sex: U
Age: 44
State: TX

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/21/2021
Hospital:

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Symptoms: Partial dose injection; Syringe leaked; A spontaneous report was received from a pharmacist concerning a 44 year old patient who received Moderna's COVID-19 Vaccine (mRNA-1273)and experienced a partial dose injection. The patient's medical history and relevant concomitant medications were not reported. On 29 Dec 2020 the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. While the dose was being administered, some of the vaccine leaked out and caused a partial dose injection No treatment information was provided. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event partial dose injection was recovered/resolved.; Reporter's Comments: This report refers to a case of Incorrect dose administered and syringe issue for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of Incorrect dose administered and syringe issue.

Other Meds:

Current Illness:

ID: 0960816
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type:
Manufacturer:
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Symptom List:

Symptoms: Immunized at age 8; Administered vials that were exposed to room temperature for more than 12 hours; A spontaneous report was received from a physician concerning an 8-year-old patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the events, immunized at age 8 and administered vials that were exposed to room temperature for more than 12 hours. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 04 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 04 Jan 2021, the patient received a vaccine dose of mRNA-1273 that had been left at room temperature more than 12 hours. It was originally thought that the freezer which stored the mRNA-1273 vaccine died on 04 Jan 2021 at 2am, so vaccine administration occurred up until 2pm. After checking freezer temperature logs, it was discovered the freezer had died at 1:11am. Treatment for the events was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events, immunized at age 8 and administered vials that were exposed to room temperature for more than 12 hours, were considered resolved on 04 Jan 2021.; Reporter's Comments: This case concerns a 8-year old patient, who was administered the first dose of mRNA-1273 from the vials that were exposed to room temperature for more than 12 hours. This report refers to a case of Product storage error and Product administration error for mRNA-1273, where out of specification product was administered to the patient of inappropriate age.

Other Meds:

Current Illness:

ID: 0960817
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type:
Manufacturer:
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Lab Data:

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Symptom List:

Symptoms: Immunized at 14 years old; Administered vials that were exposed to room temperature for more than 12 hours; A spontaneous report was received from a physician concerning an 14-year-old patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the events, immunized at age 14 and administered vials that were exposed to room temperature for more than 12 hours. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 04 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 04 Jan 2021, the patient received a vaccine dose of mRNA-1273 that had been left at room temperature more than 12 hours. It was originally thought that the freezer which stored the mRNA-1273 vaccine died on 04 Jan 2021 at 2am, so vaccine administration occurred up until 2pm. After checking freezer temperature logs, it was discovered the freezer had died at 1:11am. Treatment for the events was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events, immunized at age 14 and administered vials that were exposed to room temperature for more than 12 hours, were considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of Product administered to patient of inappropriate age and Out of specification product use for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960818
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960819
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960820
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960821
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960822
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960823
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960824
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960825
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960826
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960827
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; Vaccinated with vial that might have had a temperature excursion; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was vaccinated with vial that might have had a temperature excursion. The patient's medical history was not provided. No relevant concomitant medications were reported. On 22 Dec 2020, the nurse reported a shipment was received. The vial arrived frozen and was placed in a freezer at recommended temperature. On 02 Jan 2021, the freezer had failed, and the temperature alarm system did not alert anyone. It was noted that the freezer temperature at 5:50 AM was -5 degrees Celsius (C), at 7:50 AM the freezer was a 1.5 C. It remained between from 9.7 C at 12:51 PM then went to 8.3 C at 1:51 PM then down to -8.7 C at 2:51 PM. On 03 Jan 2021 8:45 PM, the freezer returned to its normal temperature of -20.9 C, -1 C then went to 5.5 C at 11:56 PM. On 04 Jan 2021, the temperature climbed to 19.4 C. On the same day, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A, 025L20A, or 027L20A) intramuscularly for prophylaxis of COVID-19 infection and experienced vaccination with vial that might have had a temperature excursion No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccinated with vial that might have had a temperature excursion, was considered resolved on 04 Jan 2021.; Reporter's Comments: This report refers to a case of out of specification product use, product temperature excursion issue, and product storage error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0960828
Sex: F
Age:
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: anaphylactic reaction to DPT vaccine made with horse serum; Initial information regarding an unsolicited valid serious case received from non-healthcare professional (consumer) from Pfizer (Reference number: 2021013116) on 11-Jan-2021. This case involved a female patient aged an approximately 3 to 4 year at around years 1964 or 1966 who experienced anaphylactic reaction (Anaphylactic reaction) to DIPHTHERIA, TETANUS AND NOS PERTUSSIS VACCINE made with horse serum. Medical history, medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. On an unknown date, the patient received a dose of suspect DIPHTHERIA, TETANUS AND NOS PERTUSSIS VACCINE produced by unknown manufacturer (lot number and expiry date were not reported) via an unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, it was reported that the patient developed a serious anaphylactic reaction to DIPHTHERIA, TETANUS AND NOS PERTUSSIS VACCINE made with horse serum (Anaphylactic reaction). No relevant laboratory details were provided. The event of anaphylactic reaction was assessed as medically significant as per important medical event list. It was not reported if the patient received a corrective treatment. Outcome of the event of anaphylactic reaction was unknown. There will be no information available on the batch number for this case.; Sender's Comments: This case involves an approximately 3 to 4 year old female patient who presented with anaphylactic reaction after receiving DIPHTHERIA, TETANUS AND NOS PERTUSSIS VACCINE produced by unknown manufacturer. Time to onset is unknown. Although, medical history, comorbidities, concomitant medications, additional information on investigations ruling out other etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 0960829
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: child was given an expired flu vaccine of a December 2020 expire date with no adverse event; Initial information was received on 07-Jan-2021 regarding an unsolicited valid non-serious case from a physician via other health care professional. This case involved a child patient of unknown age who child was given an expired INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] (PRE-FILLED SYRINGE) of a December 2020 expire date (expired product administered) (lot number: unknown and expiry date not reported] via an unknown route at an unknown administration site for prophylactic vaccination. Medical history, Past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications were not reported. It was an actual medication error due to expired vaccine used (latency: unknown). At the time of report, no adverse event was reported. It was not reported if the patient received a corrective treatment. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 0960830
Sex: F
Age: 3
State:

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

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

Lab Data:

Allergies:

Symptom List:

Symptoms: arm turned red with slight swelling; arm turned red; hot to the touch; injection site developed a knot that grew; Initial information was received on 12-Jan-2021 regarding an unsolicited valid non-serious from a physician via other health care professional. This case involves a 03-Year-old female patient whose arm turned red with slight swelling (vaccination site swelling), arm turned red (vaccination site erythema), hot to the touch (vaccination site warmth) and injection site developed a knot that grew (vaccination site mass), while being received vaccine DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE [DAPTACEL]. Medical history, past medical treatment, vaccination, family history and concomitant medication were not reported. Concomitant medications were not reported. On 07-Jan-2021, the patient received a dose of suspect DIPHTHERIA-15/TETANUS/5 AC PERTUSSIS VACCINE (batch number and other dosing details were not reported) at an unknown dose via unknown route and unknown administration site for prophylactic vaccination. On an unknown date, (latency: unknown) after starting the suspect vaccine therapy, patients arm turned red with slight swelling (vaccination site swelling), arm turned red (vaccination site erythema), hot to the touch (vaccination site warmth) and injection site developed a knot that grew (vaccination site mass). No laboratory data was reported. Outcome of the events was reported as unknown. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness:

ID: 0960831
Sex: F
Age: 52
State: TX

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Received vaccination #2 1/18/21 at 1000am. Dr. appointment at 1pm. EKG no known abnormalities. 1530 feet achy R arm where got shot - had muscle spasms in back, Body aches, heart rate 110. 1/19/21-worked 1/19/21 no muscle spasms.

Other Meds: N/A

Current Illness: N/A

ID: 0960833
Sex: M
Age: 34
State: AR

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NO

Symptom List:

Symptoms: 24 hours post 2nd vaccine, vomiting, HA, fatigue

Other Meds: Tylenol, Ibuprofen

Current Illness: No

ID: 0960834
Sex: F
Age: 22
State: WI

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: No history or previous allergic reactions

Symptom List:

Symptoms: Post vaccination symptom timeline 5 min- change in voice, no other symptoms, pt attributed to anxiety 7 min- could feel a sensation in her neck, but was not concerned about it 10min- was observed taking a occasional deep breath and change in swallowing was observed, Pt was given 50mg of Diphenhydramine orally 12 min- patient acknowledged she was starting to have difficulty swallowing. EMS was activated 16 min- EMS arrived and took over care. Patient was transported to hospital Received a message several hours later that patient had recovered and was doing fine

Other Meds:

Current Illness:

ID: 0960835
Sex: M
Age: 24
State: IN

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Mild nausea started around 6pm, 10 hours after initial dose. Chills started around 10:30pm and progressed to a 103 degree fever by 12:00am. Fever and chills persisted for the next 12-14 hours preventing me from going in to work. Nausea became noticeable again as the chills subsided. Fever broke around 6:00pm the next day, 01/20/2021. Significant soreness at the injection site was present almost immediately and through 01/20/2021

Other Meds:

Current Illness:

ID: 0960836
Sex: M
Age: 39
State:

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient reported feeling dizzy immediately after receiving vaccine. Patient reported dizziness resolved within 15 minute in observation area. Patient went back to work area, and felt "very faint", tachycardia, dizzy and diaphoretic after 30 minutes. Patient placed a cool rag on face and symptoms resolved shortly after.

Other Meds:

Current Illness:

ID: 0960837
Sex: F
Age: 33
State: NC

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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Allergies: NKA

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Symptoms: G2P1; 19 weeks pregnant; employee felt dizzy and lightheaded after receiving her vaccine. employee given water and Cheez-Its and reported feeling much better.

Other Meds: Prenatal Vitamins

Current Illness: Pregnancy

ID: 0960838
Sex: F
Age: 70
State: VA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
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Allergies: PCN

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Symptoms: Patient complaint of extreme metal taste in mouth and burning on tongue. 25 mg of Benadryl po given. Pt. waited 30 minutes after Benadryl and released by Dr. via telephone.

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Current Illness:

ID: 0960839
Sex: F
Age: 55
State: IN

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Symptoms: BODY ACHES, COLD CHILLS, STOMACH PAIN, BAD FATIGUE

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Current Illness:

ID: 0960840
Sex: F
Age: 55
State: NY

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/21/2021
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Allergies: Levoquin

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Symptoms: Arm soreness, headache, dry cough, tiredness, possible AFIB.

Other Meds: Lansoprazole 30mg

Current Illness: N/A

Date Died: 01/21/2021

ID: 0960841
Sex: M
Age: 23
State: NY

Vax Date: 01/17/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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Allergies: none

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Symptoms: Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired.

Other Meds: Amantadine, clonazepam, clobazam, lovenox, dextroamphetamine-amphetamine , famotidine, gabapentin, keppra, robinul, polyethylene glycol, propanolol, sertaline, senna, valproic acid, vimpat, cefepime

Current Illness: none

ID: 0960842
Sex: F
Age: 57
State: MI

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/21/2021
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Allergies: compazine latex

Symptom List:

Symptoms: tired and headache

Other Meds: effexor buspar

Current Illness: none

ID: 0960843
Sex: F
Age: 24
State: SD

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Allergies: None

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Symptoms: Body aches/joint pain, chills, nausea, fatigue, injection site muscle soreness

Other Meds: None

Current Illness: None

ID: 0960844
Sex: M
Age: 33
State: NJ

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
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Allergies: NKDA

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Symptoms: Fever and chills

Other Meds: Emgality

Current Illness: None

ID: 0960845
Sex: F
Age: 56
State: NJ

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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Allergies: none

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Symptoms: High Fever 102 Severe Headache Malaise / brain fog Chill Body Ache Exhaustion Swollen and tender lymph nodes in neck on left side Symptoms lasted for 3 days Today is day 4 and I still have Malaise, swollen lymph nodes and pressure in my head.

Other Meds: Celexa 20 mg

Current Illness: none

ID: 0960846
Sex: F
Age: 45
State: WI

Vax Date: 01/05/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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Symptoms: 1/20 staff member reported to employee health that she was advised by her own PCP to not get the second Covid vaccination. She reports she developed an all over body rash and itching 2 weeks after her Covid vaccination and contacted her PCP - they advised Benydryl and that she should not receive her second vaccination In speaking with her - she is open to speaking to VAERS staff to relay her experience She reports she did not experience any issues immediately post vaccination

Other Meds:

Current Illness:

ID: 0960847
Sex: M
Age: 60
State:

Vax Date: 12/24/2020
Onset Date: 12/25/2020
Rec V Date: 01/21/2021
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Symptoms: "fever 101, severe headache, myalgias, symptoms resolved over 36 hours"

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Current Illness:

ID: 0960848
Sex: F
Age: 58
State:

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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Allergies: Amoxicillin, augmentin, statins, tramadol, clindamycin, pork, milk, cat, dogs, horses and seasonal allergies

Symptom List:

Symptoms: 1525 - states she is experiencing vertigo. Transported via w/c to private observation area. EMT on site in attendance. Patient able to transfer from chair to w/c without difficulty. States, "my head is swimming and I have nausea" States she has hx of vertigo but this is different as per statement above. HR 86; BP 148/68; O2 97% on room air. States she drove self, has service dog with her. States she ate a late breakfast. States she had a COVID test this morning at for pre op biopsy to be done this Friday 1/22/2021. Denies exposure to COVID. 3:50, examined per Dr. Gave patient gatorade and granola bar. Also drank about 2 ounces of water and tolerated with n/v. Ate about 1/4 granola bar. O2 98%; HR 88 4:02 PERRL - NO nystagmus noted. Tol. 10oz gatorade without n/v. States she has too much nausea to eat anything. Offered ambulance transport for further evaluation. Patient unsure what to do. 4:05 - Had patient stand up next to w/c. Mobility steady. Patient looking down at her dog without any swaying noted. Patient sat back down. 4:08 Patient ambulated independently to end of hallway. Gait steady, no assistance required. Reached outside doors. No symptoms of vertigo. No n/v. States she will go home and rest. Advised to seek medical attention if vertigo returns. Declined transport to hospital. Left with her service dog to personal vehicle

Other Meds: effexor welbutrin, trazadone, gabapentin, geodon, metformin, glypiside, singulair allegra, Vit D3, Calcium, B1, flonase, albuteral

Current Illness: Inner ear infection, finished azithromycin course on 1/19/2021

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm