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: 1537144
Sex: F
Age: 42
State: VA

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: SULFA ALLERGY

Symptom List: Dysphagia, Epiglottitis

Symptoms: PATIENT WAITED THE 15 MINUTES FOR OBSERVATION AND LEFT AFTER THE RECOMMENDED TIME POST VACCINATION. AFTER LEAVING, PATIENT SAID THROAT STARTED CLOSING AND A BIG BUMP PRESENTED IN THE BACK OF HER THROAT. SHE TOOK BENADRYL IMMEDIATELY AND EMS WAS CALLED. SHE WAS FURTHER REFERRED TO AN URGENT CARE FACILITY AND WAS TREATED THERE.

Other Meds: NONE KNOWN

Current Illness: NONE KNOWN

ID: 1537145
Sex: M
Age: 55
State: OH

Vax Date: 03/20/2021
Onset Date: 04/06/2021
Rec V Date: 08/09/2021
Hospital: Y

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

Lab Data:

Allergies: Morphine

Symptom List: Anxiety, Dyspnoea

Symptoms: Full body episodes of paralysis due to exacerbation of congenital periodic paralysis. Initial time span of daily episodes of full body paralysis began April 6 and ended June 22 with several ED visits and hospitalizations. Beginning April 27, a PICC line was placed such that IV dextrose fluids could be administered at home instead of in the hospital. During this time frame, some days an episode did not take place while other days 2 episodes happened. Between July 30 and August 4, 3 different fully body episodes occurred.

Other Meds: Diamox, Fenofibrate, Valsartan, Metformin, Protonix

Current Illness:

ID: 1537147
Sex: F
Age: 27
State: ID

Vax Date: 07/26/2021
Onset Date: 07/28/2021
Rec V Date: 08/09/2021
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: None

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

Symptoms: Pericarditis R-reactive proteins elevated large amounts of palpitations SOB with and without activity chest pain

Other Meds: Eliquis Asprin Vitamins- D, B12 complex, C

Current Illness: None

ID: 1537149
Sex: F
Age: 23
State:

Vax Date: 08/06/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: My period came a week early and had super painful cramps. I never get cramps and my period has always been at the same time frame between 1-2 days.

Other Meds:

Current Illness:

ID: 1537150
Sex: F
Age: 35
State: MI

Vax Date: 07/28/2021
Onset Date: 08/04/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient reports approximately 1 week +/1 day after receiving her first Moderna COVID-19 vaccination she began to feel a tingling/numb sensation on her tongue. The following day when she awoke she had complete paralysis of one half of her face. Patient then went to see PCP where she was informed she had developed Bells Palsy. Patient is currently being treated with high dose steroids as well as valacyclovir.

Other Meds: Unknown

Current Illness: Unknown

ID: 1537151
Sex: F
Age: 57
State: MI

Vax Date: 08/06/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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: Penicillin Erythromycin and anything out the erythromycin family Claritin D

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

Symptoms: Got shot 8/6/2021 @ 1:45pm. At 2:30pm started itching- knew I was having an allergic reaction. by 3:40pm called the pharmacy to report- itching was severe (worse) no hives. was told to take 2 Benadryl. Took Benadryl- didn't work! 6 pm same day- ate some soup and took more Benadryl- was itching all over in my head and throughout my body to bottom of feet. 6:10 pm itching started calming down, then lower back right side started hurting, eyelids started twitching, face itching, and keep feeling like wanted to have diareha- had 2 BM's since having shot. 6:45pm - pain in right arm started at injection site, had dull muscle pain. Then left arm started aching. 8:30pm- itching started back stronger and moderate stomach ache. Did not sleep that night. Sat. overall- still itching, not as severe, Right shot arm really hurting- did arm exercises and got better. stomach issues still there and itching. itching FINALLY went away by Monday morning. Sunday- by mid-late afternoon, I was really feeling unwell- started to go to hospital or urgent care- it was rough. Prayed and toughed it out until could speak to my doctor on Monday- still unable to reach my Primary doctor- will see Allergy doctor tomorrow- tues 8/10/21

Other Meds: Not Meds taken that day prior to vaccination.

Current Illness: Allergy and Asthma

ID: 1537152
Sex: M
Age: 46
State: WI

Vax Date: 06/17/2021
Onset Date: 06/23/2021
Rec V Date: 08/09/2021
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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Eye inflammation and stye 4 days following dose 1 and again, 4 days following dose 2.

Other Meds: Metformin, Vyvanse

Current Illness: None

ID: 1537153
Sex: F
Age: 13
State: PA

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient fainted when standing to leave pharmacy after receiving vaccine. Patient did wait suggested time of 15 minutes after receiving vaccine.

Other Meds:

Current Illness:

ID: 1537154
Sex: F
Age: 48
State: VA

Vax Date: 08/03/2021
Onset Date: 08/05/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: food allergy - ham

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: continuous ringing in both ears (tinnitus)

Other Meds: none

Current Illness: none

ID: 1537155
Sex: F
Age: 44
State: GA

Vax Date: 08/03/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: Pork Levaquin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Illness with severe headaches, weakness, fatigue, dizziness and nausea with exertion, sharp chest pain

Other Meds: Vitamin C, Vitamin D3, omega 3

Current Illness: None

ID: 1537156
Sex: F
Age: 54
State: AK

Vax Date: 08/05/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Eggs, shellfish. Multiple medications.

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

Symptoms: Nauseous, body aches, bad headache, exhaustion.

Other Meds: Citalopram 20mg daily

Current Illness: None.

ID: 1537157
Sex: M
Age: 37
State: CO

Vax Date: 07/12/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Vaccine remained in the freezer past the recommended guidelines (14 days). Once discovered, Pfizer was contacted but did not have stability data to support acceptability of the product greater than 31 days in the freezer. All patients that were administered vaccine past 31 days were contacted and given an option to be re-vaccinated based on their doctor's recommendation.

Other Meds:

Current Illness:

ID: 1537158
Sex: M
Age: 15
State: MS

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Did good taking the shot, passed out about a minute after it was administered was talking and in good spirits.

Other Meds: None

Current Illness: None

ID: 1537159
Sex: M
Age: 78
State: IL

Vax Date: 03/06/2021
Onset Date: 08/07/2021
Rec V Date: 08/09/2021
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:

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

Symptoms: Pt received Pfizer both doses. Admitted to the hospital on 8/7/2021 d/t generalized weakness. Pt was COVID positive d/t exposure. Pt did not require oxygen throughout admission

Other Meds:

Current Illness:

ID: 1537160
Sex: F
Age: 45
State: CO

Vax Date: 07/12/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Vaccine remained in the freezer past the recommended guidelines (14 days). Once discovered, Pfizer was contacted but did not have stability data to support acceptability of the product greater than 31 days in the freezer. All patients that were administered vaccine past 31 days were contacted and given an option to be re-vaccinated based on their doctor'S recommendation or guidance.

Other Meds:

Current Illness:

ID: 1537161
Sex: M
Age: 54
State: FL

Vax Date: 04/20/2021
Onset Date: 04/23/2021
Rec V Date: 08/09/2021
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: PENICILLIN; VITAMIN D2

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

Symptoms: SHORTNESS OF BREATH AND TIGHTNESS OF CHEST. 1ST EMERGENCY ROOM VISIT PATIENT WAS SENT HOME DISAGNOSED WITH ANXIETY DISORDER. SOB AND TIGHTNESS CONTINUES DURING FOLLOWING WEEKS. PATIENT RETURNS FOR 2ND VISIT AT SAME EMERGENCY ROOM AT UNION HOSPITAL WITH SEVERE SHORTNESS OF BREATH. CAT SCAN OF LUNGS AND ULTRASOUND OF LEG REVEALLED MULTIPLE BLOOD CLOTS IN BOTH LUNGS AND BEHIND KNEE. PATIENT WAS ADMITTED TO HOSPITAL. PATIENT WAS PLACED ON IV BLOOD THINNERS DURING STAY. PATIENT WAS RELEASED ON ELIQUIS.

Other Meds: NEXIUM 20MG; PAROXETINE 37.5MG; CHLORDIAZEPOXIDE/CLIDINIUM; PREDNISONE 20MG; SIMETHICONE

Current Illness: ANXIETY; SARCOIDOSIS; KIDNEY DISEASE

ID: 1537162
Sex: F
Age: 49
State: NC

Vax Date: 04/22/2021
Onset Date: 06/01/2021
Rec V Date: 08/09/2021
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: Latex-based preservatives. Formaldehyde

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

Symptoms: Hot flashes. Currently on Tamoxifen (previously diagnosed with ER/PR+ breast cancer) and have not had hot flashes or night sweats for 2 years. After the vaccine, started getting them again. Increased Estradiol. Value for the last measurement (31Jan2020) prior to the vaccination was <11.8. After having the hot flashes for a while, had the value tested and now the value is 610.4.

Other Meds: Tamoxifen and multi-vitamin

Current Illness:

ID: 1537163
Sex: F
Age: 27
State: TX

Vax Date: 07/28/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Ear pain, Hypoaesthesia

Symptoms: red rash on arm which is spreading

Other Meds: Unknown

Current Illness: Unknown

ID: 1537164
Sex: F
Age: 21
State: FL

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

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: upon screening patient he informed that he had a fear of needles. After the immunization was given patient felt like he was going to throw up. Immediately got patient a waste back in case he was going to throw up. Patient dry heaved once but never vomited. Pt felt hot. We attempted to give patient an ice pack but he requested a fan , we got a fan and that helped. Pt's dad was present so we asked dad to come in the room to comfort and sooth patient. Pt requested water so we gave him a bottle of water. We had patient sit for 25-30 minutes. pt left without incident. called pt this evening and he said he was feeling better, was a little nauseous the rest of the day but was able to eat lunch.

Other Meds: none

Current Illness: none

ID: 1537165
Sex: F
Age: 76
State: HI

Vax Date: 02/09/2021
Onset Date: 08/07/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Nkda [No Known Drug Allergies] No Latex Allergy

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

Symptoms: Positive Covid test post full vaccination

Other Meds: Phentermine (LOMAIRA) 8 mg Oral Tab Atenolol (TENORMIN) 25 mg Oral Tab Lidocaine (LIDOCARE / ASPERCREME / LIDO KING) 4 % Top PTMD Patch hydroCHLOROthiazide 12.5 mg Oral Tab Atorvastatin (LIPITOR) 10 mg Oral Tab Dietary Supplement Oral Cap V

Current Illness:

ID: 1537166
Sex: M
Age: 45
State: NY

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: None Reported

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

Symptoms: Patient had a dizzy spell and fell to ground from sitting position. Patient skinned open a nickle sized cut on right side of face. No other symptoms were reported. Patient continued to sit down for another 15 minutes under observation and left site afterwards. Patient refused medical treatment via ambulance. After sitting for the additional 15 minutes, patient reported no other symptoms.

Other Meds: None reported

Current Illness: None Reported

ID: 1537167
Sex: M
Age: 54
State: OH

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: Unevaluable event

Symptoms: Patient develop a welt immediately after receiving the vaccine. The swelling of the welt decreased in about 15 minutes.

Other Meds: none

Current Illness: none

ID: 1537168
Sex: M
Age: 54
State: CO

Vax Date: 07/13/2021
Onset Date: 08/02/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Vaccine remained in the freezer past the recommended guidelines (14 days). Once discovered, Pfizer was contacted but did not have stability data to support acceptability of the product greater than 31 days in the freezer. All patients that were administered vaccine past 31 days were contacted and given an option to be re-vaccinated based on their doctor'S recommendation or ACIP guidance.

Other Meds:

Current Illness:

ID: 1537169
Sex: F
Age: 70
State: MS

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 08/09/2021
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: Tamiful, Levaquin

Symptom List: Injection site pain, Pain

Symptoms: Localized redness and swelling along with hard hot arm within 24 hours. Fever 100-102.3 for 4-5 days along with hallucinations and mailaise which lasted several beyond the fever. Arm itched, throbbed, and felt like was alseep for 2 weeks. My left hand had less feeling in it for several months.

Other Meds: Vivelle Dot .1, 5000 Vitamin D3, 1000 Vitamin C, 30 Zinc,

Current Illness: none

ID: 1537170
Sex: F
Age: 36
State: HI

Vax Date: 01/04/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: tested positive for Covid

Other Meds: none

Current Illness: none

ID: 1537171
Sex: M
Age: 85
State: IL

Vax Date: 03/25/2021
Onset Date: 08/06/2021
Rec V Date: 08/09/2021
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 received pfizer x2 doses. Admitted to the hospital for AMS and was COVID+. Received one dose of remdesivir then went to room air. So no further remdesivir given . 3 doses of dexamethasone 6mg daily given inpatient.

Other Meds:

Current Illness:

ID: 1537172
Sex: F
Age: 16
State: CO

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received Moderna as first dose accidentally as a 16 year old (off-label). We administered Moderna as second dose due to guidelines from the CDC website (off-label).

Other Meds:

Current Illness:

ID: 1537173
Sex: M
Age: 21
State:

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: Pt was having a syncope episode about 5 minutes after the vaccination. Mother states that he hates needles.

Other Meds:

Current Illness:

ID: 1537174
Sex: M
Age: 56
State: CA

Vax Date: 07/20/2021
Onset Date: 07/22/2021
Rec V Date: 08/09/2021
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: Lactose intolerance

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

Symptoms: Migraine headache for 3 to 4 days, extreme pain in my arm from my shoulder down to my fingers. Hot intense burning pain

Other Meds: None

Current Illness: None

ID: 1537175
Sex: F
Age: 46
State: CA

Vax Date: 07/15/2021
Onset Date: 07/16/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Tetracycline, Ciprofloxacin, and Toradol

Symptom List: Nausea

Symptoms: The client reported that she developed dizziness 24 hours after the vaccine which lasted 6-7 days. The client also reported development of left axillary lymph node swelling and pain that lasted one week. The client states the pain caused her to be unable to lift her left arm. The client reported development of itchiness in her throat and chest 1-2 days after the vaccine that is still present. Lastly, the client reported onset of a migraine 1-2 days after the vaccine which lasted 5 days. The client took Maxalt for the Migraine. The client has taken Claritin each night, but states this has provided no significant relief of her throat and chest itchiness. The client has not followed up with a PCPC or allergist. The client has a history of a hysterectomy 2.5 months ago and has had constant shortness of breath since. The client has seen her doctor regarding the shortness of breath without any conclusion on the cause of relief. The client takes oral birth control medication. She has a history of allergies to Tetracycline, Ciprofloxacin, and Toradol. The allergic reaction to these medications consists of nausea and vomiting.

Other Meds: Oral birth control.

Current Illness: Shortness of breath

ID: 1537176
Sex: F
Age: 29
State: WI

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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: Due date 10/31/21. Second pregnancy. first pregnancy healthy

Other Meds: Prenatal, iron supplement, Zyrtec daily

Current Illness: Diarrhea, slight cough, mucous

ID: 1537177
Sex: F
Age: 19
State: SC

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Pollen/seasonal allergies

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

Symptoms: Around 9 PM the day I received the vaccine, the unexpected/adverse affect I experienced was sudden swelling of my face, specifically my eyes (I do not have any dermal fillers just FYI). It was accompanied by expected side effects including fever, muscle aches and nausea. I also experienced shooting pain throughout my body, but mostly in my arms, and my skin was painful to touch anywhere on my body.

Other Meds: N/a

Current Illness: sinus infection early July

ID: 1537178
Sex: M
Age: 24
State: MI

Vax Date: 06/06/2021
Onset Date: 06/06/2021
Rec V Date: 08/09/2021
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: Fever of 101 when going to bed. Took 200mg of ibuprofen. Fever of 103 when waking up. Took 200mg of ibuprofen.

Other Meds: Claritin and zertec

Current Illness:

ID: 1537179
Sex: M
Age: 57
State: NY

Vax Date: 06/22/2021
Onset Date: 06/22/2021
Rec V Date: 08/09/2021
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: N/A

Symptom List: Tremor

Symptoms: Numbing of upper teeth, excessive salivating, ringing in the ears

Other Meds: N/A

Current Illness: N/A

ID: 1537180
Sex: M
Age: 62
State: CA

Vax Date: 08/08/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: unknown

Symptom List: Erythema, Pruritus

Symptoms: Patient was vaccinated with first shot of Pfizer, he was previously vaccinated with both doses of Moderna back in March.

Other Meds: unknown

Current Illness: unknown

ID: 1537181
Sex: F
Age: 34
State: NH

Vax Date: 08/02/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: Pollen, cats

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

Symptoms: Diagnosed with shingles one week to the day post second dose of Pfizer Covid 19 Vaccine.

Other Meds: Nuva Ring Sertraline 50mg Vitamins: fish oil, women?s daily, niacin, magnesium, probiotic, vitamin c

Current Illness: N/A

ID: 1537182
Sex: M
Age: 59
State: TX

Vax Date: 08/09/2021
Onset Date: 08/09/2021
Rec V Date: 08/09/2021
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 known allergies

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

Symptoms: No adverse reaction currently. Patient asked to monitor. Accidentally given 3rd dose of pfizer vaccine

Other Meds: Invegga Sustenna

Current Illness: Unknown

ID: 1537183
Sex: F
Age: 20
State: OR

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 08/09/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Intense body aches, fever, inability to move, constant throwing up, inability to keep down food or water, popped blood vessels in eyes, swollen face, slurred speech and extreme dehydration

Other Meds: None

Current Illness: None, tested for Covid right before and was negative

ID: 1537184
Sex: F
Age: 93
State: IL

Vax Date: 02/17/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: Pt received Moderna x2. Pt admitted on 8/8 for stroke code. Found to be TIA. Pt did receive a dose of remdesivir and dexamethasone as desaturated on RA. Found that pt has chronic respiratory failure and on chronic O2, so remdesivir and dexamethasone stopped.

Other Meds:

Current Illness:

ID: 1537185
Sex: F
Age: 29
State: GA

Vax Date: 08/07/2021
Onset Date: 08/08/2021
Rec V Date: 08/09/2021
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: NA

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

Symptoms: Fever, vomiting, migraines

Other Meds: Cymbals, lamictal, seroquil

Current Illness: NA

ID: 1537186
Sex: M
Age: 46
State: NC

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 08/09/2021
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: Pain in extremity

Symptoms: Headache, dizziness, fainting, profusely sweating about 19 hours after vaccine was administered. Patient experienced multiple fainting episodes, with elevated heart rate. During the fainting episodes, the patient fell twice and hit his head twice. He was briefly unresponsive. He was taken by ambulance to the ER where he was given fluids and X-RAY, CT Scan and lab work was done. Patient was released with instructions to follow up with primary care physician.

Other Meds: None

Current Illness: None

Date Died: 04/15/2021

ID: 1537187
Sex: F
Age: 65
State: MT

Vax Date: 03/28/2021
Onset Date: 04/15/2021
Rec V Date: 08/09/2021
Hospital:

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

Lab Data:

Allergies: Dilaudid, latex, percocet ,nuts

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

Symptoms: Pt died on April 15, 2021 of cardiac arrest.

Other Meds: flecainide 50mg 2x daily, metoprolol succinate 25mg 0.5 tablets daily, albuterol, tylenol, wellbutrin 300mg daily, busPIRone 30mg 2x daily, advil, synthroid 88mcg daily, nasacort

Current Illness: none

ID: 1537188
Sex: F
Age: 49
State: TX

Vax Date: 03/23/2021
Onset Date: 07/01/2021
Rec V Date: 08/09/2021
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: None

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

Symptoms: I have developed acne on my right cheek and face chin

Other Meds: Lisinopril, atorvastatin

Current Illness: None

ID: 1537189
Sex: F
Age:
State: CT

Vax Date: 12/23/2020
Onset Date: 01/03/2021
Rec V Date: 08/09/2021
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: Swelling; Pain in the arm; Heat in arm; Itching/it was not hot to touch but was itchy; Redness, local/a 2- 2.5 inch red area on her arm at the injection site; This spontaneous case was reported by a nurse and describes the occurrence of VACCINATION SITE WARMTH, VACCINATION SITE PRURITUS, VACCINATION SITE ERYTHEMA, VACCINATION SITE SWELLING, and VACCINATION SITE PAIN in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026L20A) for COVID-19 vaccination. Concomitant products included SYNTHROID for an unknown indication. On 23-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Jan-2021, the patient experienced VACCINATION SITE PRURITUS and VACCINATION SITE ERYTHEMA. On an unknown date, the patient experienced VACCINATION SITE WARMTH, VACCINATION SITE SWELLING, and VACCINATION SITE PAIN. At the time of the report, VACCINATION SITE WARMTH, VACCINATION SITE SWELLING, and VACCINATION SITE PAIN outcome was unknown and VACCINATION SITE PRURITUS and VACCINATION SITE ERYTHEMA had resolved. 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. Most recent FOLLOW-UP information incorporated above includes: On 25-Jun-2021: Follow-up information updated, onset date and outcome of the events updated. Sender's Comments: This case concerns a 72-year-old patient of unknown gender who had nonserious events of unexpected injection site warmth and expected erythema, injection site pain, injection site pruritus, injection site swelling. Event onset occurred with unknown latency after the first dose of mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: SYNTHROID

Current Illness:

ID: 1537190
Sex: F
Age: 38
State: CA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 08/09/2021
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: Body aches; Shaking; Sore arm; Fever of 102.6F; Headache; Chills; A spontaneous report, was received from a nurse, concerning a 38 year-old female patient, unknown race and ethnicity, who received Moderna's COVID-19 Vaccine (mRNA-1273), and experienced body aches (pain), sore arm (injection site pain), shaking (tremor), fever 102.6 (pyrexia), headache, and chills. The patient's medical history was not provided. No relevant concomitant medications were reported. On 30 Dec 2020, prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (Batch number: 039K29A), intramuscularly in left arm for the prophylaxis of COVID-19 infection. On 30 Dec 2020, at about 9 am, the patient experienced shaking, chills, fever 102.6, headache, body aches, and sore arm. Treatment for the events included acetaminophen and ibuprofen and fever got subsided. Action taken with second dose of mRNA-1273 in response to the events was not reported. The outcome of the event, fever 102.6, was considered resolved on 31 Dec 2020. The outcome for the events, shaking, chills, headache, body aches, and sore arm, were not reported.; Reporter's Comments: This case concerns a 70-year-old female who experienced nonserious events of unexpected tremor and pain and expected injection site pain, fever, chills, headache. Event onset occurred the same day as the first dose of mRNA-1273. Treated with acetaminophen. Fever resolved, but other outcomes unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1537191
Sex: F
Age: 56
State:

Vax Date: 12/28/2020
Onset Date:
Rec V Date: 08/09/2021
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: Itchy everywhere but not a rash; I don't have any severe allergic reaction; A spontaneous repor was received from a consumer who is 66-year-old, female patient that received Moderna's COVID-19 vaccine (mRNA-1273) and experienced a reaction like allergy stating she was itchy everywhere. The patient's medical history included allergy to thimerosal. Concomitant medications included were vitamin D, calcium gluconate, amlodipine, vitamin B12, and vitamin E. On 28-Dec-2020, the patient received their first of two planned doses of mRNA-1273 (Lot 025J20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On an unknown date, after administration, the patient stated that she was experiencing a reaction similar to when she took "ethanol diamine" medication. She stated she is sure she's not having a severe allergic reaction, she is just "itchy everywhere", but there is no rash. The patient was treated with betamethasone dipropionate cream, timolol maleate, coal tar and hydroxyzine. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the events, itchy everywhere, was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event of generalized pruitus a causal relationship cannot be excluded.

Other Meds: VITAMIN D [VITAMIN D NOS]; CALCIUM GLUCONATE; AMLODIPINE; vitamin 12; VITAMIN E [VITAMIN E NOS]

Current Illness: Drug allergy

ID: 1537192
Sex: F
Age: 34
State: OH

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 08/09/2021
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: Patient is pregnant; This spontaneous prospective pregnancy case was reported by a physician and describes the occurrence of MATERNAL EXPOSURE DURING PREGNANCY (Patient is pregnant) in a 35-year-old female patient (gravida 4, para 2) who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20-2A) for COVID-19 vaccination. The patient's past medical history included Melanoma in October 2013 and Spontaneous abortion on 24-Nov-2018. Concomitant products included DOXYLAMINE SUCCINATE, PYRIDOXINE HYDROCHLORIDE (DICLEGIS) for Nausea, MINERALS NOS, VITAMINS NOS (PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]) for Pregnancy. On 23-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. The patient's last menstrual period was on 12-Nov-2020 and the estimated date of delivery was 19-Aug-2021. On 23-Dec-2020, the patient experienced MATERNAL EXPOSURE DURING PREGNANCY (Patient is pregnant). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the sixth week of the pregnancy. On 23-Dec-2020, MATERNAL EXPOSURE DURING PREGNANCY (Patient is pregnant) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Dec-2020, Pregnancy test: positive (Positive) positive. 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. This is a case of product exposure during pregnancy with no associated AE's for this 35 year old female. Patient will continue to be contacted for further monitoring of AE's during the pregnancy.; Sender's Comments: This is a case of product exposure during pregnancy with no associated AE's for this 35 year old female. Patient will continue to be contacted for further monitoring of AE's during the pregnancy.

Other Meds: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; DICLEGIS

Current Illness:

ID: 1537193
Sex: F
Age:
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 08/09/2021
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: neck pain/neck sore; headache; A report was received from a consumer who was also a female patient of unknown age who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced neck pain/neck sore and headache. The patient's medical history was not provided. No relevant concomitant medications were reported. On 30 Dec 2020, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 31 Dec 2020, the patient experiencing neck pain/neck sore and headache. Treatment for the event included paracetamol and the symptoms subsided, but then returned. Action taken with mRNA-1273 in response to the events was not reported. The outcomes of the events, neck pain/neck sore and headache were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1537194
Sex: F
Age: 38
State: OH

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 08/09/2021
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: Hypersensitivity reaction; injection site hard; injection site hot; injection site itchy; tingling in face, shoulder, arm; whole face and tongue was numb; A spontaneous report was received from a physician concerning a 38-year-old, female patient who experienced hypersensitivity reaction, injection site hardness, warmth, itching, numbing and tingling of the shoulder, arm and face, and whole face and tongue was numb following their first dose of Moderna's COVID-19 vaccine. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 30 DEC 2020, the patient received their first of two planned doses of mRNA-1273 (lot/batch number unknown) in the left arm for prophylaxis of COVID-19 infection. The patient stated that eight days after the vaccination, her injection site became hard, hot and itchy. This started to resolve 48 hours later but lasted for two weeks. She also experienced numbness and tingling of her face, shoulder and arm. Her whole face and tongue were numb. Treatments of these events included Benadryl and ice. The events, hypersensitivity reaction, injection site hardness, warmth, itching, numbing and tingling of the shoulder, arm and face, and whole face and tongue was numb were considered resolved.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1537195
Sex: F
Age: 45
State: PA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 08/09/2021
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: dry heaves; arm hurting; muscle pain; joint pain; fever; chills; nausea; Headache; A spontaneous report was received from a Other Health Professional concerning a 45-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and developed muscle pain, joint pain, fever, chills, arm hurting, nausea, dry heaves, and headache. The patient's medical history, included positive COVID-19 test in Nov 2020. No relevant concomitant medications were reported. On 28 Dec 2020, the patient received her first of two planned doses of mRNA-1273 (lot: unknown) intramuscularly for prophylaxis of COVID-19 infection. 28 Dec 2020 the patient experienced fever of 99.4 to 99.6 joint pain, muscle pain, and her skin hurt. The patient also experienced dry heaves, nausea, and headache. At the time of the report on 07 Jan 2021 the events had resolved. Treatment of the events included Tylenol every four hours. Action taken with mRNA-1273 in response to the events was not provided . The outcome of the events muscle pain, joint pain, fever, chills, arm hurting, nausea, dry heaves, and headache were recovered. Reporter causality for the events was not provided. Additional information received on 07 Jan 2021 included units for fever and date of outcome for the events.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm