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From the 1/14/2022 release of VAERS data:

Found 1,031,637 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 547 out of 10,317

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VAERS ID: 1898200 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: hypothyroidism
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient called pharmacy to let us know that she had diarrhea/runny stools for approximately 1 day after vaccination. It has since resolved and she is doing fine.


VAERS ID: 1898614 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-07
Onset:2021-11-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Iliac artery occlusion, Vascular operation
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Labetalol, pravastatin, losartan
Current Illness:
Preexisting Conditions: Hypertension, hyperlipidemia
Allergies:
Diagnostic Lab Data: Vascular Surgery 11/21, 11/22, 11/23
CDC Split Type:

Write-up: Iliac artery occlusion, right. Numbness in right leg beginning 11/18/2022.


VAERS ID: 1958384 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Oklahoma  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 037F21A / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Incorrect booster given. Patient received 0.5 ml of Moderna rather that the 0.25ml booster dose


VAERS ID: 1958388 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Sertraline
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin, Dilaudid, Paxil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Incorrect booster dose given. Patient received 0.5 ml of Moderna rather that the 0.25ml booster dose


VAERS ID: 1958392 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Palate injury, Rash, Rash papular, Scab
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Was in a car wreck few days
Preexisting Conditions: Hx of Bells Palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed papular, Postula rash, centripetal, over face, over extremities, palm and one lesion o hard palate with some crusting and scabs. Erythematory lesions 3 to 6 mm sized. All scaling. Rash developed day 2 after vaccination of booster.


VAERS ID: 1958395 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira, Methotrexate
Current Illness:
Preexisting Conditions: RA
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Incorrect booster dose given. Patient received 0.5 ml of Moderna rather that the 0.25ml booster dose


VAERS ID: 1958396 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Htn, Thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Incorrect booster dose given. Patient received 0.5 ml of Moderna rather that the 0.25ml booster dose


VAERS ID: 1899242 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822309 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Influenza like illness, Injection site reaction, Injection site urticaria, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN READIMELT OTC; VITAMIN D [ERGOCALCIFEROL]
Current Illness: Abstains from alcohol; Non-smoker; Seasonal allergy (Administered steroids, Claritin Readimelt OTC and vitamin D)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Comments: The patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20211119; Test Name: Body temperature; Result Unstructured Data: 99 F; Test Date: 20211119; Test Name: Body temperature; Result Unstructured Data: 101.3 F; Test Date: 20211120; Test Name: Body temperature; Result Unstructured Data: 99 F; Test Date: 20211121; Test Name: Body temperature; Result Unstructured Data: 99 F
CDC Split Type: USJNJFOC20211150044

Write-up: RED,SWOLLEN AND ITCHY INJECTION SITE; INJECTION SITE REACTION OF A RED, HOT, HARD CIRCLE LIKE A GIANT HIVE, BIG WELT, THAT CONTINUES TO GROW; FLU LIKE SYMPTOMS; ARM WAS SORE; This spontaneous report received from a patient concerned a 25 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19 infection, and concurrent conditions included: seasonal emu oil allergy, non alcohol user, and non smoker, and other pre-existing medical conditions included: The patient had no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822309, and expiry: UNKNOWN) dose was not reported, administered on 18-NOV-2021 for prophylactic vaccination. Concomitant medications included ergocalciferol for seasonal emu oil allergy, and loratadine for seasonal emu oil allergy. On 18-NOV-2021, the patient experienced arm was sore. Treatment medications included: ibuprofen. On 19-NOV-2021, the patient experienced flu like symptoms. Laboratory data included: Body temperature (NR: not provided) 99 F, 101.3 F. On 20-NOV-2021, the patient experienced red, swollen and itchy injection site. On 20-NOV-2021, the patient experienced injection site reaction of a red, hot, hard circle like a giant hive, big welt, that continues to grow. Laboratory data included: Body temperature (NR: not provided) 99 F. On 21-NOV-2021, Laboratory data included: Body temperature (NR: not provided) 99 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from flu like symptoms on 20-NOV-2021, and had not recovered from injection site reaction of a red, hot, hard circle like a giant hive, big welt, that continues to grow, red, swollen and itchy injection site, and arm was sore. This report was non-serious.


VAERS ID: 1899245 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211150110

Write-up: ADMINISTRATION OF VACCINE WITH A DOSE THAT WAS FROZEN TWICE; This spontaneous report received from a health care professional concerned a 68 year old male. The patient''s height, and weight were not reported. 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: 211D21A, and expiry: 11-APR-2022) dose was not reported, administered on 18-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-NOV-2021, the patient experienced administration of vaccine with a dose that was frozen twice. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of vaccine with a dose that was frozen twice was not reported. This report was non-serious.


VAERS ID: 1899373 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Cough, Headache, Pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101623473

Write-up: Fever; Cough; Runny nose; Headache; Body ache; Upset stomach; This is a spontaneous report from a contactable consumer, the patient. A 23-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 18Nov2021 at 20:00 (at the age of 23-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. On 18Nov2021, the patient experienced fever, cough, runny nose, headache, body ache and upset stomach. The events resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fever, cough, runny nose, headache, body ache and upset stomach was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1899410 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211118; Test Name: COVID-19 PCR test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20211149729

Write-up: Confirmed Clinical Vaccination Failure; Confirmed COVID-19 Infection; This spontaneous report received from a patient via a company representative concerned a male of unspecified age, race and ethnicity The patient''s height, and weight were not reported. 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 expiry: unknown) dose was not reported, 1 total administered on APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 18-NOV-2021, the patient went for PCR (Polymerase Chain Reaction) testing and on 19-NOV-2021, he received results that he was positive for COVID (confirmed clinical vaccination failure and confirmed Covid-19 infection). The patient''s symptoms were fever, congestion and body aches. Laboratory data included: COVID-19 PCR test (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the confirmed clinical vaccination failure and confirmed Covid-19 infection was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000203302.; Sender''s Comments: V0: 20211149729-Covid-19 vaccine ad26.cov2.s-Confirmed clinical vaccination failure . 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: SPECIAL SITUATIONS


VAERS ID: 1899528 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Pain in extremity, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu-like symptoms and injection-site pain after two previous COVID Pfizer vaccine shots.
Other Medications: Sertraline, lamictal, buspirone, acyclovir, famotidine, omeprazole, cyclobenzaprine
Current Illness:
Preexisting Conditions: IBS, acid stomach, depression, anxiety
Allergies: Penicillin, nickel
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain began approximately 6 hours after shot; fatigue approximately seven hours after. SEVERE joint pain woke me up approximately 11-12 hours after shot, along with headache. Headache was minimal roughly twelve hours after that (24 hours after shot), SEVERE joint pain, fatigue, and injection site pain lasted about two days.


VAERS ID: 1899538 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Headache, Immunisation, Muscle spasms, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Thyroid disorder (Thyroid condition)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101624564

Write-up: Nausea; Vomiting; Headache; Joint pain; Muscle cramping; The patient received a third/booster dose; This is a spontaneous report from a contactable health care professional, the patient. A 50-year-old non-pregnant female patient received the third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF8841) via an unspecified route of administration in the left arm on 18Nov2021 at 07:00(at the age of 50-years-old) as a single dose for COVID-19 immunisation. Medical history includes thyroid condition. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the COVID vaccine. The patient received unspecified medications within two weeks of vaccination. The patient previously received diphenhydramine; paracetamol; phenylpropanolamine hydrochloride (BENADRYL) and experienced drug allergy. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3248) via an unspecified route of administration in left arm on 25Jan2021 at 12:00 (at the age of 49-years-old) as a single dose and also second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3248) via an unspecified route of administration in the left arm on 15Feb2021 at 12:00 (at the age of 49-years-old) as a single dose for COVID-19 immunisation. On 18Nov2021 at 22:00, the patient experienced nausea, vomiting, headache, joint pain and muscle cramping. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. No therapeutic measures were taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events nausea, vomiting, headache, joint pain and muscle cramping were resolving at the time of this report.


VAERS ID: 1899539 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Work       Purchased by: ?
Symptoms: Headache, Immunisation, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Drug allergy (Patient drug reaction : Allergy)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101626285

Write-up: The patient received the third/boster dose of BNT162b2; After getting the COVID booster shot, patient experienced "splitting headache; Aches; Nausea; This is a spontaneous report from a contactable consumer. An adult female patient of unknown age, received third (BOOSTER) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 18Nov2021 as a single dose for COVID-19 immunisation. It was unknown if the patient was pregnant at the time of vaccination. The medical history included drug allergy (unspecified drug) and it was unknown whether the patient had any other medical history. It was also unknown, if patient had any known allergies. Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. It was unknown if the patient received any other vaccines within four weeks prior to the vaccination. It was unknown if the patient received any other concomitant medications within two weeks prior to the vaccination. Previously, the patient had received two doses of COVID-19 vaccine (MANUFACTURER UNKNOWN) via an unspecified route of administration, on unspecified dates, as a single dose for COVID-19 immunisation. On 18Nov2021, after getting the COVID-19 booster shot, the patient experienced splitting headache, aches and nausea and had an awful night. The events resulted in doctor or other healthcare professional office/clinic visit. It was unknown whether any therapeutic measures were taken as a result of the events. Since the vaccination, it was unknown whether the patient had been tested for COVID-19. The clinical outcome of the events splitting headache, aches and nausea was unknown at the time of this report. The batch/lot numbers for BNT162b2 were not provided and will be requested during follow up.


VAERS ID: 1899551 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GABAPENTIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101632604

Write-up: Very Swollen lymph nodes in armpit on side of injection; A third (booster) dose of BNT162b2 is administered subsequent to the initial 2 dose regimen of BNT162b2; This is a spontaneous report from a contactable consumer, the patient. A 33-year-old non-pregnant female patient received third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 18Nov2021 at 16:45 (at the age of 33-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included gabapentin (MANUFACTURER UNKNOWN) taken for an unknown indication from an unknown date and unknown if ongoing. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 4Feb2021 at 12:00 (at the age of 32-years-old) and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 11Mar2021 at 12:00 (at the age of 32-years-old) as a single dose for COVID-19 immunisation. On 19Nov2021 at 20:00, the patient experienced very swollen lymph nodes in armpit on side of injection. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event very swollen lymph nodes in armpit on side of injection was resolving at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1899724 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site reaction, Injection site swelling, Spider vein
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Severe, Additional Details: Pt filled out a survey. She was very unhappy with her vaccination. She said the pharmacist stood over her, complained about her day, and was very aggressive when she gave the vaccine. There is still a bruise after 8 days. You can still see the hole where it was injected and there is a spider vein above the injection site that was not there before. Her bruise is lightening up, but injection looked fairly high on the arm. She has been taking pictures showing the progression after the vaccinat


VAERS ID: 1899740 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dizziness, Feeling abnormal, Lymph node pain, Lymphadenopathy, Nausea, Pain of skin, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna covid vaccine
Other Medications: Armour thyroid, Vitamin D3, B Complex
Current Illness: treated hypothyroidism
Preexisting Conditions: auto-immune hypothyroidism
Allergies: Penicillin, flomax, fish
Diagnostic Lab Data: Call to Dr. office 11/19/2021 and went to local walk-in clinic 11/22/2021
CDC Split Type:

Write-up: Extensive swelling and pain of the lymph nodes (under left arm and just above right clavicle) and surrounding tissue (swollen underarm and swelling up through and towards back of neck), severe joint and skin pain (entire body), high fever (103.5 2 hours after taking 400mg of ibuprofen - difficult to control), light-headedness, brain fogginess, nausea and loss of appetite that is still somewhat present


VAERS ID: 1899928 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-07
Onset:2021-11-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dizziness, Headache, Myalgia, Nasal congestion, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benazepril 20mg; Pantoprazole 40mg; Amlodipine 10mg; Iron 65mg; Multivitamin
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Morphine; citrus
Diagnostic Lab Data: Nov 20, 2021, at-home test showed positive for COVID-19.
CDC Split Type:

Write-up: COVID-19 positive. Cough, stuffy/runny nose, mild fever, headache, muscle pain, dizziness, loss of smell and taste.


VAERS ID: 1900070 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NyQuil, DayQuil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Total Loss of taste to Salt and Spice. Can taste a little bit of sweet.


VAERS ID: 1900081 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dyspepsia, Gastrooesophageal reflux disease
SMQs:, Gastrointestinal nonspecific dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heartburn/ Acid reflux


VAERS ID: 1901121 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. On 04-NOV-2021 vial was initially stored in the refrigerator. On 17-NOV-2021 10.00 AM vial was first punctured. Post puncture vial was stored under room temperature. Vial did not undergone any temperature excursions. Vial was exposed to room temperature range 46� to 77�F from 17-NOV-2021 10:53AM until 18NOV2021 11:00AM.


VAERS ID: 1901122 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided.


VAERS ID: 1901136 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received booster 5 months after second vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine) in a 43-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine). On 18-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not provided.


VAERS ID: 1901257 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Fatigue, Headache, Lethargy, Myalgia, Pyrexia, Somnolence, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hay fever; MGUS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 99.6 temperature
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Rather moderate side effects/moderate reaction to the booster; Sleepy/slept 3 hours; 99.6 temperature; Headache, fatigue, body aches, lethargy/very lethargic; Headache, fatigue, body aches, lethargy; Headache, fatigue, body aches, lethargy; Headache, fatigue, body aches, lethargy/fatigued; This spontaneous case was reported by a pharmacist and describes the occurrence of LETHARGY (Headache, fatigue, body aches, lethargy/very lethargic), VACCINATION COMPLICATION (Rather moderate side effects/moderate reaction to the booster), SOMNOLENCE (Sleepy/slept 3 hours), HEADACHE (Headache, fatigue, body aches, lethargy) and MYALGIA (Headache, fatigue, body aches, lethargy) in a 60-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939909) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included MGUS since 2018 and Hay fever. On 17-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Cutaneous) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced LETHARGY (Headache, fatigue, body aches, lethargy/very lethargic), HEADACHE (Headache, fatigue, body aches, lethargy), MYALGIA (Headache, fatigue, body aches, lethargy) and FATIGUE (Headache, fatigue, body aches, lethargy/fatigued). On an unknown date, the patient experienced VACCINATION COMPLICATION (Rather moderate side effects/moderate reaction to the booster), SOMNOLENCE (Sleepy/slept 3 hours) and PYREXIA (99.6 temperature). At the time of the report, LETHARGY (Headache, fatigue, body aches, lethargy/very lethargic), HEADACHE (Headache, fatigue, body aches, lethargy), MYALGIA (Headache, fatigue, body aches, lethargy) and FATIGUE (Headache, fatigue, body aches, lethargy/fatigued) had not resolved and VACCINATION COMPLICATION (Rather moderate side effects/moderate reaction to the booster), SOMNOLENCE (Sleepy/slept 3 hours) and PYREXIA (99.6 temperature) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: high (High) 99.6 temperature. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered LETHARGY (Headache, fatigue, body aches, lethargy/very lethargic), VACCINATION COMPLICATION (Rather moderate side effects/moderate reaction to the booster), SOMNOLENCE (Sleepy/slept 3 hours), HEADACHE (Headache, fatigue, body aches, lethargy), MYALGIA (Headache, fatigue, body aches, lethargy), FATIGUE (Headache, fatigue, body aches, lethargy/fatigued) and PYREXIA (99.6 temperature) to be possibly related. It was reported that the patient had zero reaction to the first two shots. No concomitant medication was reported. No treatment medication was reported. Leaning toward moderate for severity of events, was reported. Most recent FOLLOW-UP information incorporated above includes: On 18-Nov-2021: Follow-up received contains new events and lab data.


VAERS ID: 1901274 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Kentucky  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 5 Patients administered expired doses $g 12 hours post puncture; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (5 Patients administered expired doses $g 12 hours post puncture) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027H21B) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (5 Patients administered expired doses $g 12 hours post puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (5 Patients administered expired doses $g 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. On 16-Nov-2021, the vial was initially stored in the refrigerator. On 17-Nov-2021 at 8 AM, vial was first punctured and was stored In RT post puncture and did not undergo any temperature excursions.Total amount of time the vial was exposed to room temperature range 8� to 25�C, 46� to 77�F was 24 hours. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1901287 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: body aches; headaches; light fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (body aches), HEADACHE (headaches), PYREXIA (light fever) and CHILLS (chills) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 17-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced MYALGIA (body aches), HEADACHE (headaches), PYREXIA (light fever) and CHILLS (chills). At the time of the report, MYALGIA (body aches), HEADACHE (headaches), PYREXIA (light fever) and CHILLS (chills) had not resolved. Concomitant medications details were not reported by the reporter. Treatment details was not reported by the reporter.


VAERS ID: 1901289 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 2nd Moderna dose at day 20; This spontaneous case was reported by an other health care professional and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd Moderna dose at day 20) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd Moderna dose at day 20). On 18-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (2nd Moderna dose at day 20) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. It was reported that we need to know how to proceed because her occupational health doctor wants her to get a 3rd dose immediately. The patient was not experiencing any adverse reactions. No treatment medications were reported. This is a spontaneous case concerning a 46-year-old, female patient with no relevant medical history, who experienced the unexpected, non serious event of inappropriate schedule of product administration. The event inappropriate schedule of product administration occurred the same day with the second dose of mRNA-1273 vaccine administration, the patient received her second dose with dosage interval of 20 days from the first dose of vaccine administration. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a 46-year-old, female patient with no relevant medical history, who experienced the unexpected, non serious event of inappropriate schedule of product administration. The event inappropriate schedule of product administration occurred the same day with the second dose of mRNA-1273 vaccine administration, the patient received her second dose with dosage interval of 20 days from the first dose of vaccine administration. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1901295 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-06
Onset:2021-11-18
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity, Pain, Pharyngeal swelling, Swelling face, Vaccination site pain
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Swelling in the face; Swelling throat; Body aches; Allergic reaction; Right arm sore; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING FACE (Swelling in the face), PHARYNGEAL SWELLING (Swelling throat), PAIN (Body aches), HYPERSENSITIVITY (Allergic reaction) and VACCINATION SITE PAIN (Right arm sore) in a 25-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 011d21a, 037a21b and 025c21a) for COVID-19 vaccination. No Medical History information was reported. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced SWELLING FACE (Swelling in the face), PHARYNGEAL SWELLING (Swelling throat), PAIN (Body aches), HYPERSENSITIVITY (Allergic reaction) and VACCINATION SITE PAIN (Right arm sore). At the time of the report, SWELLING FACE (Swelling in the face), PHARYNGEAL SWELLING (Swelling throat), PAIN (Body aches), HYPERSENSITIVITY (Allergic reaction) and VACCINATION SITE PAIN (Right arm sore) had not resolved. No Concomitant product use was reported. No treatment information was provided. The patient got the booster of the Moderna COVID-19 vaccine on 17-Nov-2021 and on 18-Nov-2021, the patient was having an allergic reaction, swelling in the face and throat, right arm sore and body aches.


VAERS ID: 1901303 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Chills, Cold burn, Pain in extremity, Pain of skin, Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Pain in the arm , both arms; Burning sensation from the shoulder all the way to the elbow of both arms/a burning sensation from the hip down and is getting close to the knees; Cold sensation from the shoulder all the way to the elbow of both arms/a cold sensation from the hip down and is getting close to the knees.; Skin hurt; Cold burn; Shivery feeling from the shoulder all the way to the elbow of both arms/shivery feeling from the hip down and is getting close to the knees/ shivering; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Pain in the arm , both arms), BURNING SENSATION (Burning sensation from the shoulder all the way to the elbow of both arms/a burning sensation from the hip down and is getting close to the knees), PERIPHERAL COLDNESS (Cold sensation from the shoulder all the way to the elbow of both arms/a cold sensation from the hip down and is getting close to the knees.), PAIN OF SKIN (Skin hurt) and COLD BURN (Cold burn) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for COVID-19 vaccination: J and J COVID-19 Vaccine on 30-Mar-2021. Past adverse reactions to the above products included No adverse event with J and J COVID-19 Vaccine. Concomitant products included VITAMINS NOS for an unknown indication. On 17-Nov-2021 at 5:30 PM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced PAIN IN EXTREMITY (Pain in the arm , both arms), BURNING SENSATION (Burning sensation from the shoulder all the way to the elbow of both arms/a burning sensation from the hip down and is getting close to the knees), PERIPHERAL COLDNESS (Cold sensation from the shoulder all the way to the elbow of both arms/a cold sensation from the hip down and is getting close to the knees.), PAIN OF SKIN (Skin hurt), COLD BURN (Cold burn) and CHILLS (Shivery feeling from the shoulder all the way to the elbow of both arms/shivery feeling from the hip down and is getting close to the knees/ shivering). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) on 18-Nov-2021 for Adverse event, at a dose of At morning. At the time of the report, PAIN IN EXTREMITY (Pain in the arm , both arms), BURNING SENSATION (Burning sensation from the shoulder all the way to the elbow of both arms/a burning sensation from the hip down and is getting close to the knees), PERIPHERAL COLDNESS (Cold sensation from the shoulder all the way to the elbow of both arms/a cold sensation from the hip down and is getting close to the knees.), PAIN OF SKIN (Skin hurt), COLD BURN (Cold burn) and CHILLS (Shivery feeling from the shoulder all the way to the elbow of both arms/shivery feeling from the hip down and is getting close to the knees/ shivering) outcome was unknown.


VAERS ID: 1901315 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported.


VAERS ID: 1901316 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. On 04-Nov-2021, the vial was initially stored in the refrigerator. On 17-Nov-2021 at 10:00, the vial was first punctured. On 17-Nov-2021 at 10:53 until 18-Nov-2021 11:00, the vial was exposed to room temperature range ( 46� to 77�F). This case was linked to MOD-2021-391046 (Patient Link).


VAERS ID: 1901317 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment medications were reported.


VAERS ID: 1901319 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment medications were reported Source document stated that patient had not experienced any symptoms.


VAERS ID: 1901320 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 40-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Date the vial was initially stored in the refrigerator: 04-Aug-2021. No concomitant medication was provided. No treatment medication was given.


VAERS ID: 1901321 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 33-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) 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. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1901322 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUSPIRONE; FLUOXETINE; ALBUTEROL [SALBUTAMOL]; FENOFIBRATE; OMEPRAZOLE; EXCEDRIN [CAFFEINE;PARACETAMOL]; MIRTAZAPINE
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administered expired Moderna COVID-19 vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included BUSPIRONE, FLUOXETINE, ALBUTEROL [SALBUTAMOL], FENOFIBRATE, OMEPRAZOLE, CAFFEINE, PARACETAMOL (EXCEDRIN [CAFFEINE;PARACETAMOL]) and MIRTAZAPINE for an unknown indication. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant information was not provided. Treatment information was not provided.


VAERS ID: 1901324 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Syringe issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Solution came out the side of needle,the needle on the syringe was faulty; didn''t receive full booster dose (0.25 ml),liquid came out of injection site; This spontaneous case was reported by a pharmacist and describes the occurrence of SYRINGE ISSUE (Solution came out the side of needle,the needle on the syringe was faulty) and INCORRECT DOSE ADMINISTERED (didn''t receive full booster dose (0.25 ml),liquid came out of injection site) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 069F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced SYRINGE ISSUE (Solution came out the side of needle,the needle on the syringe was faulty) and INCORRECT DOSE ADMINISTERED (didn''t receive full booster dose (0.25 ml),liquid came out of injection site). On 18-Nov-2021, SYRINGE ISSUE (Solution came out the side of needle,the needle on the syringe was faulty) and INCORRECT DOSE ADMINISTERED (didn''t receive full booster dose (0.25 ml),liquid came out of injection site) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. It was reported that the patient was re vaccinated with Moderna during the same session. The HCP stated that again the patient did not receive the entire 0.25 ml dose as some of the liquid came out of injection site. The HCP also stated that some fluid may have been entered into patients fatty arm tissue.


VAERS ID: 1901325 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Iowa  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: A patient received a booster dose from a vial that was opened yesterday (post 12 hours puncture).; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (A patient received a booster dose from a vial that was opened yesterday (post 12 hours puncture).) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (A patient received a booster dose from a vial that was opened yesterday (post 12 hours puncture).). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (A patient received a booster dose from a vial that was opened yesterday (post 12 hours puncture).) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment information were reported by the reporter


VAERS ID: 1901357 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received booster 5 months after second vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine) in a 43-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine). On 18-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were reported. No Treatment medications were reported. Patient had a booster dose.


VAERS ID: 1901359 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received booster 5 months after second vaccine/received booster dose of Moderna COVID-19 vaccine 1 month early.; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine/received booster dose of Moderna COVID-19 vaccine 1 month early.) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine/received booster dose of Moderna COVID-19 vaccine 1 month early.). On 18-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received booster 5 months after second vaccine/received booster dose of Moderna COVID-19 vaccine 1 month early.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were provided. No treatment information were given. Patient received booster dose of Moderna COVID-19 vaccine 1 month early.


VAERS ID: 1901364 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-02
Onset:2021-11-18
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: needle and the hub got detached, and some liquid leak; needle and the hub got detached, and some liquid leak; This spontaneous case was reported by a pharmacist and describes the occurrence of DEVICE CONNECTION ISSUE (needle and the hub got detached, and some liquid leak) and UNDERDOSE (needle and the hub got detached, and some liquid leak) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037F21A, 045B21A and 031B21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced DEVICE CONNECTION ISSUE (needle and the hub got detached, and some liquid leak) and UNDERDOSE (needle and the hub got detached, and some liquid leak). On 18-Nov-2021, DEVICE CONNECTION ISSUE (needle and the hub got detached, and some liquid leak) and UNDERDOSE (needle and the hub got detached, and some liquid leak) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1901367 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: REMERON
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired dose administered to patient; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included MIRTAZAPINE (REMERON) for an unknown indication. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 ml. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment information was provided by the reporter. The vaccine was punctured and left at room temperature for about 24 hours. The reporter was not aware that the patient is experiencing any symptoms, and no treatment was given


VAERS ID: 1901379 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Rhode Island  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine used; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and medication information provided. No treatment information provided This case concerns a patient, unknown age and gender, with no known medical history, who experienced the non-serious event of expired product administered. The event occurred on the same day after unspecified dose of mRNA 1273 vaccine. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report This case was linked to MOD-2021-392126 (Patient Link).; Sender''s Comments: This case concerns a patient, unknown age and gender, with no known medical history, who experienced the non-serious event of expired product administered. The event occurred on the same day after unspecified dose of mRNA 1273 vaccine. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report


VAERS ID: 1901541 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20123

Write-up: COVID-like symptoms; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (COVID-like symptoms) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 17-Nov-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced VACCINATION COMPLICATION (COVID-like symptoms). At the time of the report, VACCINATION COMPLICATION (COVID-like symptoms) outcome was unknown. No concomitant and treatment information were reported by the reporter. Caller mentioned she received 2nd dose of the Moderna COVID-19 vaccine on the 17th Nov 2021 and was experiencing COVID-like symptoms on the 18thNov 2021. Company comment- This case concerns a female patient, unknown age, with no relevant medical history, who experienced the non-serious, unexpected event of vaccination complication. The event occurred one day after second dose of mRNA 1273 vaccine. The patient felt COVID-like symptoms after her vaccine. The rechallenge is not applicable as there is no information regarding a third dose. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 18-Nov-2021: Follow-up received on 18-NOV-2021 and contains NNI.; Sender''s Comments: This case concerns a female patient, unknown age, with no relevant medical history, who experienced the non-serious, unexpected event of vaccination complication. The event occurred one day after second dose of mRNA 1273 vaccine. The patient felt Covid-like symptoms after her vaccine. The rechallenge is not applicable as there is no information regarding a third dose.The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.


VAERS ID: 1901561 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported.


VAERS ID: 1901563 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment information was provided


VAERS ID: 1901564 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE; ATORVASTATIN; PHENYTOIN; QUETIAPINE; OXCARBAZEPINE
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administered expired Moderna COVID-19 vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine) in a 38-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LEVOTHYROXINE, ATORVASTATIN, PHENYTOIN, QUETIAPINE and OXCARBAZEPINE for an unknown indication. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Administered expired Moderna COVID-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medications were reported.


VAERS ID: 1901581 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-11-18
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Mobility decreased, Nausea
SMQs:, Acute pancreatitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MOBIC
Current Illness: Arm fracture (Broken arm)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Could not move; Extreme nausea almost to the point of vomiting; Chills; Headache; Extreme fatigue/Fatigued/just tired/Tired; This spontaneous case was reported by a consumer and describes the occurrence of MOBILITY DECREASED (Could not move), NAUSEA (Extreme nausea almost to the point of vomiting), CHILLS (Chills), HEADACHE (Headache) and FATIGUE (Extreme fatigue/Fatigued/just tired/Tired) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013F21A, 023C21A and 038B21A) for COVID-19 vaccination. Concurrent medical conditions included Arm fracture (Broken arm). Concomitant products included MELOXICAM (MOBIC) for Arm fracture. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced MOBILITY DECREASED (Could not move), NAUSEA (Extreme nausea almost to the point of vomiting), CHILLS (Chills), HEADACHE (Headache) and FATIGUE (Extreme fatigue/Fatigued/just tired/Tired). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) ongoing since an unknown date for Adverse event, at a dose of UNK mg. At the time of the report, MOBILITY DECREASED (Could not move), NAUSEA (Extreme nausea almost to the point of vomiting), CHILLS (Chills), HEADACHE (Headache) and FATIGUE (Extreme fatigue/Fatigued/just tired/Tired) outcome was unknown. Patient stated that after getting her shot (booster dose) yesterday, she woke up with extreme nausea almost to the point of vomiting, chills, headache, extreme fatigue, and chills. She was just immobile yesterday when it happened, just tired and fatigued, she could not move her due to headache just pounding. She took Extra Strength Tylenol 1000 mg; she could not take Ibuprofen because is taking Mobic 15 mg for broken arm.


VAERS ID: 1901585 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest pain, Chills, Condition aggravated, Dyspnoea, Fear, Headache, Inflammation, Musculoskeletal stiffness, Nausea, Pericarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: T3/T4 SUPPORT
Current Illness: Gluten sensitivity; Hashimoto''s disease (Hashimoto''s disease and she treats with a compounded T3/T4 medication.); Sulfonamide allergy (drug allergy to sulfa and gluten)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: May have experienced pericarditis; Stiff neck; Shooting pains in her chest/pain deep in chest/chest pains are better but "still at bay"/chest pains are now just a dull ache/no longer a severe, sharp burning pain in the chest.; Shortness of breath; Scary; Severe inflammation; Got worse when she laid down//went to bed; too weak last night to do anything; Nausea; Fever; Chills; Headache/shooting pains in her head; This spontaneous case was reported by a consumer and describes the occurrence of PERICARDITIS (May have experienced pericarditis) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Sulfonamide allergy (drug allergy to sulfa and gluten), Hashimoto''s disease (Hashimoto''s disease and she treats with a compounded T3/T4 medication.) and Gluten sensitivity. Concomitant products included T3/T4 SUPPORT for Hashimoto''s disease. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced PERICARDITIS (May have experienced pericarditis) (seriousness criterion medically significant), MUSCULOSKELETAL STIFFNESS (Stiff neck), CHEST PAIN (Shooting pains in her chest/pain deep in chest/chest pains are better but "still at bay"/chest pains are now just a dull ache/no longer a severe, sharp burning pain in the chest.), DYSPNOEA (Shortness of breath), FEAR (Scary), INFLAMMATION (Severe inflammation), CONDITION AGGRAVATED (Got worse when she laid down//went to bed), ASTHENIA (too weak last night to do anything), NAUSEA (Nausea), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Headache/shooting pains in her head). The patient was treated with IBUPROFEN 19-Nov-2021 for Chest pain, at a dose of 1 dosage form three times a day and ACETAMINOPHEN on 19-Nov-2021 at a dose of 1 dosage form. At the time of the report, PERICARDITIS (May have experienced pericarditis), MUSCULOSKELETAL STIFFNESS (Stiff neck), DYSPNOEA (Shortness of breath), FEAR (Scary), INFLAMMATION (Severe inflammation), CONDITION AGGRAVATED (Got worse when she laid down//went to bed), ASTHENIA (too weak last night to do anything), NAUSEA (Nausea), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Headache/shooting pains in her head) outcome was unknown and CHEST PAIN (Shooting pains in her chest/pain deep in chest/chest pains are better but "still at bay"/chest pains are now just a dull ache/no longer a severe, sharp burning pain in the chest.) was resolving. Company Comment: This is a spontaneous case concerning a 67 years old, female patient with clinical history of Hashimoto''s disease who experienced the expected event of PERICARDITIS (AESI) and the unexpected events of MUSCULOSKELETAL STIFFNESS, CHEST PAIN, DYSPNOEA, FEAR, INFLAMMATION, CONDITION AGGRAVATED, ASTHENIA, NAUSEA, PYREXIA, CHILLS and HEADACHE. The events occurred the same day after the third dose of mRNA-1273 vaccine. The rechallenge was not applicable since only information about the third dose was disclosed. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a 67 years old, female patient with clinical history of Hashimoto''s disease who experienced the expected event of PERICARDITIS (AESI) and the unexpected events of MUSCULOSKELETAL STIFFNESS, CHEST PAIN, DYSPNOEA, FEAR, INFLAMMATION, CONDITION AGGRAVATED, ASTHENIA, NAUSEA, PYREXIA, CHILLS and HEADACHE The events occurred the same day after the third dose of mRNA-1273 vaccine The rechallenge was not applicable since only information about the third dose was disclosed The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1901590 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Fatigue, Haematochezia, Headache
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Blood in stool; Loss of taste; Headache; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (Blood in stool), AGEUSIA (Loss of taste), HEADACHE (Headache) and FATIGUE (Fatigue) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced HAEMATOCHEZIA (Blood in stool), AGEUSIA (Loss of taste), HEADACHE (Headache) and FATIGUE (Fatigue). At the time of the report, HAEMATOCHEZIA (Blood in stool), AGEUSIA (Loss of taste), HEADACHE (Headache) and FATIGUE (Fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Company comment: This is a Spontaneous case concerning a 23-year-old, female patient with unknown medical history, who experienced the unexpected non serious (AESI) event of . The event occurred approximately 1 day after one dose of mRNA 1273 vaccine. Patient also experience hematochezia with no more information. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.; Sender''s Comments: This is a Spontaneous case concerning a 23-year-old, female patient with unknown medical history, who experienced the unexpected non serious (AESI) event of . The event occurred approximately 1 day after one dose of mRNA 1273 vaccine. Patient also experience hematochezia with no more information. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.


VAERS ID: 1901600 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wyoming  
Vaccinated:2021-10-21
Onset:2021-11-18
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202111; Test Name: Body temperature; Result Unstructured Data: High, 101F at 14:30pm; Test Date: 202111; Test Name: Body temperature; Result Unstructured Data: High, 102.7F she; Test Date: 202111; Test Name: Body temperature; Result Unstructured Data: High, 101.6F.
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Aching after 2nd dose; Feverish after 2nd dose; feel aching; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Aching after 2nd dose), PYREXIA (Feverish after 2nd dose) and MYALGIA ( feel aching ) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026D21A and 013F21A) for COVID-19 vaccination. No medical history was provided by the reporter. On 21-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced PAIN (Aching after 2nd dose) and PYREXIA (Feverish after 2nd dose). 18-Nov-2021, the patient experienced MYALGIA ( feel aching ). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at a dose of 2 Tylenol and IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at a dose of 2 Advil. At the time of the report, PAIN (Aching after 2nd dose), PYREXIA (Feverish after 2nd dose) and MYALGIA ( feel aching ) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In November 2021, Body temperature: 101 (High) High, 101F at 14:30pm, 102.7 (High) High, 102.7F she and 101.6 (High) High, 101.6F.. The patient used v-safe as treatment. No concomitant medications were reported. This case was linked to MOD-2021-392172 (Patient Link).; Sender''s Comments: Non-serious Case.


VAERS ID: 1901604 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076L21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered greater than 12 hours post initial puncture; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours post initial puncture) in a 33-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076L21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours post initial puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours post initial puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was provided by the reporter. No treatment information was provided. The vial was initially stored in the refrigerator on 17-Nov-2021. The vial initially punctured on 17-Nov-2021. The vial had no temperature excursion.


VAERS ID: 1901678 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Rash erythematous, Skin mass, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Lump in the collarbone area; Red rash going down the to the armpit; Red circle the size of a quarter and raised; Red circle raised; This spontaneous case was reported by a consumer and describes the occurrence of ERYTHEMA (Red circle the size of a quarter and raised), SWELLING (Red circle raised), SKIN MASS (Lump in the collarbone area) and RASH ERYTHEMATOUS (Red rash going down the to the armpit) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013F21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced ERYTHEMA (Red circle the size of a quarter and raised) and SWELLING (Red circle raised). On 19-Nov-2021, the patient experienced SKIN MASS (Lump in the collarbone area) and RASH ERYTHEMATOUS (Red rash going down the to the armpit). At the time of the report, ERYTHEMA (Red circle the size of a quarter and raised), SWELLING (Red circle raised), SKIN MASS (Lump in the collarbone area) and RASH ERYTHEMATOUS (Red rash going down the to the armpit) outcome was unknown. Concomitant information was not provided. No treatment was received. Reporter states that she completed the Moderna primary series prior to receiving her booster. Reporter did not allow further contact


VAERS ID: 1901688 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: pop up rashes over his lower abdomen and chest. It looks like hives; Itching on his head, arms, wrists, feet and legs; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (Itching on his head, arms, wrists, feet and legs) and URTICARIA (pop up rashes over his lower abdomen and chest. It looks like hives) in a 35-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced PRURITUS (Itching on his head, arms, wrists, feet and legs). On 19-Nov-2021, the patient experienced URTICARIA (pop up rashes over his lower abdomen and chest. It looks like hives). At the time of the report, PRURITUS (Itching on his head, arms, wrists, feet and legs) and URTICARIA (pop up rashes over his lower abdomen and chest. It looks like hives) outcome was unknown. No concomitant drug details were reported. No treatment details were reported.


VAERS ID: 1901690 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Rhode Island  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine used; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were reported. No treatment medications were reported. This case concerns a patient, unknown age and gender, with no known medical history, who experienced the non-serious event of expired product administered. The event occurred on the same day after unspecified dose of mRNA 1273 vaccine. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a patient, unknown age and gender, with no known medical history, who experienced the non-serious event of expired product administered. The event occurred on the same day after unspecified dose of mRNA 1273 vaccine. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.


VAERS ID: 1901696 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 15 years old received the Moderna COVID 19 vaccine.; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (15 years old received the Moderna COVID 19 vaccine.) in a 15-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 069F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Nov-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (15 years old received the Moderna COVID 19 vaccine.). On 18-Nov-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (15 years old received the Moderna COVID 19 vaccine.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided.; Sender''s Comments: Non-serious Case


VAERS ID: 1901720 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-11-18
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Aortic arteriosclerosis, Aortic disorder, Asthenia, Bacterial test positive, Blood culture negative, Blood glucose, Bronchitis, COVID-19, Cardiac failure congestive, Cardiomegaly, Chest X-ray normal, Culture urine positive, Dyspnoea, Enterococcus test positive, Full blood count, Gram stain, Hypoxia, Leukocytosis, Lung opacity, Pleural effusion, Pneumonia, Pulmonary congestion, Pyrexia, Renal function test normal, Respiratory distress, SARS-CoV-2 test positive, Shoulder arthroplasty, Sputum culture, Staphylococcus test positive, Urinary tract infection, Urine analysis normal, White blood cell count
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ELIQUIS 5 MG tablet fluticasone (FLONASE) 50 MCG/ACT nasal spray furosemide (LASIX) 40 MG tablet isosorbide mononitrate CR (IMDUR) 60 MG 24 hr tablet lisinopril (PRINIVIL,ZESTRIL) 20 MG tablet metFORMIN-XR (GLUCOPHAGE-XR) 500 MG extend
Current Illness:
Preexisting Conditions: Hospital Pneumonia Atrophic kidney CLL (chronic lymphocytic leukemia) Type 2 diabetes mellitus, without long-term current use of insulin Atrial fibrillation Acute on chronic respiratory failure with hypoxia VRE infection (vancomycin resistant enterococcus), with multi-drug resistance
Allergies: Motrin [Ibuprofen] Vicodin [Hydrocodone-acetaminophen]
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 11/23/21 0947 Order Status: Completed Updated: 11/23/21 0949 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/23/2021 8:45 AM TECHNIQUE: Single view chest INDICATION: covid with increasing O2 needs COMPARISON: November 21, 2021 ENCOUNTER: Not applicable _________________________ FINDINGS: There are increasing right mid and lower lung airspace opacities. Again seen is interstitial prominence of the lung fields with other scattered patchy opacities. Stable cardiomediastinal silhouette with tortuous thoracic aorta. Aortic calcifications are noted. No pneumothorax. A right pleural effusion is difficult to exclude. Stable osseous structures. _________________________ Impression: Increased right mid and lower lung airspace opacities, which could be concerning for pneumonia. A right pleural effusion is difficult to exclude. DR CHEST SINGLE VIEW Resulted: 11/21/21 0910 Order Status: Completed Updated: 11/21/21 0912 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/21/2021 7:34 AM TECHNIQUE: Single AP portable upright chest INDICATION: Hypoxemia COMPARISON: 11/18/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: No supporting lines or tubes. There is no evidence of pneumothorax. Cardiomegaly with stable pulmonary vascular congestion. Hilar regions unchanged. Stable aorta and superior mediastinum. Small effusions. Stable central bilateral airspace disease greater on the right and left. Mild increase in basilar airspace disease on the right medially. No change in the left base. Osseous structures are unchanged. _________________________ Impression: Increased airspace disease medial right base retrocardiac region. No other significant change in the chest. Findings most consistent with CHF. DR CHEST SINGLE VIEW Resulted: 11/18/21 0535 Order Status: Completed Updated: 11/18/21 0537 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/18/2021 5:00 AM TECHNIQUE: Single view chest INDICATION: shortness of breath COMPARISON: PA and lateral chest 3/12/2008 ENCOUNTER: Not applicable _________________________ FINDINGS: There is now mild cardiomegaly even given patient rotation and tilting present. Central pulmonary vascularity is felt to be within normal limits. There is a small to moderate-sized patches of mixed interstitial and airspace disease at the inferior right lower lobe just above the horizontal fissure larger than what was seen here previously and likely representative of recurrent pneumonia. Otherwise, background chronic appearing interstitial coarsening is seen slightly more pronounced at the bases likely due to progression of senescent change but superimposed process such as bronchitis could also give this appearance. Minimal blunting of the right costophrenic sulcus suggests tiny effusion. No sizable left effusion. No discernible pneumothorax. The adequately visualized portions of the osseous structures show progressive demineralization with interval right shoulder arthroplasty and profound cephalad migration here in the interval suggestive of interval rotator cuff tear. _________________________ Impression: 1. Small to moderate zone of airspace disease/pneumonia inferior right upper lobe. This is slightly more pronounced than on prior and findings would be compatible with a recurrent pneumonia. Would recommend follow-up upon completion of any anticipated therapy. 2. Suspect progression of chronic senescent interstitial coarsening of the bases but superimposed process such as bronchitis is also another possibility. This can also be followed. Note: There is a follow-up recommendation in this report. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 11/23/21 1310 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 1401 Cult Blood Peripheral No Growth 48 hours Peripheral Blood Culture Collected: 11/23/21 1311 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 1401 Cult Blood Peripheral No Growth 48 hours Sputum Culture Collected: 11/23/21 2038 Order Status: Completed Specimen: Body Fluid from Sputum Updated: 11/25/21 0848 Bacterial culture, sputum Further Incubation Required Gram stain Moderate WBCs Few Gram Positive Cocci Few Yeast Few Gram Negative Rods Few Gram Positive Rods MRSA Screen Culture (Abnormal) Collected: 11/23/21 1308 Order Status: Completed Specimen: Swabbed Collection from Naris, Right Updated: 11/25/21 0647 Methicillin resistant staphylococcus screen Methicillin-Resistant Staphylococcus aureus Abnormal Narrative: This screen determines MRSA carrier status. When negative, it predicts the absence of MRSA lower respiratory tract infection. When positive, infection due to MRSA is possible, yet cultures from the site of infection must be used to guide diagnosis and therapy. Urine Culture (Abnormal) Collected: 11/18/21 0435 Order Status: Completed Specimen: Urine, clean catch Updated: 11/24/21 0800 Bacterial culture, urine $g=100,000 CFU/mL Enterococcus faecium - vancomycin resistant Abnormal Comment: This is an edited result. Previous organism was Enterococcus faecium on 11/19/2021 at 1311 EST. Susceptibility Enterococcus faecium - vancomycin resistant Not Specified Ampicillin Resistant Levofloxacin Resistant Linezolid Susceptible 1 Nitrofurantoin Susceptible Tetracycline Resistant Vancomycin Resistant 1 This is an appended report. These results have been appended to a previously final verified report. Linear View Peripheral Blood Culture Collected: 11/18/21 0421 Order Status: Completed Specimen: Blood, Venous Updated: 11/23/21 0501 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 11/18/21 0434 Order Status: Completed Specimen: Blood, Venous Updated: 11/23/21 0501 Cult Blood Peripheral No bacteria or yeast isolated Narrative: Draw from a different site than draw one.
CDC Split Type:

Write-up: Patient currently inpatient at (8) days starting from 11/18/2021. Patient is a 90 y.o. female who presents today with shortness of breath. History is limited from the patient, however patient''s son provides additional history as possible. Patient''s son states that she was hospitalized a couple weeks ago for suspected urinary tract infection. He states following hospitalization she had significant weakness and she was discharged to assisted living for ongoing care. While at assisted living the patient was noted to have significant respiratory distress and fevers, for which reason the patient was sent to the ER for further evaluation. Patient was noted to be COVID positive. She reports being vaccinated. Patient is somewhat immunocompromised with her CLL. On presentation, the patient was requiring high-flow nasal cannula to maintain appropriate saturations. Patient does report that she uses 2-3 L of oxygen at night while sleeping, however she is unsure of any specific associated pulmonary diagnosis. Anticipated care plan was discussed with the patient and her son. Both report should patient''s respiratory status worsen intubation is not desired. Questions have been answered to patient and son satisfaction. ASSESSMENT/PLAN: Acute on chronic respiratory failure with hypoxia Assessment & Plan Patient reports baseline oxygen needs of 2-3 L at night Patient was requiring high-flow nasal cannula on admission secondary to pneumonia Continue weaning oxygen as tolerated otherwise treatment as outlined under pneumonia * Pneumonia Assessment & Plan Patient with noted positive COVID test in the emergency department (11/18/2012) Unclear whether pneumonia is bacterial in nature or related to COVID-19. Will continue to cover with IV Rocephin and azithromycin for potential bacterial pneumonia Additionally will start patient on 6 mg of Decadron for possible COVID pneumonia Routine monitoring of vitals Will monitor blood culture results Patient''s home Eliquis should be adequate anticoagulation for patient''s positive COVID status Type 2 diabetes mellitus, without long-term current use of insulin Assessment & Plan Very low-dose mealtime and corrective scale coverage while admitted Will continue trending patient''s bedside glucose for further titration CLL (chronic lymphocytic leukemia) Assessment & Plan Likely cause of patient''s noted leukocytosis Will continue monitoring complete blood count throughout admission Atrial fibrillation Assessment & Plan Continue Eliquis for anticoagulation and metoprolol for rate control Atrophic kidney Assessment & Plan Patient''s son reports a history of an atrophic kidney he states his chronically infected. He notes patient recently underwent a 10 day antibiotic course. UA in kidney function reviewed. No further indication of ongoing urinary infection is noted and patient has appropriate kidney function


VAERS ID: 1901867 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-11-18
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Bacterial test negative, Blood creatinine abnormal, Blood culture negative, Blood gases abnormal, COVID-19, COVID-19 pneumonia, Cardiomegaly, Central venous catheterisation, Chest X-ray abnormal, Computerised tomogram head normal, Condition aggravated, Dyspnoea, Echocardiogram, Ejection fraction normal, Electrocardiogram abnormal, Endotracheal intubation, Fibrin D dimer increased, Gastrointestinal tube insertion, Gram stain positive, Headache, Hypoxia, Ill-defined disorder, Intensive care, Lethargy, Lung infiltration, Lung opacity, Mechanical ventilation, Oliguria, Positive airway pressure therapy, Pulmonary vasculitis, Renal failure, Right ventricular systolic pressure, SARS-CoV-2 test positive, Serology normal, Shock, Sinus tachycardia, Sputum culture, Tricuspid valve incompetence, Ultrasound Doppler normal, Urinary tract infection, Urine analysis abnormal, pH body fluid abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet carbamazepine (CARBATROL) 100 MG capsule DULoxetine (CYMBALTA) 40 MG delayed release capsule lisinopril-
Current Illness: 3/1/21- Chronic low back pain
Preexisting Conditions: Non-Hospital Shock (HCC) Sepsis (HCC) Metabolic acidosis CAP (community acquired pneumonia) UTI (urinary tract infection) Elevated d-dimer Hyperkalemia Admitted to intensive care unit Tobacco abuse OSA (obstructive sleep apnea) Obesity, Class III, BMI 40-49.9 (morbid obesity) (HCC) Vitamin D deficiency Chronic obstructive pulmonary disease, unspecified COPD type (HCC) Essential hypertension, hypertension with unspecified goal Class 3 severe obesity due to excess calories without serious comorbidity with body mass index (BMI) of 40.0 to 44.9 in adult (HCC) Current moderate episode of major depressive disorder, unspecified whether recurrent (HCC) Acute respiratory distress syndrome (ARDS) due to COVID-19 virus (HCC) Acute renal failure (HCC)
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 11/25/21 0806 Order Status: Completed Updated: 11/25/21 0808 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/25/2021 6:23 AM TECHNIQUE: Single view chest INDICATION: F/u b/l opacities COMPARISON: [November 24, 2021 at 2236 hours ENCOUNTER: Not applicable _________________________ FINDINGS: An endotracheal tube is present distal tip approximately 2.5 cm above the carina. Gastric and enteric tubes are present traversing below diaphragm. Right IJ central venous catheter is present distal tip overlying region of the base of the right atrium. Mild low lung volumes persist. Mild increase in ill-defined and faint perihilar opacities notably involving the right greater than left chest as well as basilar regions. Heart is mildly enlarged. No large pleural effusion or pneumothorax. _________________________ Impression: 1. Lines and tubes as described above. 2. Cardiomegaly with mild increase in hazy bibasilar pulmonary opacities. DR CHEST SINGLE VIEW Resulted: 11/24/21 2236 Order Status: Completed Updated: 11/24/21 2238 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/24/2021 10:31 PM TECHNIQUE: Single view chest INDICATION: hypoxia COMPARISON: November 23, 2021 ENCOUNTER: Initial _________________________ FINDINGS: Support devices including the ET tube in the mid trachea, enteric tubes and a right IJ catheter projected over the right atrium. Cardiac appearance is unchanged. Left margin is obscured by underlying adjacent infiltrate. Groundglass infiltrates bilaterally are unchanged. _________________________ Impression: Stable appearance of the support devices. Continued radiographic findings of COVID pneumonitis although lung volumes are somewhat reduced compared to the most recent study. DR CHEST SINGLE VIEW Resulted: 11/23/21 0745 Order Status: Completed Updated: 11/23/21 0747 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/23/2021 6:38 AM TECHNIQUE: Single AP portable semiupright chest INDICATION: F/u b/l opacities COMPARISON: 11/21/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Endotracheal tube, gastric tube, feeding tube and right IJ central venous catheter all unchanged. There is no evidence of pneumothorax. Grossly stable cardiomegaly. No change in pulmonary vasculature or hilar regions. Stable aorta and superior mediastinum. Left greater than right bilateral basilar airspace disease possibly with small effusions, with minimal change in the lung bases. Somewhat groundglass density of the central to upper right lung appears slightly improved. There is slight improvement in the ground glass density in the central left lung. Left apical region remains grossly clear. Osseous structures are unchanged. _________________________ Impression: There is mild improvement in the central lungs bilaterally. Minimal change at the lung bases with small effusions suspected. FL C-ARM PROCEDURE Resulted: 11/21/21 1756 Order Status: Completed Updated: 11/21/21 1756 Narrative: This order has been auto-finalized and does not contain a result. DR CHEST SINGLE VIEW Resulted: 11/21/21 1536 Order Status: Completed Updated: 11/21/21 1538 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/21/2021 2:34 PM TECHNIQUE: Single AP portable supine chest INDICATION: F/u b/l opacities COMPARISON: 11/19/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Endotracheal tube, gastric tube and right IJ central venous catheter unchanged. Tip of the catheter is in the right atrium. There is no evidence of pneumothorax. Stable heart size. Pulmonary vasculature appears slightly less prominent. Hilar regions grossly symmetric. Stable aorta and superior mediastinum. Lungs slightly better expanded. There is slight improvement especially in the left mid to upper lung with persistent left basilar opacities and fairly diffuse right lung opacities demonstrated. No definite pleural effusion. Osseous structures are unchanged. _________________________ Impression: Mild improvement in left lung without significant change on the right since yesterday. CV Echo Limited with Contrast Collected: 11/20/21 1456 Order Status: Completed Updated: 11/20/21 1756 Narrative: LIMITED ECHOCARDIOGRAPHY REPORT Study Date: 11/20/2021 Patient Location: PORTABLE Patient Class: Inpatient Gender: Female Age: 71 yrs Height: 156 cm Weight: 107 kg Resting HR: 82 BSA: 2.0 m2 Resting BP: 125/62 mmHg Reason For Study: EF, COVID pneumonia, shock History/Symptoms: COVID 19 (11/18/2021), Tobacco Use, Obstructive Sleep Apnea, Obesity, Shock, Sepsis, Former Smoker, Mitral Valve Prolapse Electronically signed on 11/20/2021 05:55 PM Interpretation Summary The left ventricle is normal in size. There is normal left ventricular wall thickness. The left ventricular ejection fraction is 67%. No regional wall motion abnormalities noted. The right ventricle is not well visualized. There is mild tricuspid regurgitation. The estimated right ventricular systolic pressure is 44 mmHg. There is no comparison study available. STUDY PERFORMED/QUALITY: AORTIC VALVE: A limited two-dimensional The aortic valve is not well transthoracic echocardiogram was visualized. performed (2D). The technical quality of the exam was fair. Due to limited MITRAL VALVE: acoustic windows, Definity was Structurally normal mitral valve. administered. The study was done portable in the ICU. A portable study was performed on the floor because the TRICUSPID VALVE: patient was on a ventilator. The tricuspid valve is not well visualized. There is mild tricuspid LEFT VENTRICLE: regurgitation. The estimated right The left ventricle is normal in size. ventricular systolic pressure is 44 There is normal left ventricular wall mmHg. thickness. The left ventricular ejection fraction is 67%. The LV ejection fraction was determined utilizing Simpson''s Biplane method. No regional wall motion abnormalities noted. LEFT ATRIUM: The left atrium is normal in size. RIGHT ATRIUM: Right atrium not well visualized. RIGHT VENTRICLE: The right ventricle is not well visualized. PERICARDIUM/PLEURAL: No pericardial effusion. No pleural effusion. INFERIOR VENA CAVA: The IVC is normal in size (less than or equal to 2.1 cm) with <50% change during patient sniff. The estimated RA pressure is 8 mm Hg (5-10 mm Hg). Left Ventricle Tricuspid Valve EF(MOD-Avg): 67 % RVSP(TR): 44.3 mmHg EDV(MOD-sp4): 96.0 ml TR max vel: 2.7 m/sec ESV(MOD-sp4): 32.7 ml TR max PG: 29.3 mmHg SV(MOD-Avg): 58.8 ml RAP systole: 15.0 mmHg IVSd: 1.4 cm LVPWd: 0.83 cm LVIDd: 3.8 cm LVIDs: 2.6 cm EDV(MOD-sp2): 79.0 ml ESV(MOD-sp2): 24.6 ml ______________________________________________________________________________ Great Vessels IVC diam: 2.1 cm Reference Table: Normal Mild ModerateSevere Men LVEF $g 52% 41-51% 30-40% <30% Women LVEF $g 54% 41-53% 30-40% <30% Men LVIDd 4.2-5.8 5.9-6.3 6.4-6.8 $g6.8 Women LVIDd 3.8-5.2 5.3-5.6 5.7-6.1 $g6.1 LA Volume (ml/m^2) < 34 35-41 42-48 $g48 ______________________________________________________________________________ Electronically signed on 11/20/2021 05:55 PM All sources of data reside in the Cardiology PACS EJECTION FRACTION ECHO Collected: 11/20/21 1456 Order Status: Completed Updated: 11/20/21 1756 EJECTION FRACTION ECHO 67 % USV Venous Lower Extremity Duplex Bilateral Resulted: 11/19/21 2241 Order Status: Completed Updated: 11/19/21 2243 Narrative: EXAMINATION: Complete Right and Left Lower Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 11/19/2021 10:31 PM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left lower extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: covid19 elevated d-d COMPARISON: None _____________________ Right Lower Extremity Findings: Right Common Femoral Vein: No DVT. Right Femoral Vein: No DVT. Right Popliteal Vein: No DVT. Right Posterior Tibial Veins: No DVT. Right Peroneal Veins: No DVT. Right proximal Greater Saphenous Vein: No thrombus. Left Lower Extremity Findings: Left Common Femoral Vein: No DVT. Left Femoral Vein: No DVT. Left Popliteal Vein: No DVT. Left Posterior Tibial Veins: No DVT. Left Peroneal Veins: No DVT. Left proximal Greater Saphenous Vein: No thrombus. Duplex Doppler: Spectral Doppler demonstrates bilateral normal respirophasic waveforms in the common femoral veins. _____________________ Impression: There is no deep venous thrombosis in the visualized deep veins of the right or left lower extremity. * USV Venous Upper Extremity Duplex Bilateral Resulted: 11/19/21 2232 Order Status: Completed Updated: 11/19/21 2234 Narrative: EXAMINATION: Complete Bilateral Upper Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 11/19/2021 10:29 PM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left upper extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: Elevated d-dimer COMPARISON: None _____________________ Right Upper Extremity Findings: Right Internal Jugular Vein: Not evaluated Right Subclavian Vein: No thrombus. Right Axillary Vein: No thrombus. Right Brachial Vein: No thrombus. Right Radial Vein: No thrombus. Right Ulnar Vein: No thrombus. Superficial Veins: Right Basilic Vein: No thrombus. Right Cephalic Vein: No thrombus. Left Upper Extremity Findings: Left Internal Jugular Vein: No thrombus. Left Subclavian Vein: No thrombus. Left Axillary Vein: No thrombus. Left Brachial Vein: No thrombus. Left Radial Vein: No thrombus. Left Ulnar Vein: No thrombus. Superficial Veins: Left Basilic Vein: No thrombus. Left Cephalic Vein: No thrombus. ADDITIONAL FINDINGS: Normal cardiac pulsatility is present in the subclavian veins. _____________________ Impression: There is no deep venous thrombosis in the visualized deep veins of the right or left upper extremity. DR CHEST SINGLE VIEW Resulted: 11/19/21 2200 Order Status: Completed Updated: 11/19/21 2202 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/19/2021 8:55 PM TECHNIQUE: Single view chest INDICATION: confirm ETT position COMPARISON: 11/19/2021. ENCOUNTER: Subsequent _________________________ FINDINGS: The tracheal tube present and in satisfactory position. Endotracheal tube having its tip 3.9 cm above the carina. Nasogastric tube coursing below the hemidiaphragm. Left IJ central line having its tip in the expected location of the right atrioventricular junction. Monitor wires overlie the chest. The heart is enlarged. There is a moderate burden of diffuse hazy and slightly patchy opacities throughout both lungs representing airspace disease. No pneumothorax. There is no definite pleural effusion. No pneumothorax. Osseous structures similar prior exam. Impression: 1. Similar moderate burden of diffuse hazy and slightly patchy opacities within both lungs representing airspace disease. 2. Tubes and lines as described above please see the above report. No pneumothorax. 3. Cardiomegaly. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 11/20/21 1004 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 1101 Cult Blood Peripheral No bacteria or yeast isolated Sputum Culture Collected: 11/19/21 2348 Order Status: Completed Specimen: Body Fluid from Sputum Updated: 11/22/21 1009 Bacterial culture, sputum Normal Upper Respiratory Flora, no MRSA or Pseudomonas aeruginosa isolated Gram stain Moderate WBCs Few Gram Positive Cocci Narrative: Specimen received in container for artificial airway collection.
CDC Split Type:

Write-up: Patient currently inpatient at (7) days starting at 11/19/2021. Patient is a 71 y.o. female past medical history chronic obstructive pulmonary disease, hypertension, MVP, obesity class 3, prior PE and 2010 who presents today with shortness of breath. Patient intubated and sedated upon initial evaluation history obtained from emergency department note and discussion with NOK. Patient''s son reports symptom onset Monday/Tuesday (11/15 or 11/16) with severe headache different than usual headache. She had no symptoms of shortness of breath. She was evaluated in Hospital ER and had a negative CT head and serum studies. She was placed on Carbamazepine and discharged home. She developed shortness of breath and lethargy over past few days. Son reports patient used nebulizer treatments at home give history of COPD. EMS was called and noted patient hypoxic and placed on CPAP with improvement of O2 sats to 80%. In the Emergency Department, patient arrived on NIPPV which was started in route by EMS. COVID-19 PCR positive, initial ABG with acidemia. ED physician had discussion of with patient''s son who was agreeable with patient being intubated. Electrocardiogram with sinus tachycardia no acute ischemic changes. Patient was intubated and placed on propofol drip. CVC was placed. Chest x-ray with bilateral infiltrates suggestive COVID-19 and adequate RIJ CVC placement. Serum studies with renal failure. She was administered IV fluid resuscitation. Emergency department physician discussed with MICU who advised further fluid resuscitation as well as lactic acid evaluation but there were no indications for transfer at that time. UA with evidence of urinary tract infection was started on IV antibiotics. Admitted initially at another facility but given oliguria and worsening pH, transferred for possible CRRT.


VAERS ID: 1901873 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-02
Onset:2021-11-18
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 50mq qd Lisinopril 10mg qd Melatonin 10mg qd Viibryd 40mg qd Ferrous Sulfate 325mg qd
Current Illness: None
Preexisting Conditions: Hypertension Depression GERD Anemia
Allergies: None
Diagnostic Lab Data: PCP 11/19/21 ear exam, normal Dentist 11/24/21- oral exam, normal ENT scheduled for 12/16
CDC Split Type:

Write-up: Tinnitus bilateral ears, constant ringing, higher pitched in right ear. Saw PCP, Dentist, ENT, Audiologist all tes


VAERS ID: 1901895 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-07
Onset:2021-11-18
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Acute respiratory failure, Alanine aminotransferase normal, Angiogram pulmonary normal, Anion gap, Arteriosclerosis coronary artery, Aspartate aminotransferase normal, Atelectasis, Bacterial test, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bone demineralisation, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cholelithiasis, Condition aggravated, Cough, Fibrin D dimer increased, Gallbladder enlargement, Glomerular filtration rate normal, Gram stain, Granuloma, Haematocrit normal, Haemoglobin normal, Hepatic atrophy, Hiatus hernia, Kidney small, Kyphosis, Leukocytosis, Lung opacity, Mean cell volume normal, Murphy's sign test, Platelet count normal, Pneumonia, Procalcitonin increased, Protein total normal, Red blood cell count normal, Renal atrophy, Respiratory disorder, Scan with contrast abnormal, Sputum culture, Thyroid atrophy, Ultrasound abdomen abnormal, Wheezing, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (narrow), Other ischaemic heart disease (narrow), Osteoporosis/osteopenia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet ipratropium-albuterol (DUO-NEB) 0.5-2.5 (3) MG/3ML nebulizer solution levothyroxine (SYNTHROID) 88 MCG tablet multivitamin with mineral (THERA M PLUS) tablet Naphazoline-Glycerin (CLEAR EYES REDNESS
Current Illness:
Preexisting Conditions: CAP (community acquired pneumonia) Circulatory Essential hypertension, benign Endocrine/Metabolic Mixed hyperlipidemia Immune Sepsis with acute organ dysfunction Other Pre-operative cardiovascular examination Nonspecific
Allergies: Hmg-coa-r Inhibitors
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time US RIGHT UPPER QUADRANT Resulted: 11/18/21 0854 Order Status: Completed Updated: 11/18/21 0856 Narrative: EXAMINATION: Right Upper Quadrant Abdomen Ultrasound EXAM DATE: 11/18/2021 8:37 AM TECHNIQUE: Ultrasound of the abdomen right upper quadrant. INDICATION: RUQ pain earlier in the day, leukocytosis, cholelithiasis, known COVID COMPARISON: None _________________________ FINDINGS: Liver: Liver measures just slightly small at 11.5 cm. The liver parenchyma is difficult to characterize given the limitations of this exam as the patient was scanned sitting up right, there was rim shadowing and bowel gas overlying the liver, the patient had a persistent cough and the patient had difficulty holding breath at satisfactory times during the exam. Gallbladder: There are several calculi layering within the gallbladder. Gallbladder wall thickening. No pericholecystic fluid collection. Sonographic Murphy sign was negative. Common Bile Duct: The common duct measures 3.3 mm. There is no intrahepatic or extrahepatic bile duct dilatation. Pancreas: Poorly visualized due to overlying bowel gas. Right Kidney: The right kidney measures slightly small at 8.7 cm in craniocaudad length. Other Findings: No ascites. Vascular imaging: Not performed. _________________________ Impression: 1. Cholelithiasis without sonographic evidence of acute cholecystitis. 2. The liver measures just slightly small otherwise the liver is difficult to evaluate on this exam for the above reasons. 3. Mildly atrophic right kidney. CT ANGIO THORAX WITH IV CONTRAST Resulted: 11/18/21 0631 Order Status: Completed Updated: 11/18/21 0633 Narrative: EXAMINATION: CT Angiography of the Thorax EXAM DATE: 11/18/2021 6:03 AM TECHNIQUE: Standard protocol CT angiogram images were obtained through the chest following the administration of intravenous contrast. Coronal and sagittal MIP 3-D reformations were performed. CONTRAST: The amount and type of contrast are recorded in the medical record. QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: PE suspected, low/intermediate prob, positive D-dimer. COMPARISON: Single view chest radiograph 11/16/2021 and CT chest 1/16/2019 ENCOUNTER: Not applicable ____________________ FINDINGS: Base of Neck & Axillae: Status post left thyroid lobe resection. Atrophic appearing right lobe of the thyroid. No mass or adenopathy. Mediastinum & Hila: There is no mediastinal or hilar lymph node enlargement. Interval slight increase in a large hiatal hernia relative to 2019. No evidence of obstruction or volvulus of the herniated segment. Cardiovascular: Heart size and pericardium are within normal limits. Similar mild coronary artery calcifications. The thoracic aorta is not aneurysmal and there is no dissection. There is no evidence for right heart strain. Pulmonary Arteries: Short segments of the basilar pulmonary arterial tree are blurred by motion. However no large or central pulmonary embolus and I see no convincing evidence of sizable peripheral basilar PE. Lungs & Airways: Patent tracheobronchial tree without bronchiectasis. Similar appearance to a somewhat angular area of opacity of the left lower lobe adjacent to the hiatal hernia compatible with chronic compressive atelectasis. No other areas of definite significant opacity allowing for motion blurring. Similar granulomatous findings. Pleural Space: There are no pleural effusions. There is no pneumothorax. Upper Abdomen: Cholelithiasis again noted without evidence of cholecystitis along the visualized segments. Chest Wall & Musculoskeletal: Visualized soft tissues are intact. Bones are demineralized but no interval acute or suspicious findings. Slight progression of senile kyphosis. ____________________ Impression: 1. Slightly motion degraded examination at the bases but no large or central pulmonary embolus and I see no convincing evidence of sizable peripheral basilar PE. 2. Similar appearance to a zone of consolidative opacity of the left lower lobe adjacent to a large hiatal hernia and suspect chronic atelectasis. No definite acute cardiopulmonary process identified. 3. Cholelithiasis without CT evidence of acute cholecystitis along the visualized segments. Procedure Component Value Ref Range Date/Time Sputum Culture Collected: 11/19/21 1709 Order Status: Completed Specimen: Body Fluid from Sputum Updated: 11/20/21 1542 Bacterial culture, sputum See Comment Gram stain -- Comment: Microscopic examination shows epithelial cells indicating oropharyngeal contamination- Bacterial culture not performed. Lab Results Component Value Date WBC 16.16 (H) 11/22/2021 RBC 4.52 11/22/2021 HGB 13.4 11/22/2021 HCT 40.5 11/22/2021 MCV 89.6 11/22/2021 PLATELET 381 11/22/2021 Lab Results Component Value Date GLUCOSE 125 (H) 11/22/2021 SODIUM 142 11/22/2021 POTASSIUM 3.6 11/22/2021 CHLORIDE 106 11/22/2021 ANIONGAP 15 11/22/2021 BUN 30 (H) 11/22/2021 CREATININE 0.80 11/22/2021 CALCIUM 8.8 11/22/2021 TOTALPROTE 6.6 11/22/2021 ALBUMIN 2.7 (L) 11/22/2021 ALKALINEPH 130 (H) 11/22/2021 AST 19 11/22/2021 ALT 18 11/22/2021 BILIRUBINT 0.3 11/22/2021 EGFR $g60 11/22/2021
CDC Split Type:

Write-up: Patient discharged after (4) day inpatient admission from 11/18-11/22/2021. Patient is a 90 y.o. female with pmhx relevant for HTN, CKD 3a, hypothyroidism, essential tremor, and GERD admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. She is vaccinated x2. Symptoms started 11/10. Received dexamethasone from 11/19, Remdesivir was declined by the patient. Is discharged without home oxygen, she has been weaned back to room air. Due to no longer requiring oxygen dexamethasone is discontinued at discharge. CT-A chest without evidence of PE. Due to worsening respiratory status relatively late in viral course and weakly elevated procalcitonin she was covered for community acquired pneumonia with ceftriaxone and doxycycline from 11/19. Will prescribe augmentin 875 mg BID for 3 more doses (tonight and tomorrow) to complete five days of therapy. Patient has been cleared from COVID isolation requirements due to time from symptom onset. Her home chronic conditions were well controlled and medications unchanged at discharge. A RUQ US was obtained on admission for concerns of abdominal pain which subsided. The imaging did demonstrate cholelithiasis without evidence of acute cholecystitis, and expectant management is indicated. She did have some wheezing on auscultation and nebulizer treatments were initiated.


VAERS ID: 1901898 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Impaired work ability, Lethargy, Lip blister, Malaise, Pain, Pyrexia, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, asa, zetia, irbesartan, loratadine, crestor, venlafaxine
Current Illness: n/a
Preexisting Conditions: OSA, essential htn, hyperlipidemia
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got booster and felt ill ill after Covid booster-started 11/18 after wednesday''s booster-had high fever, felt lethargic/blister on lips/mouth-feeling somewhat better except for mouth sores He got shot wed 3 pm, then woke next day, and temp 99. Went to work, sent home by lunch, and then not back til sat Thursday and Friday up to 102 temp. Headache/ body ache, No nausea. By sat feeling a bit better, and went to work for the tournament. The inside of his mouth is very sore , not just one sore. No rash on the body hasnt got cold sore in yrs


VAERS ID: 1901966 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-11-01
Onset:2021-11-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blepharospasm, Blood pressure increased, Headache, Lymphadenitis, Neck pain
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Hypertension (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin B-12 VitaminD
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headaches, elevated blood pressure, inflamed lymphnodes, sore neck on left side, eye twitches.


VAERS ID: 1901971 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Balance disorder, Incoherent, Memory impairment, Oral herpes, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal infections (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: LISTED ABOVE
Other Medications: Eliquis (blood thinners), Allergy Relief-D12, Melatonin, Simvastatin, Fimasteride
Current Illness:
Preexisting Conditions: Pacemaker
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Day #1 and #2: Fainting, loss of balance and incoherent. Both long term and short term memory severely. impeded. Day. #4: Cold sores appeared. 02/05/21: First shot Moderna 037K20A (same symptoms listed above) 03/05/21: Second shot Moderna 025A21A (same symptoms listed above)


VAERS ID: 1901973 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-05
Onset:2021-11-18
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog and Lantus
Current Illness:
Preexisting Conditions: Diabetes Type 1
Allergies: Seafood
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash all over the body for 7+ days


VAERS ID: 1902045 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-11-18
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/18/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 11/18/21 presents to ED for "worsening SOB and fevers". PMHx of "HTN, OSA".


VAERS ID: 1902047 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-11-18
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dysstasia, Gait inability, Hypoaesthesia, Pain, Pain in extremity, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/18/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 11/18/21 presents to EC ED for "unable to feel her legs and attempted to stand however had shooting pains in both legs and was unable to ambulate". PMHx of "asthma, Ehlers Danlos syndrome, gastroparesis, hypothyroidism, joint pain".


VAERS ID: 1902048 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-11-18
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Dyspnoea, SARS-CoV-2 test positive, Sleep apnoea syndrome
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/18/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 11/18/21 presents to local ED for "SOB and abdominal pain and distension". PMHx of "NAFLD on transplant list, ascites, hepatic encephalopathy, CAD, HTN, HLD, DM, DVT (not on thinners), OSA, GERD, anemia"


VAERS ID: 1902057 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-11-18
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/18/21 presents to EC ED for "worsening SOB". PMHx of "HTN, IDDM, CAD"


VAERS ID: 1902059 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-11-18
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea exertional, Fatigue, Malaise, SARS-CoV-2 test positive
SMQs:, Pulmonary hypertension (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 11/18/21 presents to local ED for "DOE, fatigue, malaise". PMHx of "kidney transplant 2015, IDDM, HTN"


VAERS ID: 1902064 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Frustration tolerance decreased, Headache, Joint range of motion decreased, Musculoskeletal stiffness, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: doxazosin 8mg one daily clonazepam 2mg one daily losartan 100mg one daily hydrochlorothiazide 12.5 mg one daily zyrtec allergy10 mg one daily
Current Illness: n/a
Preexisting Conditions: high blood pressure
Allergies: Vicodin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Dull headache since 11/18/2021, pain and stiffness in left side of neck leading down into left shoulder blade and then moved to lower left bottom lung region, also moved from left to right side pain and stiffness same locations just different side. Still having those issues and dull headache, mood frustration from constant dull headache and pain and stiffness in neck hard to turn or lift head without pain.


VAERS ID: 1902138 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-10-28
Onset:2021-11-18
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Echocardiogram, Laboratory test, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin derivatives
Diagnostic Lab Data: Chest X-ray, Echocardiogram, Labs Date: 11/18/21
CDC Split Type:

Write-up: Pericarditis


VAERS ID: 1902187 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330268D / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 712CA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became light-headed and unresponsive; fainted. The nurse administering the vaccines lowered her from a chair onto the floor and made sure she was still breathing. I called 911 to get an ambulance sent to our location.


VAERS ID: 1902254 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-11-18
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrioventricular block second degree, Cardiac pacemaker insertion, Cardiac stress test, Chest X-ray, Computerised tomogram, Electrocardiogram, Electroencephalogram
SMQs:, Conduction defects (narrow), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: EKG, chest x rays, CT scan, EEG exam, stress test all completed between 11/19 and 11/21/21
CDC Split Type:

Write-up: I was hospitalized on 11/18 with a ?2nd degree AV block? that led to a pacemaker being implanted on 11/21/21


VAERS ID: 1902690 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-28
Onset:2021-11-18
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ER visit on 11/21/21 Physician on duty diagnosis
CDC Split Type:

Write-up: Bells Palsey 11/18/21 thru present Eye not closing, half smile , facial paralysis


VAERS ID: 1902842 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-11
Onset:2021-11-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Menstrual cycle started one week after injection, experience 5-10 blood clots larger than the size of a quarter


VAERS ID: 1903318 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: gave a Moderna COVID-19 vaccine to a 17 year old; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a Moderna COVID-19 vaccine to a 17 year old) in a 17-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 067F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Nov-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a Moderna COVID-19 vaccine to a 17 year old). On 18-Nov-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (gave a Moderna COVID-19 vaccine to a 17 year old) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was provided. No treatment information was provided.


VAERS ID: 1903320 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Doses administered between 12-24 hours post puncture; many people received a dose from a vial that was left at room temperature,; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered between 12-24 hours post puncture) and PRODUCT STORAGE ERROR (many people received a dose from a vial that was left at room temperature,) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 065F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered between 12-24 hours post puncture) and PRODUCT STORAGE ERROR (many people received a dose from a vial that was left at room temperature,). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered between 12-24 hours post puncture) and PRODUCT STORAGE ERROR (many people received a dose from a vial that was left at room temperature,) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications provided No treatment medications provided Most recent FOLLOW-UP information incorporated above includes: On 23-Nov-2021: Non-Significant Follow up received on 23-nov-2021 and reporters email id and fax number updated


VAERS ID: 1903563 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a 90-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant and Treatment medications were not provided. This case was linked to MOD-2021-391038 (Patient Link).


VAERS ID: 1903576 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-25
Onset:2021-11-18
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fall, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: no strength to get up; so weak that when he got up to go to another room, after 3 step, collapsed.; They were very very weak; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (no strength to get up), FALL (so weak that when he got up to go to another room, after 3 step, collapsed.) and MUSCULAR WEAKNESS (They were very very weak) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 065E21A, 013A21A and 038A21A) for COVID-19 vaccination. No Medical History information was reported. On 25-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced ASTHENIA (no strength to get up), FALL (so weak that when he got up to go to another room, after 3 step, collapsed.) and MUSCULAR WEAKNESS (They were very very weak). At the time of the report, ASTHENIA (no strength to get up), FALL (so weak that when he got up to go to another room, after 3 step, collapsed.) and MUSCULAR WEAKNESS (They were very very weak) outcome was unknown. Concomitant medications was not reported. Treatment medications was not reported The patient had the Moderna booster (lot 065E21A) on 17Nov2021. On 18Nov2021, he had a situation, really scary. His legs from his waist down, they die. They were very very weak, so weak that when he got up to go to another room, after 3 steps, he collapsed. He is 6 feet and 3 inches and weigh 350 pounds. He is 75. He had no strength to get himself up. This case was linked to MOD-2021-391975 (Patient Link).


VAERS ID: 1903578 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-11-18
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acoustic stimulation tests, Deafness, Hypoacusis, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D3; PROZAC; ATORVASTATIN; METOPROLOL; LIPITOR; AMBIEN; ATIVAN; ZYRTEC ALLERGY
Current Illness: Deafness left ear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211119; Test Name: Hearing tests; Result Unstructured Data: Hearing has gone down to 50% of original
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: lost most of the hearing in my good ear/been unable to hear from her right (good) ear; people were talking and I couldn''t understand anything when people were talking, she could not understand what they were saying. The words were not clear; All of a sudden, when she got up in the morning, she couldn''t hear anything; This spontaneous case was reported by a consumer and describes the occurrence of SUDDEN HEARING LOSS (All of a sudden, when she got up in the morning, she couldn''t hear anything) and DEAFNESS (lost most of the hearing in my good ear/been unable to hear from her right (good) ear) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 091D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Deafness left ear. Concomitant products included COLECALCIFEROL (VITAMIN D3), FLUOXETINE HYDROCHLORIDE (PROZAC), ATORVASTATIN, METOPROLOL, ATORVASTATIN CALCIUM (LIPITOR), ZOLPIDEM TARTRATE (AMBIEN), LORAZEPAM (ATIVAN) and CETIRIZINE HYDROCHLORIDE (ZYRTEC ALLERGY) for an unknown indication. On 25-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced SUDDEN HEARING LOSS (All of a sudden, when she got up in the morning, she couldn''t hear anything) (seriousness criterion medically significant) and HYPOACUSIS (people were talking and I couldn''t understand anything when people were talking, she could not understand what they were saying. The words were not clear). On an unknown date, the patient experienced DEAFNESS (lost most of the hearing in my good ear/been unable to hear from her right (good) ear) (seriousness criterion medically significant). At the time of the report, SUDDEN HEARING LOSS (All of a sudden, when she got up in the morning, she couldn''t hear anything), DEAFNESS (lost most of the hearing in my good ear/been unable to hear from her right (good) ear) and HYPOACUSIS (people were talking and I couldn''t understand anything when people were talking, she could not understand what they were saying. The words were not clear) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Nov-2021, Acoustic stimulation tests: hearing has gone down to 50% of original (abnormal) Hearing has gone down to 50% of original. No treatment information was reported. Company comment: This case concerns a 78 year old female with relevant medical history of Deafness in the left ear, who experienced Serious ( medically significant ) unexpected events of Sudden hearing Loss , Deafness and non-serious unexpected event of hypoacusis which occurred 25 days after vaccination with the 3rd dose ( booster dose) of mRNA-1273 vaccine ( Moderna Covid 19 Vaccine). Acoustic stimulation test was done which showed that the hearing went down by 50% in the right ear. The re-challenge for this case is not applicable since the events outcome were reported as unknown and the events reported occurred on the 3rd dose ( booster dose ) and no additional doses will be given. The age of the patient and the condition of hearing loss in the L ear is a confounder for this case . ( elderly patients are prone to hearing loss as a result of aging) . The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns a 78 year old female with relevant medical history of Deafness in the left ear, who experienced Serious ( medically significant ) unexpected events of Sudden hearing Loss , Deafness and non-serious unexpected event of hypoacusis which occurred 25 days after vaccination with the 3rd dose ( booster dose) of mRNA-1273 vaccine ( Moderna Covid 19 Vaccine). Acoustic stimulation test was done which showed that the hearing went down by 50% in the right ear. The re-challenge for this case is not applicable since the events outcome were reported as unknown and the events reported occurred on the 3rd dose ( booster dose ) and no additional doses will be given. The age of the patient and the condition of hearing loss in the L ear is a confounder for this case . ( elderly patients are prone to hearing loss as a result of aging) . The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.


VAERS ID: 1903580 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: booster dose given instead of 1st dose; This spontaneous case was reported by a nurse and describes the occurrence of INCORRECT DOSE ADMINISTERED (booster dose given instead of 1st dose) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 ml. On 18-Nov-2021, the patient experienced INCORRECT DOSE ADMINISTERED (booster dose given instead of 1st dose). On 18-Nov-2021, INCORRECT DOSE ADMINISTERED (booster dose given instead of 1st dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient was administered with 0.25ml of booster dose instead of 0.5ml of first dose of Moderna COVID-19 Vaccine. Concomitant medications were not provided. Treatment information was not provided.


VAERS ID: 1903584 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chills, Decreased appetite, Fatigue, Myalgia, Pyrexia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Heart disorder
Preexisting Conditions: Medical History/Concurrent Conditions: Heart attack
Allergies:
Diagnostic Lab Data: Test Date: 20211118; Test Name: Body temperature; Result Unstructured Data: 101.4�F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: kept sleeping/I slept about 12 hrs, I think; no appetite; body aches/ still have body aches, but they''re half better.; real tired; chills really bad; fever of 101.4�F; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (kept sleeping/I slept about 12 hrs, I think), DECREASED APPETITE (no appetite), MYALGIA (body aches/ still have body aches, but they''re half better.), FATIGUE (real tired) and CHILLS (chills really bad) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Heart attack. Concurrent medical conditions included Heart disorder. On 17-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced SOMNOLENCE (kept sleeping/I slept about 12 hrs, I think), DECREASED APPETITE (no appetite), MYALGIA (body aches/ still have body aches, but they''re half better.), FATIGUE (real tired), CHILLS (chills really bad) and PYREXIA (fever of 101.4�F). At the time of the report, SOMNOLENCE (kept sleeping/I slept about 12 hrs, I think), DECREASED APPETITE (no appetite), FATIGUE (real tired), CHILLS (chills really bad) and PYREXIA (fever of 101.4�F) outcome was unknown and MYALGIA (body aches/ still have body aches, but they''re half better.) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Nov-2021, Body temperature: 101.4 (High) 101.4�F. No concomitant and treatment medication were reported. On18-Nov-2021, (that morning) the patient felt real tired kept sleeping. Later on the patient had a fever of 101.4�F, body aches, chills really bad and no appetite. That night, the patient slept about 12 hrs. On 19-Nov2-021, the patient still have body aches, but they''re half better. This case was linked to MOD-2021-392019 (Patient Link).


VAERS ID: 1903595 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-19
Onset:2021-11-18
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dry mouth, Heart rate, Heart rate increased, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; LOSARTAN; LAMOTRIGINE
Current Illness: Hypertension; Seizure
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211118; Test Name: Heart rate; Result Unstructured Data: Increased
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: dry mouth; throat tightening (but confirmed that breathing was not impacted, was able to drink); rapid heart rate; This spontaneous case was reported by a consumer and describes the occurrence of DRY MOUTH (dry mouth), THROAT TIGHTNESS (throat tightening (but confirmed that breathing was not impacted, was able to drink)) and HEART RATE INCREASED (rapid heart rate) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 044A21A, 040B21A and 069F21A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Seizure. Concomitant products included AMLODIPINE and LOSARTAN for Hypertension, LAMOTRIGINE for Seizure. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 18-Nov-2021, the patient experienced DRY MOUTH (dry mouth), THROAT TIGHTNESS (throat tightening (but confirmed that breathing was not impacted, was able to drink)) and HEART RATE INCREASED (rapid heart rate). At the time of the report, DRY MOUTH (dry mouth), THROAT TIGHTNESS (throat tightening (but confirmed that breathing was not impacted, was able to drink)) and HEART RATE INCREASED (rapid heart rate) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Nov-2021, Heart rate: increased (High) Increased. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment were reported. The patient experienced dry mouth, throat tightening (but confirmed that breathing was not impacted, was able to drink) and rapid heart rate. No prior similar experience as he never had vaccines previously.


VAERS ID: 1903598 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine used; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 18-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1903605 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Vaccination site induration, Vaccination site movement impairment, Vaccination site pain
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Stiff and sore right arm when lifting arm above shoulder.; sore right injection site arm after second shot/Stiff and sore right arm when lifting arm above shoulder.; Stiff and sore right arm when lifting arm above shoulder.; Inappropriate schedule of vaccine administration; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MOVEMENT IMPAIRMENT (Stiff and sore right arm when lifting arm above shoulder.), VACCINATION SITE PAIN (sore right injection site arm after second shot/Stiff and sore right arm when lifting arm above shoulder.), VACCINATION SITE INDURATION (Stiff and sore right arm when lifting arm above shoulder.) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administration) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 077C21B) for COVID-19 vaccination. Previously administered products included for an unreported indication: JANSSEN COVID-19 VACCINE (Patient received her Johnson and Johnson covid-19 vaccine for her first vaccine Arm was sore and patient had a headache. Jansen lot number 1808978 Patient had a headache the first two days after the vaccine. Patient had a sore right arm.). On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administration). On an unknown date, the patient experienced VACCINATION SITE MOVEMENT IMPAIRMENT (Stiff and sore right arm when lifting arm above shoulder.), VACCINATION SITE PAIN (sore right injection site arm after second shot/Stiff and sore right arm when lifting arm above shoulder.) and VACCINATION SITE INDURATION (Stiff and sore right arm when lifting arm above shoulder.). On 18-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administration) had resolved. At the time of the report, VACCINATION SITE MOVEMENT IMPAIRMENT (Stiff and sore right arm when lifting arm above shoulder.), VACCINATION SITE PAIN (sore right injection site arm after second shot/Stiff and sore right arm when lifting arm above shoulder.) and VACCINATION SITE INDURATION (Stiff and sore right arm when lifting arm above shoulder.) outcome was unknown. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1903606 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Received expired vaccine beyond 12 hours post puncture; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 018F21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021 at 10:00 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021 at 10:00 AM, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture). On 18-Nov-2021 at 10:00 AM, EXPIRED PRODUCT ADMINISTERED (Received expired vaccine beyond 12 hours post puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. Healthcare worker stated that 8 patients received the booster dose with an expired vial more than 12 hours post punctured. The vial was initially stored in the refrigerator on 10-Nov-2021. On 17-Nov-2021, the vial was first punctured at 12 noon. The vial did not undergo any temperature excursions.


VAERS ID: 1903610 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: a patient received a 0.25CC dose of Moderna Covid19 Vaccine as a first dose instead of a 0.5CC dose.; This spontaneous case was reported by a nurse and describes the occurrence of ACCIDENTAL UNDERDOSE (a patient received a 0.25CC dose of Moderna Covid19 Vaccine as a first dose instead of a 0.5CC dose.) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 005C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Nov-2021, the patient experienced ACCIDENTAL UNDERDOSE (a patient received a 0.25CC dose of Moderna Covid19 Vaccine as a first dose instead of a 0.5CC dose.). On 18-Nov-2021, ACCIDENTAL UNDERDOSE (a patient received a 0.25CC dose of Moderna Covid19 Vaccine as a first dose instead of a 0.5CC dose.) 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. No concomitant drug details were reported. No treatment details were reported.; Sender''s Comments: Non-serious Case


VAERS ID: 1903619 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: The syringe came apart; Some of the dose dripped down; This spontaneous case was reported by a consumer and describes the occurrence of DEVICE CONNECTION ISSUE (The syringe came apart) and UNDERDOSE (Some of the dose dripped down) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Nov-2021, the patient experienced DEVICE CONNECTION ISSUE (The syringe came apart) and UNDERDOSE (Some of the dose dripped down). On 18-Nov-2021, DEVICE CONNECTION ISSUE (The syringe came apart) and UNDERDOSE (Some of the dose dripped down) had resolved. No concomitant and treatment information were reported by the reporter. Patient got the booster dose yesterday. And while the pharmacist was administering the vaccine, the syringe came apart and some of it dripped down. Reporter did not allow further contact


VAERS ID: 1903785 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Vaccination site erythema, Vaccination site pain, Vaccination site pruritus, Vaccination site swelling, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Clotting disorder; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101646983

Write-up: Red, swollen, warm to the touch injection site; Red, swollen, warm to the touch injection site; Red, swollen, warm to the touch injection site; Injection site with pain and itching; Injection site with pain and itching; Administration date 18Nov2021; dose received =3; This is a spontaneous report from a contactable nurse. A 63-year-old non-pregnant female patient received third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 33026BD) via an unspecified route of administration in the right arm on 18Nov2021 (at the age of 63-years-old) as a single dose for COVID-19 immunisation. Medical history included clotting disorder and hypertension. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient received unspecified concomitant medications. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: GN6197) via an unspecified route of administration in the right arm on an unknown date in 08Mar2021 (at the age of 62-years-old) and also received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8727) via an unspecified route of administration in the left arm on an unknown date in 2021 (at the age of 62-years-old) as a single dose for COVID-19 immunisation. The patient previously took butorphanol tartrate (STADOL) and erythromycin (MANUFACTURER UNKNOWN) and experienced drug allergy. On 21Nov2021, the patient experienced red, swollen, warm to the touch, injection site with pain and itching. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were taken as a result of the events red, swollen, warm to the touch, injection site with pain and itching which included treatment with unspecified antihistamines, paracetamol (TYLENOL) and ibuprofen (MANUFACTURER UNKNOWN) on an unknown date in 2021. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events red, swollen, warm to the touch injection site and injection site with pain and itching was recovering at the time of this report.


VAERS ID: 1904022 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin
Current Illness: Upper respiratory cold the week prior
Preexisting Conditions: Asthma, allergies
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Widespread hives across torso, arms and upper legs


VAERS ID: 1904030 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH IH8028 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen armpit Fatigue


VAERS ID: 1904164 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8078 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acoustic stimulation tests normal, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 20mg daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: hearing test was OK.
CDC Split Type:

Write-up: tinnitus developed in one ear 4 days after the vaccination. Otherwise patient 100% healthy. Never had any hearing issues.


VAERS ID: 1904189 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Differential white blood cell count, Electrocardiogram, Full blood count, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 supplement
Current Illness: None
Preexisting Conditions: High Blood Pressure Hypercholesterolemia
Allergies: Sudaged
Diagnostic Lab Data: EKG on 11/27/2021 CBC/Differential OP 11/27/2021
CDC Split Type:

Write-up: Minor chest pains. Fluttering/pounding heart


VAERS ID: 1904338 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Extra dose administered, Pain, Pyrexia, Secretion discharge, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium 600 mg daily Guaifenesin 400 mg twice daily Omega-3 1000 mg daily Loratadine 10 mg 4 days a week Desloratadine 5 mg 3 days a week Levothyroxine 112 mcg daily Omeprazole 40 mg every other day
Current Illness: mild seasonal allergies
Preexisting Conditions: chronic sinusitis
Allergies: mild reaction to pineapple (limited mouth numbness)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster vaccination. Initially, fever and aches. Mild cough developed into upper respiratory infection 2 days after injection. Upper respiratory infection continues, with fever reaching as high as 100.3 (normal body temperature is 97.3). As of 11/28/2021, temperature ranges from .5 to 1 degree above patient normal. Prolonged cough and heavy mucus expulsion continues.


VAERS ID: 1904372 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-06
Onset:2021-11-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Impaired work ability, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medicines or prescriptions, just vitamin supplements C, D, B, tumeric
Current Illness: none - extremely heathly
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Confirmed Deep Vein Thrombosis diagnosis with ultrasound of left lower leg on 11/22/21 around 2:00pm.
CDC Split Type:

Write-up: Diagnosed with Deep Vein Thrombosis in lower left leg. Immediately put on blood thinner medication and elevated leg, with warm compresses. Removed temporarily from work. Advised this is very serious as if blood clot gets loose it could be fatal. Treatment and outcome still in process as this is reported.


VAERS ID: 1904512 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna dose was drawn up and administered after recommended 12 hour punctured Beyond Use Date (BUD) but before recommended 24 hour room temperature unpunctured BUD.


VAERS ID: 1904520 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1904521 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-01-18
Onset:2021-11-18
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1904523 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1904525 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


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