VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 0965357
Sex: F
Age: 56
State: OR

Vax Date: 01/05/2021
Onset Date: 01/13/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: 2 inch knot @ inj site PCP recommended benedryl & Ibuprofen

Other Meds:

Current Illness:

ID: 0965358
Sex: F
Age: 53
State: OR

Vax Date: 01/05/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Ward red 2" lump at inj site

Other Meds:

Current Illness:

ID: 0965359
Sex: U
Age:
State: OR

Vax Date: 01/15/2021
Onset Date: 01/17/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Latex

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

Symptoms: Swollen Knot 4" wide red, itchy warm to touch

Other Meds:

Current Illness:

ID: 0965360
Sex: F
Age: 67
State: IL

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

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

Lab Data:

Allergies: hay fever / reactions to antibodies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: before/during/after patient experienced tachycardia + "tingling". No rash, no resp. issues. Patient's baseline is PR=100. After 3rd set of vitals, well w/in her norms. MD advised patient as to what to expect (eg sore arm) 67 y/o female who presents with raised heart rate and body tingling. Pt thinks it could be anxiety. No vaccine allergies Exam - unremarkable except for tAchycArdiA PlAN - OBS with resolution of symptoms and tAchycARdiA. unlikely to be allergic RXN

Other Meds: NO (Ambien / Melatonine)

Current Illness: virus, but tested covid - (low grade fever)

ID: 0965361
Sex: F
Age: 41
State: OR

Vax Date: 01/12/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: red, itchy, warm lump quarter size 1/19 grew to golf ball size 1/20

Other Meds:

Current Illness:

ID: 0965362
Sex: F
Age: 53
State: OR

Vax Date: 01/05/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Warm lump 2" in diameter

Other Meds:

Current Illness:

ID: 0965363
Sex: F
Age: 35
State: OR

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

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

Lab Data:

Allergies: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 4.5 x 3.5 cm warm, red bump at injection site

Other Meds:

Current Illness:

ID: 0965364
Sex: F
Age: 27
State: OR

Vax Date: 01/12/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: 3" rash, itchy welty red @ inJection site - improving

Other Meds:

Current Illness:

ID: 0965394
Sex: F
Age: 42
State: ME

Vax Date: 01/11/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: redness/swelling/warmth to injection site - right upper arm

Other Meds: 0

Current Illness: 0

ID: 0965429
Sex: F
Age: 28
State: TX

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

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

Lab Data:

Allergies: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: MILD SHORTNESS OF BREATH, LIGHTHEADED

Other Meds: NONE

Current Illness: NONE

ID: 0965455
Sex: F
Age: 55
State: TX

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

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

Lab Data:

Allergies: PROZAC - RASH

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

Symptoms: LIGHTHEADED, PALPITATIONS

Other Meds: BLOOD PRESSURE AND DIABETES MEDS

Current Illness: UNKNOWN

ID: 0965466
Sex: F
Age: 72
State: TX

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: On 1/21, pt came reported on AE at local injection site. According to pt, it developed on 01/15 with symptoms of swelling, redness, tender to touch, and itching. The size was about a quarter. Pt took Benadryl & Cortisone cream and had shown great improvement / minimal sign/ symptom at time of reporting. No other complaints reported.

Other Meds: N/A

Current Illness: N/A

Date Died: 01/19/2021

ID: 0967743
Sex: M
Age: 77
State: TX

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

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

Lab Data:

Allergies:

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

Symptoms: Possible seizer, unknown at this time, aprox 1hr and 20min after vac given. Passed away aprox 2hrs after vac.

Other Meds:

Current Illness: n/A

ID: 0971853
Sex: F
Age: 57
State: VA

Vax Date: 01/05/2021
Onset Date: 01/13/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: On day 8 after receiving my vaccine, Moderna, below injection site a red, raised area & itching. On day 14 still having a red spot around 3" in size, with some itching.

Other Meds: Prozac 40 mg daily, Nexium 40 mg daily, Xanax .25 mg, Propranolol 80 mg, Elavil 25 mg, Crestor 10 mg, HCTZ 25 mg

Current Illness: no

ID: 0971872
Sex: F
Age: 61
State: ME

Vax Date: 12/31/2020
Onset Date: 01/02/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: PCN, Keflex, latex, alcohol rub, grass, mold

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient reports she received Moderna Covid 19 vaccine lot #039K20A on 12/31/2021. Patient reports she developed fatigue, T 100.8, swelling and hardness at injection site 24-48 hrs after receiving vaccine. Patient self managed with Tylenol and rest. The following week, patient reports she had intermittent odd heart sensation. On 1/12/21 patient noticed a 5-6 inch red itchy mark at injection site. That night, patient developed tinnitus in the right ear. On 1/13/21 patient went to Urgent Care, then saw her otolaryngologist. Patient reports she had an ECG and labs. These tests were normal. On 1/15/21, patient went to PCP. Patient had halter monitor and is awaiting results. PCP submitted referral. Patient is awaiting appointment with allergist and employee health provider. Patient missed 3 days of work. Patient states "redness at injection site is fading and tinnitus is better."

Other Meds: Levothyroxine, Lostatin

Current Illness: denies

ID: 0971880
Sex: F
Age: 26
State: PA

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

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

Lab Data:

Allergies: Avelox, Penicillin, Cats, eggplant, dogs, latex

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Flushing, rash to back, tachycardia

Other Meds:

Current Illness:

ID: 1353874
Sex: M
Age: 73
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: FATIGUE Narrative: FEVER,MYALGIA,ARTHRALGIA LASTED ONE HOUR. FATIGUE STARTED THE NEXT DAY AND LASTED ALL DAY

Other Meds:

Current Illness:

ID: 1353875
Sex: M
Age: 82
State:

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

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: weakness, chills, disorientation Narrative:

Other Meds:

Current Illness:

ID: 1353876
Sex: M
Age: 80
State:

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: CHILLS Narrative:

Other Meds:

Current Illness:

ID: 1353877
Sex: M
Age: 88
State:

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

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

Lab Data:

Allergies:

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

Symptoms: diaphoresis Narrative: Patient was clammy and pale and vomited after receiving Moderna Covid-19 vaccine. Patient BP dropped to 70/40 and HR 120. Patient felt dizzy. 2L of oxygen by nasal cannula given. 911 was called and patient taken to hospital and seen in ER. Patient was discharged from hospital. Patient previously tested positive for COVID-19

Other Meds:

Current Illness:

ID: 1353878
Sex: M
Age: 80
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: SORENESS AT INJECTION SITE Narrative:

Other Meds:

Current Illness:

ID: 1353879
Sex: M
Age: 62
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: SORENESS AT INJECTION SITE Narrative:

Other Meds:

Current Illness:

ID: 1353880
Sex: M
Age: 64
State:

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

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

Lab Data:

Allergies:

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

Symptoms: fatigue, shortness of breath, chills Narrative:

Other Meds:

Current Illness:

ID: 1353881
Sex: M
Age: 73
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: 2nd dose administered 4 days to early

Other Meds:

Current Illness:

ID: 1353882
Sex: M
Age: 43
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: CHILLS

Other Meds:

Current Illness:

ID: 1353883
Sex: M
Age: 78
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Chills, loss of taste and smell, weakness, shallow breathing Narrative: Patient referred to facility ER for COVID- 19 testing and evaluation of symptoms

Other Meds:

Current Illness:

ID: 1353884
Sex: M
Age: 86
State: PA

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Narrative: Patient received inadvertently early 2nd dose of Pfizer- BioNTech COVID-19 vaccination. He received his 1st dose 1/14/2021 while at dialysis. On 1/19/2021 he then came to the vaccination clinic and received what was thought to be his 1st dose, but after the fact was recognized as his 2nd dose. This 2nd dose on 1/19/21 was only 5 days after his 1st dose on 1/14/21, instead of the recommended 21 days. Symptoms: & Inadvertant early 2nd dose Treatments:

Other Meds:

Current Illness:

ID: 1353885
Sex: M
Age: 76
State: FL

Vax Date: 11/14/2020
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient remains hospitalized but respiratory symptoms are improving, AST/ALT are down-trending, & PT/INR returned to normal. Symptoms: Bleeding, Abnormal INR & ElevatedLiverEnzymes

Other Meds: Tamsulosin, amiodarone, pomalidomide, dexamethasone, metoprolol, hydromorphone, lisinopril, pravastatin, miconazole topical, warfarin, acetaminophen, aspirin, cholecalciferol

Current Illness:

ID: 1353886
Sex: M
Age:
State:

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

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

Lab Data:

Allergies:

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

Symptoms: lip swelling, right side Narrative:

Other Meds:

Current Illness:

ID: 1353887
Sex: M
Age: 61
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Narrative: Patient was found to be short of breath with heart rate in the 140s. Initially he was thought to possibly be having an allergic reaction to the vaccine. For this, he received prednisone, Benadryl and famotidine. These medications did not improve his symptoms. He was then discovered to be in atrial flutter. He was admitted to the ICU for close monitoring. There he remained hemodynamically stable. He was treated with beta blockade that improved his heart rate and his symptoms. He was discharged to home the following day.

Other Meds:

Current Illness:

ID: 1353888
Sex: M
Age: 83
State:

Vax Date: 01/14/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Narrative:

Other Meds:

Current Illness:

ID: 1353889
Sex: M
Age: 72
State:

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No, Primary Care Provider recommends for patient still get 2nd dose of vaccine.

Other Meds:

Current Illness:

ID: 1353890
Sex: M
Age: 71
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: lethargy Narrative:

Other Meds:

Current Illness:

ID: 1353891
Sex: F
Age: 36
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: FATIGUE AND SORENESS AT INJECTION SITE Narrative: FATIGUE RESOLVED WITH NAP THAT DAY. SORENESS LASTED 3 DAYS

Other Meds:

Current Illness:

ID: 1353896
Sex: M
Age: 79
State:

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: SORENESS AT INJECTION SITE FEVER AND SORENESS LASTED THREE DAYS

Other Meds:

Current Illness:

ID: 0963729
Sex: U
Age: 0
State: MI

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/22/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: No additional adverse events reported; a dose of ROTATEQ was administered during a temperature excursion; This spontaneous report was received from a medical assistant referring to a 7 months old patient of unknown gender. The patient's concomitant medication, pertinent medical history and drug allergies or reactions were not reported. On 18-DEC-2020, the patient was vaccinated with improperly stored rotavirus vaccine, live, oral, pentavalent(ROTATEQ) (strength was not reported, lot # 1684149, expiration date was reported as 21-JUN-2021, but upon internal validation established as 25-JUN-2021) 2 ml orally for prophylaxis (product storage error). It was reported that the suspect vaccine was exposed to a temperature of 8.5 degree Celsius for a time frame of 3 minutes. Data logger was not involved. There were no previous temperature excursions. No further adverse event (AE) information was provided.

Other Meds:

Current Illness:

ID: 0963800
Sex: F
Age: 23
State: TX

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Anaphylactic reaction; A spontaneous report was received from a 23-year-old, female consumer who was also a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced anaphylactic reaction. The patient's medical history included allergy to amoxicillin. Concomitant medications reported included gabapentin, escitalopram oxalate, and montelukast sodium. On 04 Jan 2021, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number: 011L20A) intramuscularly for prophylaxis of COVID-19 infection. On 05 Jan 2021, within 24 hours of vaccination, the patient experienced anaphylactic reaction. Treatment for the event included Diphenhydramine. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event, anaphylactic reaction, was considered resolved on 06 Jan 2021.; Reporter's Comments: This case concerns a 23 year old female patient, who experienced a serious unexpected event of Anaphylactic reaction. Event occurred apparently within 24 hrs. after first dose of mRNA-1273 (Lot# 011L20A) vaccine administration. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: GABAPENTIN; LEXAPRO; SINGULAIR

Current Illness: Allergy to antibiotic (Amoxicillin)

ID: 0963801
Sex: F
Age: 83
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Blooded stools; Eyes are a little bit itchy; Right eye swollen; A spontaneous report was received from a consumer who was an 83-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced blooded stools, eyes are a little bit itchy, and right eye swollen. The patient's medical history was not provided. Concomitant medications reported included magnesium. On 04 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J00/NA) intramuscularly for prophylaxis of COVID-19 infection. On the evening of 04 Jan 2021, the patient experienced blooded stools, eyes are a little bit itchy, and right eye swollen. The patient reported having blooded stools that were not diarrhea, but had occurred three or four times. Treatment for the events included non specified allergy medicine for the eyes. On 06 Jan 2021, the patient reported feeling better in regard to the blooded stools and was unsure if it was actually blood or not in her stools and she had ate spicy and red food. Action taken with mRNA-1273 in response to the events was not provided. The event, blooded stools, was considered resolved. The outcome for the events, eyes are a little bit itchy and right eye swollen was unknown.; Reporter's Comments: This case concerns an 83-year-old female patient with unknown medical history, who received their first of two planned doses of mRNA-1273 (Lot 025J00/NA), and who experienced the unlisted serious event of Haematochezia and the unlisted non-serious events of Eye pruritus and Eye swelling. Based on the current available information and temporal association between the use of the product and the start date of the event on the day of vaccination, a causal relationship cannot be excluded making the events possibly related to the vaccine.

Other Meds: MAGNESIUM

Current Illness:

ID: 0963802
Sex: F
Age: 68
State: FL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fainted; Did not feel well; Hit head; A little pain in arm; A spontaneous report was received from a 68-year-old female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced the events, fainted, hit head, did not feel well, and a little pain in arm. The patient's medical history was not provided. Relevant concomitant medications reported included ezetimibe, atorvastatin, and atenolol. On 04 Jan 2021 at 9:00 am, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 in the left arm for prophylaxis of COVID-19 infection. On 06 Jan 2021, the patient reported that she took the vaccine on 04 Jan 2021 and she did not feel anything after but a little pain in her arm. On 05 Jan 2021 around 7:00 pm, the patient went to her fridge for a drink and told her husband she did not feel very well, and then fainted. The patient reported that she hit her head and has never fainted before. No treatment information was reported. Action taken with mRNA-1273 in response to the events was not reported. The outcome for the events, fainted, hit head, did not feel well, and a little pain in arm, were unknown.; Reporter's Comments: This case concerns a 68-year-old female patient with unknown medical history, who received their first of two planned doses of mRNA-1273 (Lot unknown), and who experienced the serious unlisted event of Syncope, the non-serious listed event of Pain in extremity, and the non-serious unlisted events of Head injury and Malaise. Based on the current available information and temporal association between the use of the product and the onset of the events on the day after vaccination, a causal relationship cannot be excluded and the events are considered possibly related to the vaccine.

Other Meds: EZETIMIBE; ATORVASTATIN; ATENOLOL

Current Illness:

ID: 0963803
Sex: U
Age:
State: KS

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Intentionally received two doses of vaccine back to back; Intentionally received two doses of vaccine back to back; A spontaneous report was received from a healthcare professional concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and intentionally received two doses of vaccine back to back. The patient's medical history was not provided. No relevant concomitant medications were reported. On 4 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 7 Jan 2021, the patient received a second dose of mRNA-1273. The patient intentionally received the two doses of the Moderna COVID-19 vaccine back to back. No treatment information was provided. No other adverse event was reported. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, intentionally received two doses of vaccine back to back, was considered resolved.; Reporter's Comments: This report refers to a case of inappropriate schedule of product administration and intentional product use issue for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0963804
Sex: U
Age:
State: TX

Vax Date:
Onset Date:
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Plunger broke loose and vaccine leaked while administering; Given less or more of the dose; A spontaneous report was received from a physician concerning a patient who received Moderna's Vaccine (mRNA-1273) and experienced syringe issue and incorrect dose administered by device. The patient's medical history was not provided. No relevant concomitant medications were reported. On unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection, and during the administration of the vaccine, the plunger broke loose, and the vaccine leaked out. The patient was likely given less than a full dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The events, syringe issue and incorrect dose administered by device, were considered resolved on unknown date.; Reporter's Comments: This report refers to a case of syringe issue and incorrect dose administered for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0963805
Sex: U
Age:
State: NH

Vax Date:
Onset Date:
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 0.1ml instead of 0.5ml dose given; A spontaneous report was received from a nurse concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and had 0.1ml instead of 0.5ml dose given. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: 039K20A) for prophylaxis of COVID-19 infection. On an unknown date, during vaccine administration, the patient was given a 0.1 milliliters (ml) dose of vaccine instead of 0.5 ml. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, 0.1ml instead of 0.5ml dose given, was considered resolved.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273 (lot # 039K20A). There were no reported AEs associated with this case of incorrect dose administered.

Other Meds:

Current Illness:

ID: 0963806
Sex: F
Age: 82
State: OK

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Only a third of the vaccine was given; Patient felt liquid dripping on her right arm; The needle messed up; A spontaneous report was received from a consumer who was a 82-year old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and the needle messed up, the patient felt liquid dripping on her right arm, and only a third of the vaccine was given. The patient's medical history was not provided. No relevant concomitant medications were reported. On 06 Jan 2021 the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20-2A) intramuscularly in the right arm for prophylaxis of COVID-19 infection. On 06 Jan 2021, during vaccine administration, the needle messed up and the patient felt liquid dripping on her right arm. The patient was given only one third of the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The events, needle messed up, the patient felt liquid dripping on her right arm, and only a third of the vaccine was given, were considered resolved on 06 Jan 2021.; Reporter's Comments: This report refers to a case of incorrect dose administered, exposure via skin contact and needle issue for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0963807
Sex: F
Age: 64
State: NJ

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: tingling in figures of both arms on and off; injection given to her is little lower and not properly in muscle; Headache; A spontaneous report was received from a dentist concerning a 64-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced headache, tingling in fingers of both arms, and injection given to her is little lower and not properly in muscle. The patient's medical history was not provided. Concomitant medication included rosuvastatin calcium. On 01 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 011L20A) intramuscularly for prophylaxis of COVID-19 infection. On the same day, the patient experienced headache, tingling in fingers of both arms, and injection given to her is little lower and not properly in muscle. The treatment information included paracetamol and ibuprofen. Action taken with mRNA-1273 in response to the events was not provided. The event, injection given to her is little lower and not properly in muscle, was considered resolved on 01 Jan 2021. The outcome for the events, headache and tingling in figured of both arms, was unknown.; Reporter's Comments: This case concerns 64-year-old, female, who experienced the non-serious unexpected events of paraesthesia, a non-serious expected event of headache and incorrect route of product administration for mRNA-1273 (Lot# 011L20A). The events of paraesthesia and headache occurred 1 day after the first dose of mRNA-1273 (Lot# 011L20A). There were no reported AEs associated with this case of incorrect route of product administration. The treatment details were not provided. Based on temporal association between the use of the product and the start date of the events (paraesthesia and headache), a causal relationship cannot be excluded.

Other Meds: CRESTOR

Current Illness:

ID: 0963808
Sex: M
Age:
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: received dose 1 of the Moderna vaccine past the 6 hr used-by time; A spontaneous report was received from a male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and received dose 1 of the Moderna vaccine past the 6 hour used-by time. The patient's medical history was not provided. No relevant concomitant medications were reported. On 31 Dec 2020, the patient received their first of two planned doses of mRNA-1273 (Lot number 025L20A) intramuscularly for prophylaxis of COVID-19 infection. On 31 Dec 2020, the patient stated that he received 1 dose of the vaccine past the 6 hour used-by time. He stated that his dose of the vaccine was administered 48 hours after the bottle was opened on 29 Dec 2020. No treatment information was reported. Action taken with mRNA-1273 in response to the event was not reported. The event, received dose 1 of the Moderna vaccine past the 6 hour used-by time, was considered resolved on 31 Dec 2020.; Reporter's Comments: This case concerns a male patient who received their first of two planned doses of mRNA-1273 (Lot 025L20A), reporting Out of specification product use without any associated adverse events.

Other Meds:

Current Illness:

ID: 0963809
Sex: M
Age:
State: AZ

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Vaccine injected into shoulder joint; A spontaneous report was received from a male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and the vaccine was injected into shoulder joint. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 30 Dec 2020, the patient received their first of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. On 30 Dec 2020, during vaccine administration, the vaccine was injected into the patient's shoulder joint instead of the muscle. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the event was not provided. The event, vaccine injected into shoulder joint, was considered resolved on 30 Dec 2020.; Reporter's Comments: This report refers to a case of incorrect route of product administration for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0963810
Sex: F
Age: 51
State: MI

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: We think an empty syringe was administered to a patient; A spontaneous report was received from a pharmacist concerning a 51-years old female patient who received Moderna's COVID-19 Vaccine (mRNA-1273) who experienced empty syringe administered to patient. The patient's medical history was not provided. No relevant concomitant medications were reported. On 08 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number 025L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The pharmacist reported that they thought an empty syringe was administered to the patient. They wanted to administer a confirmed dose to the patient, so a second dose was administered. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, empty syringe administered to patient, was resolved on 08 Jan 2021.; Reporter's Comments: This report refers to a case of 51- year-old female patient who experienced non-serious unexpected event of empty syringe was administered to the patient (Product dose omission in error). There were no reported AEs associated with this case of product dose omission in error.

Other Meds:

Current Illness: No adverse event (No reported medical history)

ID: 0963811
Sex: F
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 01/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Received first dose of moderna vaccine but it was administered 1 cm below the deltoid muscle; A spontaneous report was received from a physician concerning a female patient who was received Moderna's COVID-19 Vaccine (mRNA-1273) and who experienced received first dose of Moderna vaccine but it was administered 1 cm below the deltoid muscle. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 on an undisclosed date intramuscularly for prophylaxis of COVID-19 infection and experienced product administered at inappropriate site when the vaccine was administered one centimeter below the deltoid by a medical student. Treatment information was not provided. Action taken with mRNA-1273 in response to the event, received first dose of Moderna vaccine but it was administered 1 cm below the deltoid muscle, was not provided. The event, received first dose of Moderna vaccine but it was administered 1 cm below the deltoid muscle, was considered recovered/resolved.; Reporter's Comments: This report refers to a case of incorrect route of product administration for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0963812
Sex: F
Age: 44
State: NC

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Left arm cellulitis; Multiple other bumps going down her arm; Itchiness on her left arm close to the vaccination site; One big welt approximately the size of a nickel; A spontaneous report was received from a 44 year-old, female health care professional, who was also the patient, who received Moderna's COVID-19 vaccine and experienced left arm cellulitis, multiple other bumps going down her arm, itchiness on her left arm close to the vaccination site, and one big welt approximately the size of a nickel. The patient's medical history was not provided. Concomitant product use was not provided. On 29 Dec 2020, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20A) in their left arm for prophylaxis of COVID-19 infection. On the morning of 06 Jan 2021, the patient felt itchiness on her left arm close to the vaccination site. The patient had one big welt approximately the size of a nickel, with multiple other bumps going down her arm. The patient took a diphenhydramine hydrochloride, and her symptoms were improving. The bumps going down her arm were resolving, but not fully resolved. Later, the patient noted that she had experienced cellulitis on her left arm starting eight days after vaccination (06 Jan 2021). She received an injection of triamcinolone acetonide on 11 Jan 2021 that helped with the cellulitis's noticeability. Action taken with mRNA-1273 in response to the events was unknown. The outcome of the event cellulitis was unknown. The events multiple other bumps going down her arm, itchiness on her left arm close to the vaccination site, and one big welt approximately the size of a nickel, were considered recovering/resolving.; Reporter's Comments: This case concerns a 44- year old, female, healthcare professional. The patient's medical history was not provided. The patient experienced a serious event of cellulitis, injection site pruritis, vaccination site inflammation and papules. The event occurred 9 days after first dose of mRNA-1273 (Lot number: 025J20A). Vaccination site inflammation is listed on the factsheet and is related to mRNA. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 0963813
Sex: F
Age: 16
State: TX

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Moderna vaccine given to a 16 year old; A spontaneous report was received from a nurse concerning a female 16 year old patient who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, vaccine given to a 16 year old. The patient's reported medical history included severe intellectual disabilities. No relevant concomitant medications were reported. On 7 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 7 Jan 2021, the nurse reported the Moderna COVID vaccine was given to a 16 year old female patient. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, vaccine given to 16 year old, was considered resolved on 7 Jan 2021.; Reporter's Comments: This case concerns a 16-year-old patient who received their first of two planned doses of mRNA-1273 (Lot 037K20A), reporting Product administered to patient of inappropriate age without any associated adverse events.

Other Meds:

Current Illness: Intellectual disability

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm