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: 1499672
Sex: F
Age: 38
State: CT

Vax Date: 04/12/2021
Onset Date: 04/18/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Severe bruising on right forearm, upper thighs on both right and left legs, back of knees on right and left legs and shins of both legs.

Other Meds: 150 mg Effexor

Current Illness:

ID: 1499673
Sex: F
Age: 27
State: AZ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 07/24/2021
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: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: 27yoF without hx of anaphylaxis had acute N/V and shakiness about 10mins after 1st dose of Pfizer vaccine was administered. Vitals 118/74, HR 80s, RR 22. Was speaking fine throughout, w/o any SOB/wheezing or chest pain. Sx were resolved after 10 mins. Had extended monitoring x30 minutes and remained at baseline and was allowed to leave vaccine blitz site. Instructed that 2nd vaccine should be given in Clinic.

Other Meds: unknown

Current Illness: unknown

ID: 1499674
Sex: M
Age: 38
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: no adverse events. When I enter info in immunization Registry, I notice he got Moderna 1st dose on 1/1/21 and second dose on 1/30/2021 already. He lied that he never got covid vaccine before.

Other Meds:

Current Illness:

ID: 1499675
Sex: M
Age: 65
State: WA

Vax Date: 01/20/2021
Onset Date: 02/04/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dx: Myocarditis first s/s 02/04/2021 Pt with h/o chronic cardiovascular disease, HTN< Poissble alternative etiology: possible cardiac sarcoid and T cruzi infection as cause for cMRI findings; these were on the differential in the absence of other definitive cause

Other Meds: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Current Illness: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

ID: 1499676
Sex: M
Age: 26
State: WA

Vax Date: 04/24/2021
Onset Date: 05/27/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: During cardiac workup for unrelated symptoms, low normal/borderline decreased heart function seen on echo (LVEF 50.7%). Began treatment with diltiazem. Began noticing SOB with mild exertion (walking <100 yards) and heartrate stayed above 100bpm despite medication. Mildly elevated blood pressure. Followup cardiac MRI performed 7/6 corroborated echo findings (LVEF 52%) and showed patchy areas of subacute pericarditis and myocarditis inflammation with changes to tissue noticed. Visited urgent care with pericardial chest pain 7/21, received indocin as short term replacement for nabumetone NSAID treatment. Currently waiting on stress test scheduled for 9/16.

Other Meds: Fluoxetine, hydroxyzine, docusate sodium, methylphenidate, nabumetone, metamucil, cranberry concentrate, Humira, omeprazole, vitamin D

Current Illness: none

ID: 1499678
Sex: F
Age: 50
State: AZ

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 07/24/2021
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: lisinopril - unknown

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

Symptoms: developing itching on arm, belly, ear following moderna #2. given 50mg diphenhydramine with improvement, vitals with normal HR/RR, unable to obtain pulse ox. patient monitored additional 15 minutes and sent home

Other Meds: unknown

Current Illness: unknown

ID: 1499679
Sex: M
Age: 14
State: CA

Vax Date: 07/21/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chest pain, tiredness, arm pain, difficulty lifting arm,

Other Meds: None

Current Illness: No

ID: 1499680
Sex: F
Age: 47
State: NV

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Patient mentioned that she has been having a reaction that possibly is a side effect from her current medication therapy. Per Spanish translator, she's been getting numbness of the tongue and after she received the vaccine, around 10-13 minutes after, she informed me that she felt that the numbness on her tongue got worse. I asked if her tongue is swollen, her throat tightening and if she has a hard time breathing. She said no. There are no physical signs of anaphylaxis. I gave her Benadryl and asked her to stay for 15 more minutes. I have been checking her in between her additional 15mins observation and she says she feels better. She wanted to leave. She mentioned she's a little dizzy before she left. I informed her that if she feels worse when she gets home, she needs to see a Doctor right away.

Other Meds: Losartan, Diltiazem, Hydrochlorothiazide, meloxicam, pantoprazole

Current Illness: none

ID: 1499681
Sex: M
Age: 60
State: WA

Vax Date: 01/14/2021
Onset Date: 01/19/2021
Rec V Date: 07/24/2021
Hospital: Y

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

Lab Data:

Allergies: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: DX: Pericarditis 01/20/2021 S/S: Neck pain, acute chest pain or pressure, Chest pain, more on the left side at the anterior axillary line radiating across the chest while watching a movie occurred previous day and again day of admission while walking. Possible alternative etiology: Initial concern for ischemia given history (prior MI with stenting, significant residual disease), but pharmacologic stress perfusion study did not show change from prior. One note describes pain reproducible with palpation, raising question of chest wall pain, but not mentioned elsewhere in notes, so appears pericarditis was considered the most likely etiology. 60 year old male with extensive CAD history with new chest pain. Was hospitalized with new diagnosis of probable pericarditis. Reported first dose vaccine given 01/14/2021, 4 days prior to initial symptoms. Of note, would not meet case definition for pericarditis (has chest pain but no other finding), but would meet myocarditis case definition (chest pain and troponin elevation); potential myocarditis is not discussed in the clinical notes, perhaps because the troponin elevation was fairly minimal.

Other Meds: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Current Illness: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

ID: 1499682
Sex: M
Age: 22
State: AZ

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 07/24/2021
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: Patient received second Moderna vaccine at vaccine event. He had reported some post vaccine tingling with first vaccine, so he was triaged after second vaccine to the 30 minute observation area. He again complained of left sided tingling and also subjective numbness of face and tongue. His exam was normal. Normal cranial nerve function. Normal speech. Normal VS. No meds administered. Given some snacks. Symptoms resolved over course of another 30 minutes. Discharged to home without incident

Other Meds: unknown

Current Illness: unknown

ID: 1499683
Sex: F
Age: 0
State: TX

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: No known allergies.

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

Symptoms: Infant did not display any abnormal signs or symptoms.

Other Meds: None.

Current Illness: None.

ID: 1499684
Sex: F
Age: 64
State: WA

Vax Date: 04/07/2021
Onset Date: 05/16/2021
Rec V Date: 07/24/2021
Hospital: Y

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

Lab Data:

Allergies: N/A: Data collected from Health Authority report pulled at the State level. Limited details available in report.

Symptom List: Rash, Urticaria

Symptoms: DX: Pericarditis S/S: Lethargy/fatigue, Dyspnea on exertion, dyspnea with lying down or orthopnea, edema, anorexia or poor feeding, tachypnea, acute chest pain or pressure Clinician description:3-4 weeks of progressive shortness of breath and dyspnea on exertion. Typically sleeps propped up on 3 pillows, no new orthopnea or nocturnal dyspnea. History of sleep apnea but intolerant of CPAP S/S onsetn: 03/26/2021

Other Meds: N/A: Data collected from Health Authority report pulled at the State level. Limited details available in report.

Current Illness: N/A: Data collected from Health Authority report pulled at the State level. Limited details available in report.

ID: 1499686
Sex: M
Age: 69
State: WA

Vax Date: 01/02/2021
Onset Date: 02/25/2021
Rec V Date: 07/24/2021
Hospital: Y

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

Lab Data:

Allergies: N/A: Data collected from report. Limited details available in report.

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

Symptoms: DX: Myocarditis S/S: Dyspnea on exertion onset 02/19/2021

Other Meds: N/A: Data collected from report. Limited details available in report.

Current Illness: N/A: Data collected from report. Limited details available in report.

ID: 1499687
Sex: M
Age: 70
State: AZ

Vax Date: 02/02/2021
Onset Date: 03/25/2021
Rec V Date: 07/24/2021
Hospital: Y

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: NKA

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

Symptoms: Patient presented to ED 3/25/21 with right Bell's Palsy. COVID-19 Positive. Patient completed COVID-19 vaccinations on 1/12 and 2/2. COVID-19 Infection: #Suspected COVID infection: Onset date: unknown presented with: no symptoms. Recent exposures: none. initial CRP: 0.29, LDH: 215 D-dimer: 0.54 -Admit to hospital: contact/droplet precuations -Covid test date: 3/25/21 RA sats: 94% in ER. -empiric abx coverage: none - No Remdesivir or Dexamethasone for treatment. - Pt completed both COVID-19 vaccine doses 1/12 and 2/2/21. Discharge planning Ambulatory O2 challenge daily: Last fever: none Home support for ADLs if needed: YES Medications: 30 day supply R Bells' Palsy: - R facial weakness with inability to close his R eye and sparing the forehead. - Pt also evaluated by Clinic Telestroke and they feel his symptoms are consistent with Bells Palsy. - CT head negative for acute bleed. - MRI brain due to complaints of also dysphagia and some dysarthria. - Facial weakness seems moderate to severe given above findings as well. - Lacrilube qHS and Artificial tears q2h PRN dryness R eye - Prednisone 60mg daily x 7d - Valacyclovir 1g tid x 7d per protocol. Dysphagia: - Could be due to severity of Bells Palsy. - MRI brain to rule out acute CVA. - Speech and swallow eval: mild weakness on mouth on R but normal swallow. Rec NDDI diet with clears and use of straw on L side of mouth. DM2: - A1c: 6.3 this admission. - Outpatient Meds: metformin - CC diet. - SSI for now. HTN: - Continue Norvasc. BP controlled. HLD: - Continue ASA and Atorva. RAD: - Continue Advair. MM: - Will touch bases with Hematology. BPH: - Tamsulosin. Glaucoma: - Continue Travatan. Hosp Issues: CODE STATUS: FULL CODE Diet: NPO for now DVT Proph: SCD boots Disp: Speech cleared pt stating he has no difficulty swallowing. If the MRI brain is negative for an acute process, will plan to discharge the patient home today. Notes: Two patient identifiers confirmed. Patient said that he was doing well without any medical issues and without concerns at this time. This nurs cm reminded patient about mask wearing, social distancing and frequest handwashing. Patient verbalized understanding. F/U Plan: Moderate Risk - 2 week post d/c f/u. Electronically signed on: Electronically signed on: 2021-03-29

Other Meds: unknown

Current Illness: unknown

ID: 1499688
Sex: F
Age: 49
State: AZ

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 07/24/2021
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: Adhesive

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

Symptoms: Continuing severe left shoulder and arm pain with left arm weakness. It has been 4 months and the pain is getting worse, as is the weakness.

Other Meds: Buprenorphine, gabapentin, ibuprofen, robaxin, tylenol, l thyroxine, birth control, fat soluble vitamins

Current Illness: None

Date Died:

ID: 1499689
Sex: M
Age: 35
State: WA

Vax Date: 05/11/2021
Onset Date: 06/03/2021
Rec V Date: 07/24/2021
Hospital: Y

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

Lab Data:

Allergies: N/A: Data collected from report pulled. Limited details available in report.

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

Symptoms: DX: Myocarditis Onset of S/S 06/02/2021 S/S:Dyspnea on exertion, Fever/chills,Tachypnea Found to have acute basilar ischemic stroke, taken for emergent thrombectomy, but experienced progressive edema and ultimately tonsillar herniation. 35 year old man with medical history notable for likely untreated hypertension and tobacco use disorder who presented with reported fever, confusion, shortness of breath, and facial swelling, initially treated for allergic reaction/angioedema without effect, progressed to respiratory failure, found to have acute basilar ischemic stroke, taken for emergent thrombectomy, but experienced progressive edema and ultimately tonsillar herniation resulting in death. Regarding cardiac picture, patient with abnormal ECG, mildly reduced EF on echo (though could be due to untreated hypertension or to respiratory failure/critical illness), borderline troponin (need to check reference range). ED note initially mentions concern for myocarditis due to vaccine causing heart failure and subsequent respiratory failure, but appears this piece was written prior to MRI showing basilar stroke. Death note has myocarditis listed as a cause of death (among many), though a bit unclear if this was intentionally listed or just reflects a list of all hospital problems. Also had a CT of his head which showed scattered foci of gas within intraorbital soft tissues along with mild proptosis; unclear etiology for this (perhaps a fall with facial injuries prior to arriving at hospital?) Awaiting additional physician notes/imaging reports.

Other Meds: N/A: Data collected from report pulled. Limited details available in report.

Current Illness: N/A: Data collected from report pulled. Limited details available in report.

ID: 1499690
Sex: M
Age: 48
State: AZ

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 07/24/2021
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: ibuprofen - rash

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

Symptoms: Patient experienced hives on face/neck after first Moderna dose in Feb, treated w/ benadryl at that time, lasted several hours, no mouth/throat swelling. Patient was scheduled for his 2nd Moderna dose at clinic. Given his reaction to moderna previously he was sent to outpatient pharmacy to get Janssen (J&J) vaccine. After the Janssen Covid vaccine was administered patient immediately began feeling red, hot, and itchy. Was given benadryl 25mg/5ml oral dose x2 after being monitored for 30 min. Told patient if symptoms got worse or persisted to come back to hospital. After monitoring patient he felt safe to go home and had no visible signs of reaction after 30 min. Called patient to follow up 24 hours later and he stated he felt a "little itchy" that evening and had flu like symptoms when he woke up in the morning (achy, chills) but the itching went away last night.

Other Meds: unknown

Current Illness: unknown

ID: 1499691
Sex: M
Age: 40
State: WA

Vax Date: 03/29/2021
Onset Date: 04/16/2021
Rec V Date: 07/24/2021
Hospital: Y

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

Lab Data:

Allergies: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: DX: Pericarditis; S/S Headache, fever/chills, Acute chest pain or pressure, Chest pain made worse by lying down, deep inspiration, or cough,Chest pain relieved by sitting up or leaning forward-- onset 04/14/2021 "Progressive severe diffuse anterior chest pain radiates towards his anterior neck...describes a pleuritic component to his chest pain."

Other Meds: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

Current Illness: N/A: Data collected from ESSENCE report pulled at the State level. Limited details available in report.

ID: 1499692
Sex: F
Age: 42
State:

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 07/24/2021
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: 1.) 07/21/21 An hour after 2nd shot, numbness in toes 2.) 07/22/21 Morning after my left eye felt like it was getting pink eye but no outward symptoms of pink eye 3.) 07/23/21 Night, Raised red area around shot site. Warm to touch but not itchy. Vertigo, feeling like I?m losing my balance. Dizziness. Left leg has numbness.

Other Meds: Multivitamin Flaxseed oil

Current Illness:

ID: 1499694
Sex: F
Age: 61
State: AZ

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: gabapentin - unknown lupron - unknown codeine - vomiting

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

Symptoms: Patient developed itching after second Pfizer vaccine. She had the same thing after first vaccine and responded well after po Benadryl. Providers discussed whether to give second vaccine at mobile clinic and decided to go ahead, since first reaction was very mild and totally resolved with time and Benadryl. Patient also got itching with codeine. She again did well. Nothing but mild itch. No hives or any other reaction. Kept additional time. Totally resolved by discharge.

Other Meds: unknown

Current Illness: unknown

ID: 1499695
Sex: F
Age: 36
State: AZ

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 07/24/2021
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: NKA

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

Symptoms: Pt was administered 1st dose of Pfizer Covid vaccine in right deltoid. A few minutes after while sitting in the observation area, she began to vomit. BP 132/96 P 104 SpO2 98, 3 minutes later, BP 161/106 P 119, SpO2 98. Pt has a hx of allergic reaction to coffee and MSG. ER notified. Pt was transported to ER via wheelchair at 0915. Pt was in no acute distress, alert, oriented x3.

Other Meds: unknown

Current Illness: unknown

ID: 1499696
Sex: M
Age: 18
State: NC

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 07/24/2021
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: Nausea and vomiting Fever

Other Meds:

Current Illness:

ID: 1500184
Sex: M
Age: 44
State: AZ

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 07/24/2021
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: MS Contin - trouble urinating tramadol - unknown diazepam - unknown

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

Symptoms: About 15 minutes after vaccine was given, patient started feeling numbness and pain in right upper arm where vaccine was given. Patient has a PMH of stroke on the right side and diabetes. Patient also reported itchiness in right leg and dizziness. Vitals were taken and neuro exam performed. Patient given water and snack but started feeling stiffness in neck. Referred to ED for evaluation of symptoms.

Other Meds: unknown

Current Illness: unknown

Date Died: 07/04/2021

ID: 1500185
Sex: F
Age: 83
State: DC

Vax Date: 06/30/2021
Onset Date: 07/02/2021
Rec V Date: 07/24/2021
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: Allergic to pennicilin

Symptom List: Injection site pain, Pain

Symptoms: My mother passed away 3 days after jab on July 4, 2021

Other Meds: Gabapentin, Lovastatin, Paradaxa, metoprolol , Vitamin D,

Current Illness: Rheumatoid Arthritis, pre diabetic, slight hypertension. My mother was bedridden the last 6 mos of her life. She passed three days after the jab! S

ID: 1500186
Sex: M
Age: 38
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received second dose of Moderna vaccine at event. Immediately he experienced nausea and vomiting. He was very anxious about getting the vaccine. Vitals were monitored and were stable. He was observed for 30 minutes and did well with no further adverse reactions. He contacted a family member to come and drive him home.

Other Meds: unknown

Current Illness: unknown

ID: 1500187
Sex: F
Age: 54
State: OH

Vax Date: 04/05/2021
Onset Date: 06/21/2021
Rec V Date: 07/24/2021
Hospital: Y

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: Pt presented with symptoms of UTI along with dry cough, SOB, and fever. CXR showed lingular pneumonia. Pt did not require oxygen on admission. Pt discharged on levofloxacin (to complete 5-day course).

Other Meds:

Current Illness:

ID: 1500188
Sex: F
Age: 61
State: AZ

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 07/24/2021
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: amlodipine - unknown ceftriaxone - unknown lisinopril - unknown losartan - unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient given first dose of COVID vaccine - Moderna. Shortly after, patient started experiencing itching and hives all over body as well as some nausea. Patient called EMS and was brought to ED

Other Meds: unknown

Current Illness: unknown

ID: 1500189
Sex: F
Age: 32
State: VA

Vax Date: 05/02/2021
Onset Date: 05/06/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Skin lesion all over body

Other Meds: Prenatal vitamins & Maca

Current Illness: None

ID: 1500190
Sex: M
Age: 69
State: ME

Vax Date: 04/30/2021
Onset Date: 07/03/2021
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Downward decline in mental capacity. It was going to come with his condition (alzheimers disease) but there's been a significant turn for the worst since he took the vaccine. It was evidentiary approximately 6 weeks after his second and final vaccination.

Other Meds: Donepezil 5mg Verapamil 240mg Avorstatin 10mg Lisinopril 10mg

Current Illness: Alzheimers disease

Date Died:

ID: 1500191
Sex: M
Age: 38
State:

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 07/24/2021
Hospital: Y

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: Death

Other Meds:

Current Illness:

ID: 1500192
Sex: F
Age: 46
State: NV

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 07/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin.

Symptom List: Injection site pain

Symptoms: I got Moderna vaccine on 12/30/2020 around 11.30a.m. at hospital where l work. After 4-5 minutes to got Moderna covid 19 vaccine, l had dizziness and weakness of my body. My vision was blurry. I felt pressure back of my head and l felt numbness top of my head. Er Nurses checked me. They check my tension and level of oxygen of my body.l wait 15 minutes in the same room after a nurse took me to other room when l started to see everthing normal.

Other Meds: No.

Current Illness: No.

ID: 1500193
Sex: F
Age: 16
State: AZ

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 07/24/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Pt reported hx of fainting to vaccines. Made sure she was comfortable sitting in her car. I attempted to distract her, but she still fainted. She was out for approximately 3 seconds before recovering spontaneously. I applied ammonia inhalants as she was awaking, and she immediately came to. Afterwards, she complained of HA, lightheadedness, + fatigue. On exam, lungs: CTA B/L; Cardio: normal RRR, no murmurs, gallops, rubs; HEENT: no erythema or edema of face or throat. Denied CP, palp, SOB, pruritis, dizzy Ammonia inhalant used. Post-vaccination wait for 30 mins. HA, lightheadedness, and fatigue resolved w/in 30 min wait. Pt went home.

Other Meds: unknown

Current Illness: unknown

ID: 1500194
Sex: M
Age: 66
State: CA

Vax Date: 07/22/2021
Onset Date: 07/01/2021
Rec V Date: 07/24/2021
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: My left arm began to hurt almost immediately after the injection, and still hurts 24 hours later. That night at 1015 pm 8 hours after I received my shot I chest and upper arms started to itch . I took off my shirt and looked in the mirror. I could see redness across my chests and upper shoulders both sides have a reddish rash which does itch. I?ve had to buy anti itch cream. And today 24 hours after my injection my upper lip started to swell up and soon my lower lip swelled up and went numb.. even affecting my nostril area.

Other Meds:

Current Illness:

ID: 1500469
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 07/24/2021
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: Parent's other son, now 16, had an adverse reaction to his measles-mumps-rubella (MMR) vaccine when he was younger, and has not been vaccinated since; This spontaneous report was received from a consumer through a online article. Mother says hospital clueless about reporting to vaers regarding a currently 16 year old male patient. Information regarding the patient's pertinent medical history, concomitant therapies, drug reactions, or allergies was not reported. On an unknown date,(reported as when he was younger) the patient?s mother reported her son was vaccinated with an unspecified measles-mumps-rubella MMR vaccine (dose, route of administration, vaccination scheme frequency, anatomical location, lot number and expiration date were not reported) and experienced and adverse reaction (vaccination complication) to it. It was reported the patient has not been vaccinated since. The outcome of the event was not reported. The consumer's causality assessment between the measles-mumps-rubella MMR vaccine and the vaccination complication was related.

Other Meds:

Current Illness:

ID: 1500470
Sex: U
Age:
State: CA

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 07/24/2021
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: No adverse event; 15 years old received an adult dose of VAQTA.; received 1.0 ml instead of 0.5 ml; This spontaneous report was received from a medical assistant concerning a 15-year-old patient of unknown gender. The patient's medical history, concurrent conditions and concomitant medications were not provided. On 25-JUN-2021, the patient was vaccinated with an adult dose of hepatitis a vaccine, inactivated(VAQTA), 1 ml instead of 0.5 ml, intramuscular, lot # T017179, expiration date: 26-OCT-2021, for prophylaxis. No adverse events reported. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: T017179; expirationdate: 26-OCT-2021; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; evaluatedbymfr: Not returned to manufacturer; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not suggest a causal association with the device or device constituent

Other Meds: VAQTA SYRINGE (DEVICE)

Current Illness:

ID: 1500471
Sex: U
Age:
State: NJ

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 07/24/2021
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 AEs; MMR II that underwent a temperature excursion was administered/ Temperature 57F/ 56.3F/ 47.8F; This spontaneous report has been received from a healthcare business professional (office manager) referring to a patient whose age and gender was not reported. The patient's pertinent medical history, drug reactions, allergies, and concomitant medications were not reported. On 03-JUN-2020, Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (rHA) (M-M-R II) (lot number S020162, expiration date 30-JUN-2021) was out of temperature range for 1 hour (h) and 53 minutes (min) and reached 57 degrees Fahrenheit (F). On 04-JUN-2020, it was out of range for 48 min and reached 56.3 degrees F. Finally, on 10-SEP-2020, it was out of range for 11 minutes and reached 47.8 degrees F. On 17-JUN-2021, a temperature excursion of 57 degrees F for 1 h and 53 min, 56.3 degrees F for 48 min, 47.8 degrees F for 11 minutes, and 47.8 for 5 minutes occurred according to the data logger. On the same day, Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (M-M-R II) was administered to the patient as prophylaxis (dose, dose number, vaccination scheme frequency, route of administration, and anatomical location of vaccination were not reported). No additional adverse events occurred.

Other Meds:

Current Illness:

ID: 1500472
Sex: U
Age:
State: PA

Vax Date: 06/21/2021
Onset Date: 06/21/2021
Rec V Date: 07/24/2021
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: No symptoms were reported by the patient. No additional AE's/PQC's were noted; temperature excursion for VARlVAX/ Per caller product was administered to (1) patient.; This spontaneous report was received from a registered nurse referring to a patient of unknown age and gender. Information regarding the patient's pertinent medical history, drug allergies/reactions or concomitant medications was not provided. On 21-JUN-2021, the patient was vaccinated with an improperly stored dose of varicella virus vaccine live (Oka/Merck) (VARIVAX), dose reported as 1 (units not provided) subcutaneously (lot number: T032322 with expiration date 22-SEP-2022) for prophylaxis (vaccination scheme frequency and anatomical location were not reported). The administered dose of the vaccine experienced a temperature excursion of 12.1 degrees Fahrenheit for 1 hour and 23 minutes, as recorded by a data logger; there was no previous temperature excursion. No symptoms were reported by the patient and there were no adverse events.

Other Meds:

Current Illness:

ID: 1500473
Sex: F
Age: 0
State: WI

Vax Date: 06/25/2021
Onset Date: 06/25/2021
Rec V Date: 07/24/2021
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: No adverse event; Patient DOB is 08-JUN-2021 and she received PROQUAD on 25-JUN-2021; Incorrect product storage; This spontaneous report was received from a medical assisstant and refers to a 17-days-old female patient. Information regarding the patient's concomitant therapies, concurrent conditions, medical history and historical drugs was not provided. On 25-JUN-2021, the patient was vaccinated with improperly stored Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (PROQUAD) (dosage regimen and route of administration were not reported), lot numbers reported to suffer temperature excursion were T014388, T025221 (rHA) and T027115 (rHA) and respective expiration dates 24-OCT-2021, 19-JAN-2022 and 02-FEB-2022 (It was not specified which lot was administered to the patient) administered as prophylaxis. The improperly stored dose of the suspect vaccine experienced a temperature excursion unknown by the reporter for an unknown timeframe; it was also unknown if there were previous temperature excursions. No adverse symptoms were reported. This one of several cases from the same reporter.; Sender's Comments: US-009507513-2106USA007465: US-009507513-2107USA006276:

Other Meds:

Current Illness:

ID: 1500474
Sex: U
Age: 5
State: MI

Vax Date: 09/11/2008
Onset Date: 07/07/2021
Rec V Date: 07/24/2021
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: Patient is not exhibiting any adverse symptom; Received an extra dose of Vaqta/Indicate at which point in the process the medication error ocurred: Administration; This spontaneous report was received from a medical assistant and refers to an 18-year-old male patient. The patient's concurrent conditions included seasonal allergies and no information was provided regarding the patient's medical history or drug reactions. On 11-SEP-2008, the patient was vaccinated with the first dose of Hepatitis A Vaccine, Inactivated (VAQTA) for prophylaxis (strength, dose number, anatomical location, route of administration, lot number and expiration date were not reported) and on 17-NOV-2010 received the second dose (strength, dose number, anatomical location, route of administration, lot number and expiration date were not reported). On 07-JUL-2021, an administration error occurred, and the patient was vaccinated with an extra dose of Hepatitis A Vaccine, Inactivated (VAQTA) intramuscularly, lot # T033519 with expiration date on 11-DEC-2021. The vaccine was administered by a trained healthcare professional and treatment was not required for the experience and the patient did not exhibit any adverse symptom. The same date the patient was vaccinated with diphtheria vaccine toxoid, pertussis vaccine acellular 5-component, tetanus vaccine toxoid (ADACEL) and hepatitis b vaccine.

Other Meds: ADACEL; HEPATITIS B [HEPATITIS B VACCINE]

Current Illness: Seasonal allergy

ID: 1500475
Sex: M
Age:
State: GA

Vax Date: 07/31/2012
Onset Date: 07/08/2021
Rec V Date: 07/24/2021
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: anxiety; dizzy/dizziness; After a longer than recommended interval; Inadvertently gave himself the 40 mcg (1.0 ml) dose intended for dialysis patients; This spontaneous report was received from a pharmacist regarding himself, a male patient of unknown age. No information was provided regarding the patient's medical history, concurrent conditions, drug reactions, allergies or concomitant medications. On 31-JUL-2012, the patient was vaccinated with the first dose of Hepatitis B Vaccine (Recombinant) (RECOMBIVAX HB) for prophylaxis (strength, dose number, anatomical location, route of administration, lot number and expiration date were not reported) and on 07-SEP-2012 the patient received the second dose of Hepatitis B Vaccine (Recombinant) (RECOMBIVAX HB) for prophylaxis (strength, dose number, anatomical location, route of administration, lot number and expiration date were not reported). On 08-JUL-2021, the patient self-administered his third dose of Hepatitis B Vaccine (Recombinant) (RECOMBIVAX HB) lot # T020448 with expiration date on 13-APR-2023 for prophylaxis (strength, dose number, anatomical location and route of administration were not reported), inadvertently gave himself the 40 microgram (1.0 ml) that was intended for dyalisis patients . The dose was given after a longer than recommended interval. The same date, the patient experienced anxiety and felt that might be from anxiety he started with dizziness. On 09-JUL-2021, the patient was fine and recovered from dizziness and regarding the outcome of anxiety resolved on an unspecified date in July 2021. The causal relationship between the events and vaccination with Hepatitis B Vaccine (Recombinant) (RECOMBIVAX HB) were not reported.

Other Meds:

Current Illness:

ID: 1500476
Sex: U
Age:
State: TX

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/24/2021
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: No additional AE reported; vaccine administered after temperature excursion; Temperature 9.6 C; This spontaneous report as received from a nurse refers to a patient of unknown age and gender. Pertinent medical history, drug reactions, allergies and concomitant medications were not reported. On 12-JUL-2021, the patient was vaccinated with an improperly stored dose of rotavirus vaccine, live, oral, pentavalent (ROTATEQ) (lot number: U007860, expiration date: 14-JAN-2022) 2 mL administered orally. The vaccine was stored in temperature 9.6 degrees Celsius for 11 minutes (product storage error temperature too high). There was no previous temperature excursion. Digital data lodger was involved. No adverse event was reported.

Other Meds:

Current Illness:

ID: 1500477
Sex: U
Age:
State: NY

Vax Date: 07/12/2021
Onset Date: 07/12/2021
Rec V Date: 07/24/2021
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: No additional adverse effect reported; VARIVAX that underwent a temperature excursion was administered; This spontaneous report as received from a registered nurse refers to a patient of unknown age and gender. Pertinent medical history, drug reactions, allergies and concomitant medications were not reported. On 12-JUL-2021, the patient was vaccinated with an improperly stored dose of varicella virus vaccine live (oka/merck) (VARIVAX) (lot number: S031497, expiration date: 07-OCT-2021; dose and route of administration not provided). The vaccine was stored in temperature 0.6 degree Celsius for 30 minutes. There was previous temperature excursion in temperatures from -10 to 8 degrees Celsius (-4.5 degrees Celsius) for 2 hours and 20 minutes. Digital data lodger was involved. No adverse event was reported. This is one of the two reports from the same reporter.; Sender's Comments: US-009507513-2107USA004652:

Other Meds:

Current Illness:

ID: 1500478
Sex: U
Age:
State: MI

Vax Date: 07/07/2021
Onset Date: 07/07/2021
Rec V Date: 07/24/2021
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: No signs or symptoms reported; a temperature excursion; This spontaneous report was received from an office manager referring to a patient of unknown age and gender. Information about medical history, concurrent conditions and concomitant therapies was not provided. On 07-JUL-2021, the patient was vaccinated with improperly stored varicella virus vaccine live (oka/merck)(VARIVAX) (lot # T032318, expiration date 22-SEP-2022, 1 dosage form) for prophylaxis (product storage error). Temperature excursions were 15 Fahrenheit degree to 46 Fahrenheit degree (30.3 Fahrenheit degree) for 6 hours 30 minutes and 0 seconds; 6 Fahrenheit degree to 14 Fahrenheit degree (14.1 Fahrenheit degree) for 5 hours 0 minutes and 0 seconds; 15 Fahrenheit degree to 46 Fahrenheit degree (16.6 Fahrenheit degree) for 14 hours 0 minutes and 0 seconds; 15 Fahrenheit degree to 46 Fahrenheit degree (19.7 Fahrenheit degree) for 1 hour 0 minutes and 0 seconds. Time frame 26 Hours 30 Minutes 0 Seconds (cumulative). There was no previous temperature excursion. Data logger was involved. No signs or symptoms were reported.

Other Meds:

Current Illness:

ID: 1500479
Sex: M
Age:
State: FL

Vax Date: 10/21/2017
Onset Date:
Rec V Date: 07/24/2021
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: The pt. suffered vision loss, unbalance and stuttering and was diagnosed with cerebrovascular accident; Information has been received from a lawyer, regarding a case in litigation and concerning to a male patient (pt.) of unknown age. The pt's concurrent conditions, medical history and concomitant medications were not reported. In or around 21-OCT-2017, the pt. was inoculated with zoster vaccine live (ZOSTAVAX) (dose, route of administration, anatomical location, lot # and expiry date were not provided) for routine health maintenance and for the prevention of shingles (herpes zoster). On an unknown date, shortly after receiving zoster vaccine live (ZOSTAVAX), the pt. suffered vision loss, unbalance, and stuttering, and was diagnosed with cerebrovascular accident. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the pt's symptoms resulted in physical limitations not present prior to using it. The pt. also experienced mental and emotional distress due to resulting physical limitations and seriousness of his condition. As a result of the manufacture, marketing, advertising, promotion, distribution and/or sale of zoster vaccine live (ZOSTAVAX), the pt. sustained severe and permanent personal injuries. Further, as a tragic consequence, the pt. suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result, the pt. had suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of the event cerebrovascular accident was not recovered. The reporter considered the event cerebrovascular accident to be related to zoster vaccine live (ZOSTAVAX). The reporter considered cerebrovascular accident to be disabling event. Upon internal review, the event cerebrovascular accident was considered to be medically significant.

Other Meds:

Current Illness: Routine health maintenance

ID: 1500480
Sex: U
Age:
State: NM

Vax Date: 09/20/2012
Onset Date:
Rec V Date: 07/24/2021
Hospital: Y

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: other zoster-related conditions; shingles; Information has been received from a lawyer regarding a case in litigation concerning a patient (pt) of unknown age and gender. The pt's medical history, concurrent conditions and concomitant medications were not provided. On or about 20-SEP-2012, the pt was vaccinated with zoster vaccine live (ZOSTAVAX) (dose, route of administration, anatomical location, lot#, expiration date were unknown) by a healthcare professional for the long-term prevention of shingles and zoster-related conditions. Subsequent to pt's zoster vaccine live (ZOSTAVAX) inoculation, pt was treated by a healthcare professional for shingles and other zoster-related conditions. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), pt had and would continue suffer ongoing injuries, including but not limited to: mental and physical pain and suffering; medical care and treatment for these injuries; significant medical and related expenses as a result of these injuries, including but not limited to medical losses and costs include care for hospitalization, physician care, monitoring, treatment, medications, and supplies; diminished capacity for the enjoyment of life; diminished quality of life; increased risk of premature death, aggravation of preexisting conditions and activation of latent conditions; and other losses and damages; and would continue to suffer such losses, and damages in the future. The outcome of shingles and zoster-related conditions was unknown and the causal relationship between shingles, zoster-related conditions and zoster vaccine live (ZOSTAVAX) was considered related.

Other Meds:

Current Illness:

ID: 1500481
Sex: U
Age:
State: TX

Vax Date: 11/02/2013
Onset Date:
Rec V Date: 07/24/2021
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: vomiting, fever, and mental status changes and was diagnosed with Herpes Simplex encephalitis; This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to a female patient of unspecified age. No information was provided regarding medical history, concurrent conditions, or concomitant medications. On or around 02-NOV-2013 the patient was vaccinated with zoster vaccine live (ZOSTAVAX) for for routine health maintenance and for its intended purpose: the prevention of shingles (herpes zoster)(dose, route of administration, lot number and expiration date were not reported). On an unknown date, the pt. experienced vomiting, fever, and mental status changes and was diagnosed with herpes simplex encephalitis. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient's symptoms have resulted in physical limitations do not present prior to using the product. The patient also experiences mental and emotional distress due to resulting physical limitations and seriousness of her condition. As a result of zoster vaccine live (ZOSTAVAX), the patient sustained severe and permanent personal injuries. Further, as a tragic consequence of the Company's wrongful conduct, the patient suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result of the Company's conduct, the patient has suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of the event was considered not recovered/not resolved. The event was considered related to zoster vaccine live (ZOSTAVAX). Upon internal review herpes simplex encephalitis was considered to be medically significant event. Upon internal review the herpes simplex encephalitis was considered to be disabling.

Other Meds:

Current Illness: Routine health maintenance

ID: 1500482
Sex: M
Age:
State: OR

Vax Date: 09/10/2013
Onset Date:
Rec V Date: 07/24/2021
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: lower extremity cellulitis; swelling of extremity; shortness of breath; generalized fatigue/fogginess; difficulty concentrating; Chronic Inflammatory Demyelinating Polyneuritis/ ascending numbness into his extremities which eventually moved into his shoulders and hips; generalized fatigue/fogginess; This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to a male patient of unknown age. No information was provided regarding medical history, concurrent conditions, or concomitant medications. In or around 10-SEP-2013, the patient was inoculated with zoster vaccine live (ZOSTAVAX) (lot#, expiration date, dose, dose# and route not specified) for routine health maintenance and for its intended purpose: the prevention of shingles (herpes zoster). Shortly after receiving zoster vaccine live (ZOSTAVAX) vaccine, the patient initially suffered and developed lower extremity cellulitis, swelling of extremity, shortness of breath and generalized fatigue/fogginess and difficulty concentrating. Immediately following these injuries and in relation to the above, he experienced ascending numbness into his extremities which eventually moved into his shoulders and hips. The patient was further diagnosed with chronic inflammatory demyelinating polyneuritis. As a direct and proximate result of zoster vaccine live (ZOSTAVAX) vaccine, the patient's symptoms had resulted in physical limitations not present prior to using zoster vaccine live (ZOSTAVAX). The patient also experienced mental and emotional distress due to resulting physical limitations and seriousness of his condition. As a result of the manufacture, marketing, advertising, promotion, distribution and/or sale of zoster vaccine live (ZOSTAVAX), the patient sustained severe and permanent personal injuries. Further, the patient suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. As a direct and proximate result of zoster vaccine live (ZOSTAVAX), the patient had suffered and incurred damages, including medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of all events was considered to be not recovered and causal relationship was assessed as related. The lawyer considered all events to be disability. Upon internal review, the events of cellulitis and chronic inflammatory demyelinating polyradiculoneuropathy were determined to be medically significant.

Other Meds:

Current Illness:

ID: 1500483
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 07/24/2021
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: passed out; the patient was told that she had a neural disease. She thinks it was multiple sclerosis; very sick; not good at taking care of herself; This spontaneous report was received from the patient's sister who is currently a 31-years-old female patient. The patient's pertinent medical history included miscarriage. The patient's current conditions included neurological diseases and reproductive issues. Drug/allergies were reported as yeast allergy that ran in the family. Concomitant medications were unknown by the reporter. On an unknown date, also reported as at approximately age 18, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (GARDASIL) (dose, vaccination scheme frequency, route and anatomical location of administration, lot number, and expiration date were not reported) with indication reported as "vaccine" (prophylaxis). The reporter was not certain if it was quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (GARDASIL) or hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) but stated that it was "the first one that came out". On an unknown date, also reported as "sometime after receiving the vaccine", the patient became very sick (illness) and passed out (loss of consciousness). The patient went to the emergency room (ER) and she was told that it was due to a reaction of the quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (GARDASIL) shot. On an unknown date, noted as "later", the patient was told that she had a neural disease and the reporter thought it was multiple sclerosis. The reporter stated that there was a lot of information that she did not know because her sister was not good at taking care of herself (Impaired self-care) and following up with her physicians about her health. The patient sough medical attention. It was unknown by the reporter if any treatment was given for the events, if laboratory diagnostics or studies were performed and no product quality complaint was reported. The outcome of the events was not provided. The causal relationship between quadrivalent human papillomavirus (types 6,11,16,18) recomb. Vaccine (GARDASIL) and the events was not reported. Upon internal review, the events passed out and multiple sclerosis were determined to be medically significant. This is one of several reports for the same patient.; Sender's Comments: US-009507513-2107USA006556: US-009507513-2107USA006557:

Other Meds:

Current Illness: Hypersensitivity; Neurological disorder NOS; Reproductive tract disorder NOS

ID: 1500484
Sex: U
Age:
State: MN

Vax Date: 10/12/2016
Onset Date:
Rec V Date: 07/24/2021
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: Bilateral Ischemic Optic Neuropathy; Blurred Vision; This initial spontaneous report was received from a lawyer regarding a case in litigation, referring to a patient of unknown age and gender. No information was provided regarding medical history, concurrent conditions, or concomitant medications. In or around 12-OCT-2016, the patient was inoculated with zoster vaccine live (ZOSTAVAX) for routine maintenance and for its intended purpose: the prevention of shingles (herpes zoster) (strength, dose, route of administration, anatomical location, lot number, and expiration date were not reported). On an unknown date (reported as shortly after received zoster vaccine live (ZOSTAVAX) vaccine), the patient suffered vision problems and was diagnosed with blurred vision and bilateral ischemic optic neuropathy. As a direct and proximate result of the patient's use of the zoster vaccine live (ZOSTAVAX) vaccine, the patient's symptoms have resulted in physical limitations did not present prior to used vaccine. The patient also experiences mental and emotional distress due to resulted physical limitations and seriousness of his condition. The patient sustained severe and permanent personal injuries (disability). Further, as a tragic consequence, and suffered serious, progressive, permanent and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. The patient had suffered and incurred damages, included medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of optic ischaemic neuropathy and vision blurred were not recovered. The reporter considered optic ischaemic neuropathy and vision blurred to be related to zoster vaccine live (ZOSTAVAX). Upon internal review, optic ischaemic neuropathy was considered to be a medically significant event.

Other Meds:

Current Illness: Routine health maintenance

ID: 1500485
Sex: U
Age:
State: WI

Vax Date: 12/06/2013
Onset Date:
Rec V Date: 07/24/2021
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: Herpes Zoster Ophthalmicus; This initial spontaneous report was received from a lawyer regarding a case in litigation, referring to a patient of unknown age and gender. No information was provided regarding medical history, concurrent conditions, or concomitant medications. In or around 06-DEC-2013, the patient was inoculated with zoster vaccine live (ZOSTAVAX) for routine maintenance and for its intended purpose: the prevention of shingles (herpes zoster) (strength, dose, route of administration, anatomical location, lot number, and expiration date were not reported). On an unknown date (reported as shortly after received zoster vaccine live (ZOSTAVAX) vaccine), the patient suffered blurry vision, floaters, and was diagnosed with herpes zoster ophthalmicus. As a direct and proximate result of the patient's use of the zoster vaccine live (ZOSTAVAX) vaccine, the patient's symptoms have resulted in physical limitations did not present prior to used vaccine. The patient also experiences mental and emotional distress due to resulted physical limitations and seriousness of his condition. The patient sustained severe and permanent personal injuries (disability). Further, as a tragic consequence, and suffered serious, progressive, permanent and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment and injury. The patient had suffered and incurred damages, included medical expenses; the loss of accumulations; and other economic and non-economic damages. The outcome of ophthalmic herpes zoster was not recovered. The reporter considered ophthalmic herpes zoster to be related to zoster vaccine live (ZOSTAVAX). Upon internal review, ophthalmic herpes zoster was considered to be a medically significant event.

Other Meds:

Current Illness: Routine health maintenance

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm