VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
PLEASE CHECK BACK SOON
Download the files above while you wait.







Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1558452
Sex: F
Age: 44
State: TX

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/14/2021
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: rash throat small difficulty to swallow. she took Benadryl. she is fine. I told her to go to emergency.

Other Meds:

Current Illness:

ID: 1558453
Sex: F
Age: 42
State: NC

Vax Date: 03/31/2021
Onset Date: 04/28/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: 8/12/21-had heart catherization at hospital which showed no blockages and no heart attack but showed LBBBb.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: On July 6, 2021 I went to hospital for an ECG because I was going to have a myomectomy surgical procedure scheduled for 7/12/21. The results for my ECG came back abnormal and showed that I had Left Bundle Branch Block (LBBB). Since the ECG came back abnormal, I was referred to specialist. I had an appointment with specialist on 7/22/21 and an Echocardiogram that same day. The results for the ECG was abnormal and showed that I had LBBB. Specialist then scheduled me to have a stress test on 7/28/21 and 7/29/21 which showed LBBB with heart failure with reduced ejection fracture.

Other Meds: Multivitamin Metformin Derma-smoothe Ibuprofen Zyrtec Norethindrone Metro-gel

Current Illness: None

ID: 1558454
Sex: F
Age: 58
State: IL

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/14/2021
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: n/a

Allergies: n/a

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

Symptoms: Initial sign was stiffness in the joint of the left shoulder and numbness /tingling in left hand. Later that evening chills but no fever, restlessness during the night. The next morning tired and facial soreness (same issues as in March when tested positive for covid). Lethargy proceeded throughout the day. Fell asleep by 7:15 pm and sleep through to next morning approximately 6 am. Proceeded to start my day with continued lethargy, strange eyesight issues (not knowing what it feels like to be 'tripping' I would have to say the things that were presented have to be pretty close to 'tripping'). Odd things standing out when I looked around possibly like 3d. Inanimate objects projecting themselves very 'loudly' to me. While looking at my cell phone it was pulled out at the corners stretching it diagonally like it was animated. Very emotional, crying for no reason. Very odd experience. Later that day it was very tiring to go up and down stairs and would take my breathe away. Again, this was a previous experience in March. Friday still tired but could function for the most part, VERY short on patience to the point of intolerable and feeling like a stroke or heart attach was coming on (probably a panic attach). Today, Saturday the 14th feeling relatively normal again.

Other Meds: Hydrochlorothiazide 25mg

Current Illness: n/a

ID: 1558455
Sex: F
Age: 55
State: CO

Vax Date: 06/05/2021
Onset Date: 07/01/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received her second dose of Moderna on her left arm on June 5th 2021. The local injection site irritation was normal to her. Three to four weeks later, she experienced a sharp pain during a lifting. The pain was at the middle part of her upper left arm, not her shoulder, not the injection site. Her doctor told her to watch the symptom at that time. Last week (more than 2 months after her second Moderna shot), the sharp pain came back again during a lifting. Patient mentioned this to our pharmacist since it was the same arm that she had her second Moderna Covid19 vaccine. We told her to try cold compress around that painful site and follow up with physician. She dose have an appointment with her doctor at the end of August.

Other Meds:

Current Illness:

ID: 1558456
Sex: F
Age: 35
State: GA

Vax Date: 08/12/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Nausea, cramps, vomiting, chills

Other Meds:

Current Illness:

ID: 1558457
Sex: F
Age: 44
State: SC

Vax Date: 04/19/2021
Onset Date: 08/06/2021
Rec V Date: 08/14/2021
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: Any non-opioid-based painkiller. Vicodin, codeine

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

Symptoms: Positive test as of August 10 tongue swelling lack of taste tired

Other Meds: Adderall, Xanex, losartan 100mg, omeprazle, Atorvastatin, metoprolol, Duloxetine, aspirin, purgesell, , Effie the, exetembe, Iron supplement, probiotics, vitamin C,

Current Illness: Heart failure, five stents in heart attack

ID: 1558458
Sex: F
Age: 47
State: NC

Vax Date: 02/28/2021
Onset Date: 03/15/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: Went to ENT

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Ringing in ears two weeks after first injection

Other Meds: Pirmella, Advil PM

Current Illness: None

ID: 1558459
Sex: F
Age: 48
State: TX

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: 500mg twice a day of naproxen ordered. MRI to be completed on Tuesday 8-17-21.

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Woke up at 4am day after shot with pins and needles tingling in right arm hand and fingers down to my right leg foot and toes. Very bad pain until about 2pm then let up. Now comes and goes daily with shocks in back shoulder blade, neck and arms occasionally then goes away. Pain in my right hand and right leg and foot happens at night and very painful when trying to sleep. Usually goes away in hand but lasts throughout the day in calve and foot/ankle. Pins and needles when walking. Very painful on day 10 today.

Other Meds: None

Current Illness: None

ID: 1558460
Sex: F
Age: 30
State: MO

Vax Date: 08/12/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swollen tongue and lips, hives all over abdomen, arms, and legs

Other Meds: N/a

Current Illness: None

ID: 1558461
Sex: M
Age: 27
State:

Vax Date: 08/05/2021
Onset Date: 08/09/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: Went to a clinic on Monday and was told it does not appear to be COVID or Myo/Pericarditis though I suspect it may be one of those

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Mild side effects until about Monday/Tuesday, mild shortnessof breath and tightness of chest, after a couple days shortness of breath and chest pains became more serious, trouble sleeping due to it, will visit clinic again if symptoms don't improve by Monday

Other Meds: None

Current Illness: None

ID: 1558462
Sex: F
Age: 46
State: OR

Vax Date: 01/31/2021
Onset Date: 02/02/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: none

Allergies: Beef

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

Symptoms: fever, headache, nausea (as forwarned) but also swelling of joints in hands, back pain, palpitations, tiredness, difficulty catching breath, disorientation

Other Meds: vitamin C, Vitamin D3

Current Illness: none

ID: 1558463
Sex: F
Age: 44
State: MD

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: Allergic to surgical tape and surgical glue

Symptom List: Rash, Urticaria

Symptoms: Chills, fever and body aches 24 hours after receiving first dose of vaccine

Other Meds: Adderrall, Lexapro, Clonaxepam, seraquil, melatonin, multi vitamin, vitamin D2, vitamin D3c, daily probiot

Current Illness: None

ID: 1558464
Sex: F
Age: 34
State: FL

Vax Date: 08/05/2021
Onset Date: 08/11/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Chest tightness/pain

Other Meds: Prenatal vitamins, birth control

Current Illness: N/A

ID: 1558465
Sex: M
Age: 36
State:

Vax Date: 08/07/2021
Onset Date: 08/09/2021
Rec V Date: 08/14/2021
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: within 2 days of initial Pfizer injection developed headache, fatigue, fever up to 100.7, neck ache, diarrhea up to 30 times a day, and severe abdominal cramping pain (pain lasted 2 days). Patient has lost 8 pounds. Patient examined on day 6 of symptoms and still having intermittent low grade fever and diarrhea up to 5 times a day,

Other Meds:

Current Illness:

Date Died: 06/20/2021

ID: 1558466
Sex: M
Age: 64
State: TX

Vax Date: 06/01/2021
Onset Date: 06/19/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: Medical examination by medical examiners

Allergies: None

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

Symptoms: Felt fatigued the day before adverse event, died in his sleep of arterial occlusion

Other Meds: Fluphenazine, Trihexyphenidyl, Duloxetine, Amlodipine

Current Illness: None

ID: 1558467
Sex: F
Age: 49
State: GA

Vax Date: 07/31/2021
Onset Date: 07/31/2021
Rec V Date: 08/14/2021
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: macrobid

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

Symptoms: Within minutes I became very dizzy and started to black out. My heart also started to flutter and beat quickly. My head also felt like it was growing like a balloon. The dizziness and heart fluttering subsided after a minute or two and then started again a few minutes later. This happened a few times. I focused on a video game and also talked to a person waiting for their shot. I stayed for about a half hour because I was afraid I was going to pass out if I stood up. The pharmacist was busy and waved me to go probably after about 15-20 minutes. I did not tell the pharmacist how I was feeling because I was embarrassed and I just wanted to leave. I was sick the rest of the day with common symptoms like aches and headache, and one or two more heart flutters but no more dizziness at home. I am afraid now to get the second dose in fear of worse happening, so I am reporting this and will likely not get the second dose although I am nervous about not getting it.

Other Meds: multi-vitamin, aspirin 81 mg

Current Illness: None

ID: 1558468
Sex: M
Age: 37
State: MA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: None

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

Symptoms: - Sore arm at site of injection 12 hours after shot. - Diarrhea, general malaise, and fever 16 hours after shot- improved later in day.

Other Meds: Allegra and Flonase

Current Illness: None

ID: 1558469
Sex: F
Age: 32
State: NY

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: None, took extra strength Tylenol 500 mg, no relief.

Allergies: None to medications, allergic to kiwi and mosquitos

Symptom List: Ear pain, Hypoaesthesia

Symptoms: First pregnancy, vaccinated at 26 weeks. Estimate Delivery Date is November 15th. Experiencing tingling in the right arm, and extreme nerve pain in the left leg, hip, buttox, ankle, and foot. The pain began today around 24 hours after the vaccine and got progressively worse but did not experience this prior to the vaccine. It hurts to stand or walk and feels like a stabbing pain and like my left leg and skin is on fire.

Other Meds: Iron supplements, Vitamin C supplements, Garen of life prenatal multivitamins, DHA supplements

Current Illness: No illnesses. Diagnosed with chronic seasonal asthma but I did not have any respiratory distress prior to or after the vaccination.

ID: 1558470
Sex: F
Age: 34
State: PA

Vax Date: 08/09/2021
Onset Date: 08/12/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: 8/12-went to ER had X-ray and blood work and was told everything was normal-clearly it is not.

Allergies: Morphine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I got this on a Monday. This has been a horrible ordeal. I was a perfectly healthy person until mandated by work to get this vaccine. When I got the injection, before I left the pharmacy my left arm went numb. It stayed numb for a few hours. Then at dinner my esophagus spasmed and felt like a Charlie horse. That lasted for a few hours on and off. Then that night, normal flu/COVID symptoms which lasted for 1 -2 days-fever headaches, chills, achy, run down, trouble breathing. Thought I was on the mend and only had a slight fever Wednesday. Then Thursday I started to feel light headed and numb hands throughout the day. Around 1pm I had to pull my car over and have a friend continue driving as I was extremely light headed and my whole right arm had gone numb. Within 15 minutes of that I blacked out completely and when I came to, couldn?t breathe, both arms numb and tingling and then I continued to fade as if going to pass out again. My friend freaked out. And called 911 and I went to a hospital. They ran tests that apparently came back normal. I went home and that night and all day Friday I had chest pain, numb arms, dizziness and trouble breathing. Saturday morning (today)those symptoms were still present just not as pronounced only now I have sharp shooting pain randomly in my heart area, right rear of my head, and my legs. This is terrifying and I hope you people stop recommending this to healthy people.

Other Meds: Birth control pill-aviane Ararat-Hydroxine 10mg

Current Illness: None

ID: 1558471
Sex: M
Age: 56
State: CA

Vax Date: 01/12/2021
Onset Date: 01/16/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: Coronary CTA Feb 21, coronary cath March 21, showed 65-70% occlusion in multiple vessels, no intervention Improved with time and passed nuclear stress test and treadmill stress test by April

Allergies: NKDA, environmental allergies/pollen

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

Symptoms: Angina, possible coronary artery thrombosis I was running regularly 15-20 miles per week. Four days after my second dose developed angina while running. Within a couple of weeks couldn?t go up a flight of stairs.

Other Meds: ASA, Crestor, MVI

Current Illness: None

ID: 1558472
Sex: U
Age: 52
State: TX

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
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: none

Allergies: none

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

Symptoms: slight hallucinations

Other Meds: none

Current Illness: none

ID: 1558473
Sex: F
Age: 16
State: HI

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: none available

Allergies: No known allergies

Symptom List: Unevaluable event

Symptoms: Few minutes after the vaccination, patient seemed very tired and weak. Upon approaching the patient, she was crying. She seemed in distress. She started turning pale and slowly losing consciousness and balance while seating on the chair. Patient did not fall off the chair because I was holding her. It seemed like a syncope like reaction until her face started drooping and she started convulsing for few seconds. She came back to conscious within few seconds and complains her head hurts. One dose of Epipen 0.3mg was administered to the patient and EMT came and took the patient away.

Other Meds: Patient does not take any medications per mom

Current Illness: No known disease

ID: 1558474
Sex: F
Age: 32
State: FL

Vax Date: 08/05/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: No known allergies

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

Symptoms: Arm was somewhat sore the following day after injection. Then extremely sore two days after injection. Less sore day three after. Eighth day after injection, I was dizzy while at the park with my child. The morning of the 9th day after injection, I woke up with a circular rash, slightly itchy and my arm sore again. It is currently the end of ninth day and still have rash.

Other Meds: Azo cranberry pill Hair, Skin and Nail supplement

Current Illness: None

ID: 1558475
Sex: M
Age: 65
State: WA

Vax Date: 01/17/2021
Onset Date: 08/05/2021
Rec V Date: 08/14/2021
Hospital: Y

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

Lab Data: COVID positive on 8/5/21 upon admission.

Allergies: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Patient was fully vaccinated with Pfizer 2 dose series (12/27/20 and 1/17/21). However, patient tested started having COVID symptoms on 7/27/21, tested COVID positive on 7/29/21 in the community. Patient came to our facility, on 8/5/21 with profound diarrhea, nausea, vomiting, and SOB with exertion. Patient was admitted in our facility from 8/5/21 to 8/10/21 and left the hospital AMA in stable condition on 8/10/21. Dexamethasone was given during admission, and diarrhea resolve prior to discharge.

Other Meds: amlodipine, gabapentin PRN sleep, metoprolol XL, MVI, pantoprazole, telmisartan-hctz

Current Illness:

ID: 1558476
Sex: U
Age:
State: AZ

Vax Date:
Onset Date: 08/12/2021
Rec V Date: 08/14/2021
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: Sore arm, fever 102F, aches, sore back. Throwing up, cant hold anything down (24 hours now)

Other Meds:

Current Illness: None

ID: 1558477
Sex: F
Age: 34
State: NY

Vax Date: 07/27/2021
Onset Date: 08/05/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: X-ray showing fractured sesmoid on 8/13/21

Allergies: None

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

Symptoms: Very weak overall but especially muscles after vaccination. Fractured my sesmoid bone within the week of vaccination without any recollection of how it could have happened and never having any bone fractures previously.

Other Meds: None

Current Illness: None

ID: 1559241
Sex: M
Age: 90
State: WA

Vax Date: 03/16/2021
Onset Date: 08/09/2021
Rec V Date: 08/14/2021
Hospital: Y

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

Lab Data: COVID positive 8/9/21.

Allergies: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received COVID vaccine Moderna 2 dose series (2/16/21 and 3/16/21). COVID symptoms started on 8/1/21 and he came to our facility Medical Center on 8/9/21 due to worsening symptoms. Patient was tested COVID positive on 8/9/21 upon admission and was admitted to the inpatient setting for COVID PNA with acute respiratory failure. Patient was transferred to CCU on 8/11/21 and intubated on 8/13/21.

Other Meds: baby aspirin, atorvastatin, finasteride, Flonase nasal sp, gabapentin, hydrochlorothiazide, loratadine, losartan, tamsulosin

Current Illness:

ID: 1559242
Sex: F
Age: 24
State:

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: 15 minutes after receiving the 1st dose of Pfizer covid vaccine, patient became restless, started vomiting, and complained of difficulty breathing with acute respiratory distress. Patient's friend answered no when asked if this happened to her before stating that this is something new. RN activated anaphylaxis protocol at the mobile site, local FD on site called dispatch, RN drew and administered 0.5 mg epinephrine IM to right vastus lateralis. After 5 minutes, patient reports breathing improved, feeling much better, no more vomiting, able to sit still and talk clearly, vital signs within normal limits, breath sounds normal. EMS arrived and turned over care to them. Patient refused to go with ambulance, signed AMA, friend reassured that he is going to take her to a medical center

Other Meds:

Current Illness:

ID: 1559243
Sex: M
Age: 26
State: CT

Vax Date: 07/28/2021
Onset Date: 08/14/2021
Rec V Date: 08/14/2021
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: I can see it with my own too eyes right now. 9 days after the vaccination

Allergies: None

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

Symptoms: My left arm has become red and swollen and In Pain in an area where the vaccine was administered.

Other Meds: Vyvanse Lisinopril

Current Illness: None

ID: 1559244
Sex: M
Age: 62
State: DE

Vax Date: 03/31/2021
Onset Date: 04/20/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Nausea

Symptoms: Numb toes left and right foot. Severe lower back, pelvic region, constant leg pain.

Other Meds: Lisinopril 2.5mg, Brilanta 90mg, Metoprolol 25mg, Atorvastatin 80mg

Current Illness:

ID: 1559245
Sex: M
Age: 54
State: FL

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: No tests and no doctor or medical facility visited as of today 8/14/21. I have an appointment scheduled with my primary care physician on Tuesday August 17th and I plan to bring up my suspicion of GUILLAIN-BARRE SYNDROME

Allergies: none

Symptom List: Injection site pain

Symptoms: Suspected case of GUILLAIN-BARRE SYNDROME: Received the jab 5 days ago on 8/9/21 - two hours after receiving the injection to the right arm my face numbed up with tingling especially pronounced in the jaw and thick tongue felt similar to the numbing effect after a dentist appointment. Awkward trying to move my jaw around. Face tingling was worst the first day and symptoms were more mild the next day regarding tingling in the face but have been consistent and ever present. 8/11 numbness in legs after a long walk. Today 8/14 tingling/numbness continues in the face and the lymph nodes behind my jaw are swollen and today observed numbness and pain in both legs pain is a rated a 3 out of 10 with 10 being most severe

Other Meds: carvedilol 6.25mg twice daily

Current Illness: none

ID: 1559246
Sex: M
Age: 28
State: WA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 08/14/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Feeling of heart fluttering and tension. Resting heart rate increased from average of 61-71 to 104-131 as reported by watch around 8:30. Took asprin tablet. Resting heart rate reduced to 80-97 by 9:30pm. Remained sitting during entire event. Used blood pressure cuff at 9:45-10:00pm. Reported 137/88 with BPM of 74. As of 9:45pm Aug 14, resting heart rate being reported by watch as 74-92. Feeling of tension and fluttering has subsided but heart rate remains noticeably higher than before.

Other Meds: None

Current Illness: None

ID: 1559247
Sex: F
Age: 68
State: WA

Vax Date: 03/14/2021
Onset Date: 08/10/2021
Rec V Date: 08/14/2021
Hospital: Y

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

Lab Data: COVID status positive (8/10/21).

Allergies: ACE inhibitors

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

Symptoms: Patient received Janssen COVID vaccine on 3/14/21. On 8/10/21, patient was admitted to our facility for COVID PNA with acute hypoxic respiratory failure (COVID status positive 8/10/21). As of today (8/14/21), patient is still admitted in the inpatient unit med/surg floor.

Other Meds: Amlodipine, baby aspirin, atorvastatin, calcium carbonate, vitamin d, fish oil, empagliflozin, fluconazole, glimepiride, levothyroxine, losartan, metformin, MVI

Current Illness:

ID: 1558706
Sex: M
Age: 74
State: FL

Vax Date: 01/16/2021
Onset Date: 03/06/2021
Rec V Date: 08/15/2021
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: Rash on his back and is slighlty pruritic; rash went from appearing as a four by four red blotch; Ten or twelve smaller red spots; This spontaneous case was reported by a consumer and describes the occurrence of RASH PRURITIC, RASH MACULAR, and RASH ERYTHEMATOUS in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 028L20A. and 039K20A) for COVID-19 vaccination. Concurrent medical conditions Grass allergy, Dust allergy, Hypertension, Hypercholesteraemia, and Cancer. Concomitant products included LOSARTAN, AMLODIPINE, and ZEBETA for Blood pressure high, CRESTOR for High cholesterol. On 16-Jan-2021 at 3:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Feb-2021 at 9:30 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 06-Mar-2021, the patient experienced RASH PRURITIC. 06-Mar-2021, the patient experienced RASH MACULAR and RASH ERYTHEMATOUS. The patient was treated with TRIAMCINOLONE ACETONIDE for Rash, at a dose of 0.1%; PEPCID for Adverse event, at an unspecified dose and frequency and BENADRYL for Adverse event, at an unspecified dose and frequency. On 10-Apr-2021, RASH PRURITIC, RASH MACULAR, and RASH ERYTHEMATOUS had resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. At the annual physical appointment on 18Mar2021, he received the second dose of the Shingrix vaccine series and treated the rash with Pepcid during the day and Benadryl at night and also Triamcinolone cream. Serious patch of rash 4x4 inch on left shoulder blade, much pain, was treated with Triamcinolone Acetonide 0.1% for two weeks before rash started to wane, remnants remains for another month. Action taken with mRNA-1273 in response to the event was not applicable. This case was linked to US-MODERNATX, INC MOD-2021-069973, US-MODERNATX, INC MOD-2021-069767, MOD21-071085. Most recent FOLLOW-UP information incorporated above includes: On 25-May-2021: Added patient demographics such as height, weight, race and ethnicity were updated. Other relevant history was added. Second dose date was changed and event onset date was changed as well. Event outcome was updated to recovered. Concomitant medications were updated. Treatment information was added. On 28-May-2021: Follow-up received on 28 May 2021 included no new information. On 16-Jul-2021: Updated reporter details and event details were provided.

Other Meds: LOSARTAN; AMLODIPINE; ZEBETA; CRESTOR

Current Illness: Cancer; Dust allergy; Grass allergy; Hypercholesteraemia; Hypertension

ID: 1558729
Sex: F
Age:
State: PR

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: This is a spontaneous report from a contactable consumer or other non hcp (patient). A 30-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for Injection, Batch/Lot Number: EW0196), via an unspecified route of administration on an unspecified date (at the age of 30-year-old) as dose 1, single; dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot Number: FA74842) as dose 2, single, both doses for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced chills, fever, nausea, vomiting/feels like throwing up, feeling very bad, all on an unspecified date. Patient is a consumer. Patient had both doses of the Pfizer COVID 19 vaccine. Patient wants to know how long these symptoms will last and should she go to the emergency room. Patient went to the bathroom because she experienced nausea and vomiting. The patient was experiencing chills, fever, nausea, and vomiting. Patient says she was told if her symptoms of vaccine last more than 24 hours to call. Patient says she has had her second dose of Pfizer COVID-19 vaccine. Patient provides LOT for first dose EW0196 from her vaccine card, and second dose LOT FA74842, unable to clarify further. Patient says she may have to leave suddenly as she is feeling very bad and feels like throwing up. When call is joined unknown gentleman says patient has nausea right now, and chills, and fever and she wants to know is there something she can do to avoid it. Outcome of the events was unknown.

Other Meds:

Current Illness:

ID: 1558749
Sex: U
Age: 1
State: TX

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/15/2021
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 AE's; Temperature excursion / temperature 6.134 F; This spontaneous report was received from licensed vocational nurse and refers to a 12 months old patient of unknown gender. There was no information regarding their medical history, concurrent conditions nor concomitant therapies provided. On 08-AUG-2021, a dose of varicella virus vaccine live (Oka/Merck) (VARIVAX) dose/frequency reported as 1 (units not provided), lot # T029535, expiration date 01-SEP-2022 was stored improperly in a temperature of 6.134 degree Fahrenheit (F) for 30 minutes and on 09-AUG-2021 (described also as this morning), it was administered to the patient (exact dose, route of administration and anatomical location were not provided) for prophylaxis. No previous temperature excursion was reported. The patient was asymptomatic and no adverse event was reported. This is one of two reports from the same reporter.; Sender's Comments: US-009507513-2108USA002735:

Other Meds:

Current Illness:

ID: 1558750
Sex: U
Age:
State: OH

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/15/2021
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 additional AE reported.; expired dose of VAQTA was administered to a patient; This spontaneous report was received from a certified medical assistant and refers to a patient of unknown age and gender. There was no information about the patient's concurrent conditions, concomitant therapies or medical history provided. On 06-AUG-2021, the patient was vaccinated with an expired dose of hepatitis A vaccine, inactivated (VAQTA) lot # T018670, expiration date 11-JUL-2021 (dose, route of administration and anatomical location were not reported) for prophylaxis. No additional adverse event was reported.

Other Meds:

Current Illness:

ID: 1558751
Sex: U
Age:
State: TX

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/15/2021
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: The patient not experienced any adverse event associated with the vaccination / No additional AE reported.; 2 month old patient was administered Varivax accidently.; This spontaneous report was received from a nurse and refers to a 2-month-old patient of an unknown gender. No information regarding the patient's medical history, concurrent conditions or concomitant medications was provided. On 09-AUG-2021, the 2-month-old patient was accidently vaccinated with varicella virus vaccine live (Oka/Merck) (VARIVAX) 0.5 ml, lot # T035401 was confirmed to be valid, expiration date 16-OCT-2022, (route and site of administration were not reported) for prophylaxis (Inappropriate age at vaccine administration). The patient did not experience any adverse event associated with the vaccination.

Other Meds:

Current Illness:

ID: 1558752
Sex: F
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: blood clots in both her legs.; This is a spontaneous report from a contactable consumer (patient's daughter-in-law) based on information received by Pfizer from agency (manufacturer control number: US-BRISTOL-MYERS SQUIBB COMPANY-BMS-2021-075012), license party for apixaban (ELIQUIS). A 91-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), on an unspecified date (lot number and expiry date: unknown) as dose number unknown, single for Covid-19 immunisation; and apixaban (ELIQUIS), oral from an unspecified date (Lot Number: 1795397; Expiration Date: Aug2023) to an unspecified date, at 2.5 mg, 2x/day (BID), then oral from an unspecified date (lot number and expiry date: unknown) to an unspecified date, at 5 mg, 2x/day (BID) for deep vein thrombosis (DVT)/ blood clots. The patient's medical history and concomitant medications were not reported. Patient was on Eliquis for blood clots. The patient received the COVID vaccine and within few weeks, she developed blood clots in both her legs. The reporter did not provide causality assessment. The clinical outcome of the event was unknown. Action taken with apixaban was dose increased. No follow-up attempts are possible. Information on lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: BMS medical evaluation comment: This 91-year-old patient had leg thrombosis after receiving apixaban therapy and COVID vaccine. Elderly age and underlying thrombotic risk are significant contributory factors for leg thrombosis in this patient and hence it is considered not related to apixaban. Additionally, COVID vaccine could be a confounding factor for the reported event.

Other Meds: ELIQUIS

Current Illness:

ID: 1558753
Sex: F
Age:
State: NY

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 08/15/2021
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: Diarrhoea; Chills; Pyrexia; Exposure during breastfeeding; This case was received (Reference number: 0936865) on 06-Apr-2021 and was forwarded to Moderna on 06-Apr-2021. This spontaneous case was reported by an other health care professional and describes the occurrence of MATERNAL EXPOSURE DURING BREASTFEEDING (Exposure during breastfeeding), DIARRHOEA (Diarrhoea), CHILLS (Chills) and PYREXIA (Pyrexia) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Peanut allergy, Allergy to nuts (Allergic to pecan), Allergy to nuts (Allergic to nuts) and Stomach flu. Concomitant products included SERTRALINE for an unknown indication. On 08-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Jan-2021, the patient experienced MATERNAL EXPOSURE DURING BREASTFEEDING (Exposure during breastfeeding). On 09-Jan-2021, the patient experienced DIARRHOEA (Diarrhoea), CHILLS (Chills) and PYREXIA (Pyrexia). At the time of the report, MATERNAL EXPOSURE DURING BREASTFEEDING (Exposure during breastfeeding) outcome was unknown and DIARRHOEA (Diarrhoea), CHILLS (Chills) and PYREXIA (Pyrexia) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient reported that she experienced symptoms of chills, pyrexia, diarrhea and exposure during breastfeeding. No treatment information was provided. This case was linked to MOD-2021-249287 (Parent-Child Link). See case MOD-2021-249287 for details regarding the child case.

Other Meds: SERTRALINE

Current Illness: Allergy to nuts (Allergic to pecan); Allergy to nuts (Allergic to nuts); Peanut allergy

ID: 1558754
Sex: M
Age:
State:

Vax Date: 01/12/2021
Onset Date:
Rec V Date: 08/15/2021
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: unevaluable event; This case was received via United States FDA VAERS (Reference number: 0937243) on 06-Apr-2021 and was forwarded to Moderna on 06-Apr-2021. This spontaneous case was reported by an other health care professional and describes the occurrence of UNEVALUABLE EVENT (unevaluable event) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041L20A) for COVID-19 vaccination. No Medical History information was reported. On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced UNEVALUABLE EVENT (unevaluable event). At the time of the report, UNEVALUABLE EVENT (unevaluable event) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The concomitant medications on use were not provided. No laboratory data was provided. No treatment information was provided.

Other Meds:

Current Illness:

ID: 1558755
Sex: M
Age:
State: TX

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 08/15/2021
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: 16 year-old-patient inadvertently received the Moderna Vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year-old-patient inadvertently received the Moderna Vaccine) in a 16-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037A21B) for COVID-19 vaccination. The patient's past medical history included No adverse event (No medical history reported.) and Product administered to patient of inappropriate age. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year-old-patient inadvertently received the Moderna Vaccine). On 08-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year-old-patient inadvertently received the Moderna Vaccine) had resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided. Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Accepted VAERS ICSR as Follow-Up, likely NNI, there was no new info in the SD

Other Meds:

Current Illness:

ID: 1558756
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: SEVERE neurological complications; This case was reported by a consumer via interactive digital media and described the occurrence of neurological symptom in a patient who received DTPa (Reduced antigen) (Tdap Vaccine) for prophylaxis. On an unknown date, the patient received Tdap Vaccine. On an unknown date, unknown after receiving Tdap Vaccine, the patient experienced neurological symptom. On an unknown date, the outcome of the neurological symptom was unknown. It was unknown if the reporter considered the neurological symptom to be related to Tdap Vaccine. Additional details were provided as follows: This case was reported by patient himself/herself. The age at vaccination was not reported. The patient received Tdap vaccine and experience severe neurological complications.

Other Meds:

Current Illness:

ID: 1558757
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: Suspected vaccination failure; shingles illness; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure was unknown and the outcome of the shingles was recovered/resolved. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingrix. Additional details were provided as follows: This case was reported by the patient himself/ herself. The age at vaccination was not reported. The patient received the vaccine in February and just finished a week of severe shingles illness. The patient stated Shingrix was 85 percent effective. Unfortunately, it did not prevent or lessen shingles for the patient. This case was considered as suspected vaccination failure since the details regarding completion of primary immunization schedule, time to onset and laboratory test confirming shingles were unknown at the time of reporting.

Other Meds:

Current Illness:

ID: 1558758
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: had the shot and still got shingles 6 more times \ Suspected Vaccination failure; got shingles 6 more times; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a female patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine. Additional details were provided as follows: The age at vaccination was not reported. The physician told the reporter that she had Shingles shot and still got shingles 6 more times. This case was considered as suspected vaccination failure as details regarding completion of primary vaccination schedule, time to onset and laboratory test confirming herpes zoster were unknown at the time of reporting. The follow-up would not possible as no contact details were available.

Other Meds:

Current Illness:

ID: 1558759
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: I had two shots doesn't work for me/suspected vaccination failure; doesn't work for me; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a patient who received Herpes zoster (Shingles vaccine) for prophylaxis. Co-suspect products included Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received the 2nd dose of Shingles vaccine and the 1st dose of Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine and Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine and Shingles vaccine. Additional details were provide are as follows: The case was reported by patient himself/herself. The age at vaccination was not reported. The patient received 2 shots of Shingles vaccines and they did not work for the patient. This case was considered as suspected vaccination failure since the details regarding time to onset and laboratory test confirming shingles were unknown at the time of reporting.

Other Meds:

Current Illness:

ID: 1558760
Sex: M
Age: 75
State: NY

Vax Date: 07/11/2021
Onset Date: 07/01/2021
Rec V Date: 08/15/2021
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: double vision; blurry vision; This case was reported by a consumer via call center representative and described the occurrence of double vision in a 75-year-old male patient who received Herpes zoster (Shingrix) for prophylaxis. The patient's past medical history included shingles (had a first outbreak of Shingles 1st July 2021 on his left side affecting his eyes and eyebrows). Concurrent medical conditions included diabetes. Concomitant products included famciclovir. On 11th July 2021, the patient received the 1st dose of Shingrix (intramuscular) .5 ml. In July 2021, less than a week after receiving Shingrix, the patient experienced double vision and blurred vision. On an unknown date, the outcome of the double vision and blurred vision were not recovered/not resolved. It was unknown if the reporter considered the double vision and blurred vision to be related to Shingrix. Additional details were provided as follows: The case was reported by patient himself. The patient went to his patient care physician (PCP) and was prescribed famciclovir 500 mg bid. On 11th July 2021, patient went back to his primary care physician office and his famciclovir order was extended and he received the first dose of Shingrix. Three to four days later he had blurry vision and double vision, both were unresolved. The patient went to an eye doctor that said his vision should clear up in 4 to 5 months and to cover one eye while driving. The reporter consented to follow up.

Other Meds:

Current Illness: Diabetes

ID: 1558761
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: A first dose / was given Sub q; This case was reported by a nurse via call center representative and described the occurrence of intramuscular formulation administered by other route in a patient who received Men B NVS (Bexsero) for prophylaxis. Co-suspect products included meningococcal B recom vaccine + aloh + omv pre-filled syringe device (Bexsero Pre-Filled Syringe Device) injection syringe for prophylaxis. On an unknown date, the patient received the 1st dose of Bexsero (subcutaneous) and Bexsero Pre-Filled Syringe Device. On an unknown date, unknown after receiving Bexsero and Bexsero Pre-Filled Syringe Device, the patient experienced intramuscular formulation administered by other route. On an unknown date, the outcome of the intramuscular formulation administered by other route was unknown. This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences. Additional details provided were as follows: Age at vaccination was not reported. The nurse reported that, the patient received 1st dose of Bexsero subcutaneously which led to intramuscular formulation administered by other route. The reporter did not share any other information. The reporter did not consent to follow-up.

Other Meds:

Current Illness:

ID: 1558762
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: BLOOD CLOTS; This spontaneous report received from a consumer via social media via company representative concerned 28 patients of an unspecified age, sex, race, and ethnic origin. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, and expiry: unknown) dose, start therapy date were not reported, frequency time was 1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients experienced blood clots. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of blood clots was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210815161, 20210815560 and 20210815504.; Sender's Comments: V0: 20210815704-Covid-19 vaccine ad26.cov2.s-blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

Other Meds:

Current Illness:

ID: 1558763
Sex: M
Age:
State: NJ

Vax Date:
Onset Date:
Rec V Date: 08/15/2021
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: MIGRAINE REACTIONS TO SOUNDS; REGURGITATION; LAZY EYE ON THE LEFT SIDE; LEFT SIDE FACE MUSCLE LOOSE; NUMBNESS IN HANDS AND LEGS ARE PREDOMINATELY ON THE RIGHT SIDE; CHILLS; FEVER; This spontaneous report received from a consumer concerned a 79 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: high blood pressure, and patient had no lifestyle changes prior to high blood pressure. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown and expiry: UNKNOWN) dose was not reported,1 total, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient visited the hospital for high blood pressure and while there, he was offered the Covid-19 vaccine, a few days later started to experience the symptoms, the patient experienced vertigo, nausea, chills, fever, regurgitates, spells of dizziness, blurred vision, migraine reactions to sounds. Patient experienced numbness in hands and legs are predominately on the right side, left side face muscle loose. Neurologist stated patient had severe headaches. Cardiologist stated that his heart was okay. Patient visited eye and ear infirmary specialist, doctor administered Botox injections into his ear. After a week of symptoms began seeking medical advice and had three exams KKG and two others. Neurologist stated points to a rare form of migraine. Treatment medications (dates unspecified) included: botulinum toxin type a. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from regurgitation, migraine reactions to sounds, lazy eye on the left side, numbness in hands and legs are predominately on the right side, left side face muscle loose, fever, and chills. This report was serious (Other Medically Important Condition).; Sender's Comments: V0: 20210817357- Covid-19 vaccine ad26.cov2.s- Migraine reactions to sounds. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY

Other Meds:

Current Illness: Blood pressure high

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am