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You are viewing patients aged: 81, in state: WI

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VAERS_IDRECVDATESTATEAGE_YRSCAGE_YRCAGE_MOSEXRPT_DATESYMPTOM_TEXTDIEDDATEDIEDL_THREATER_VISITHOSPITALHOSPDAYSX_STAYDISABLERECOVDVAX_DATEONSET_DATENUMDAYSLAB_DATAV_ADMINBYV_FUNDBYOTHER_MEDSCUR_ILLHISTORYPRIOR_VAXSPLTTYPEFORM_VERSTODAYS_DATEBIRTH_DEFECTOFC_VISITER_ED_VISITALLERGIESLink 1Link 2
093511101/11/2021WI81.081MVACCINE ADMINISTERED AROUND 11 AM. NURSE DISCOVERED A LARGE HOT RED 2 INCH PATCH ON HIS LEFT CHEEK (98.2 DEGREES). THERE WAS A OVER A DEGREE DIFFERENCE IN TEMPERATURE FROM RIGHT CHEEK TO LEFT CHEEK (97. - ISH DEGREES) THERE WAS ALSO A SMALL AREA ON THE Y01/08/202101/08/20210NONESENSUPPLEMENT SHAKE, PROHEAL PROTEIN SUPPLEMENT, HYDROCORTISONE 10MG TAB, ASA 81MG, VIT D 1000 UNIT, LEVOTHYROXINE 112MCG, METFORMEN 500MG, METOPROLOL 25MG, MULTIVITAMIN, PROTONIX 20MG,ADMITTING DIAGNOSIS WAS UNILATERAL PRIMARY OSTEOARTHRITIS OF THE RIGHT KNEEOSTEO ARTHRITIS, DEMENTIA, CONGESTIVE HEART FAILURE, TYPE 2 DIABETES, TACHYCARDIA, HYPERLIPIDEMIA, ESSENTIAL HYPERTENSION, HYPEROSMOLALITY AND HYPERNATREMIA,201/11/2021YNONE2021VAERSSYMPTOMS2021VAERSVAX
094784301/15/2021WI81.081FResident began having a general decline in condition on 1/8/21 and continued to decline until her passing on 1/10/21.N12/29/202001/08/202110SENMetoprolol, Ferrex, Hydroxychloroquine, Calcitriol, Fluticason,Loperamide, Levothyroxine, Famotdine, Amlodipine, ES Tylenol, Prednisone, Slow-MagnesiumSepsis, Chronic Kidney Disease, A-Fib, Nonrheumatic aortic val valve stenosis, Crohn's DiseaseSee above201/15/2021Penicillins, Estrogens, Estrogens, Conjugated, Codeine, Epen, Epinepherine, Raloxifene HCl, Warafrin, Hydrochlorothiazide, Lasix, Triamterene, Cephalexin, Sulfas, Azathioprine, Clarithromycin, Zolpidem Tartrate, Alendronate Sodium2021VAERSSYMPTOMS2021VAERSVAX
098035201/28/2021WI81.081MAcute pancreatitis; Acute renal failure; Low blood pressure; Weakness; Decreased appetite; Fatigue; Alanine aminotransferase increased; Aspartate aminotransferase increased; Troponin increased; Lipase increased; Blood bilirubin increased; A spontaneous repY3Y01/05/202101/08/20213Test Date: 20210111; Test Name: alanine transaminase; Result Unstructured Data: significantly elevated; Test Date: 20210111; Test Name: aspartate transaminase; Result Unstructured Data: significantly elevated; Test Date: 20210111; Test Name: bilirubin; ResUNKDementia (Advanced); Heart disease, unspecified; Living in nursing homeMedical History/Concurrent Conditions: Leukemia NOS (Possible); Pulmonary embolismUSMODERNATX, INC.MOD20210201/27/20212021VAERSSYMPTOMS2021VAERSVAX
098329401/28/2021WI81.081MPatient had full body hives starting on 1/25/2021 (mainly on arms) Hoarseness in throat and congestion Child treated with Benadryl Advised treatment from PCP was/is as of 1/28/2021 Zyrtec 10 mg AM + pepcid 20 mg AM Zyrtec 10 mg PM + pepcid 20 mg PM LY01/25/202101/25/20210nonePVTMonurol 3gm weekly (was taken the day of the vaccine), DiltiaZem 120 mg BID, Furosemide 40 mg daily, Toprol XL 100 mg 1 tablet daily, Donepezil 5mg (2 tablets nightly), Namenda, Sertraline 50 mg, Vitamin B12 500 mcg daily, Vitamin C 1000 mnoneProblem List Endocrine IFG (impaired fasting glucose) Cardiovascular Syncope Paroxysmal atrial fibrillation (*) Nonrheumatic mitral valve regurgitation Mitral regurgitation Left ventricular enlargement Left atrial enlargement History of atrial fibrillation201/28/2021Penicillin's Penicillin G Sulfa Antibiotics Heparin2021VAERSSYMPTOMS2021VAERSVAX
099878002/03/2021WI81.081Mpt states after taking the vax he woke up with headache and sinus congestion. After getting up next morning he noticed a numbness on the left side of his face, mouth and teeth. He got a tingling sensation that moved from his arm down into his thumb andY02/01/202102/02/20211nonePVTIBUnonenone202/03/2021none2021VAERSSYMPTOMS2021VAERSVAX
100284802/04/2021WI81.081FPatient reported systemic urticaria beginning approximately 5 hours following vaccination. Patient medicated with dose of diphenhydramine and symptoms abated soon thereafter with no further reported effects.Y01/27/202101/27/20210PUB202/04/20212021VAERSSYMPTOMS2021VAERSVAX
101615702/09/2021WI81.081M1/20 i was tired for about 2 hrs. 1/21 I had a little different bowel movements . about 8 days later. started to get a little wobbly getting out of chair. 3 days later i had to use a cane to get around. and then the next morning i was fine.Y01/19/202101/20/20211PVT202/09/20212021VAERSSYMPTOMS2021VAERSVAX
102738602/12/2021WI81.081Fpatient started to experience uncontrollable twitching of arms and legs and severe flushing of face aprox 15 minutes after vaccine administrationU02/12/202102/12/20210none knownPHMCoumadin,losartan,amlodipinenoneHBPTdap 10/2018 excessive swelling in arm of administration202/12/2021Ynone2021VAERSSYMPTOMS2021VAERSVAX
103295902/16/2021WI81.081FTook a Tylenol for discomfortY01/31/202101/31/20210NonePUBHydroxyzine 10mg Tylenol 500 3 x day Restasis 2xday Pain pump with dilaudid and bupivocaine Diclofenac gelBack pain202/16/2021Sulfa Emycin2021VAERSSYMPTOMS2021VAERSVAX
103628102/17/2021WI81.081Mfeet and lower leg became very red and very itchy in the night. by morning only toes blotchy red and itch gone.Y02/15/202102/16/20211PVTxaralto, allopurinol, vitd, calcium, multi vit, metoprilol, lysinopril, baby aspirinback painhas a pace maker, high blood pressure, back pain,gout at times,202/17/2021none2021VAERSSYMPTOMS2021VAERSVAX
104200302/19/2021WI81.081FSevere L-sided Bell's Palsy, onset 2/15/2021. . Per CDC recommendations we are reporting this to VAERS.N01/31/202102/15/202115Evaluation in ER 2/17/2021PVTamlodipine, aspirin, calcium supplement, multivitamin, Tums, vitamin-D, zincnone significantessential hypertension, GERD202/19/2021YYamoxicillin (rash of unclear severity)2021VAERSSYMPTOMS2021VAERSVAX
104625202/22/2021WI81.081FA few hours after the vaccine, came home and got a headache, then she got nausea. She went to bed, and all night and into the next day had fever/chills. She got up during the night to get some water she collapsed and could not get up as she was so weak. Y02/18/202102/18/20210None.OTHCentrum one a day.None.None.202/22/2021None.2021VAERSSYMPTOMS2021VAERSVAX
105126802/24/2021WI81.081MPossible Stroke; Increase pressure and numbness in fingers; Headache; A spontaneous report was received from a pharmacist concerning an 81-year old male patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced possible stroke, face numbYU02/02/202102/10/20218UNKXANAX; HYDROXYZINEMedical History/Concurrent Conditions: No adverse event (No reported medical history.)USMODERNATX, INC.MOD20210202/23/20212021VAERSSYMPTOMS2021VAERSVAX
105458602/25/2021WI81.081MThe patient developed sudden onset nausea, diaphoresis and hypotension and shaking. Symptoms improved with IV fluids and rest. She was hospitalized 2 days.Y2U02/03/202102/22/202119She was found to have an elevated d-dimer without pulmonary embolism or DVT identified.UNKdocusate sodium, multivitamin, paroxetine, risperidone, trazodone, albuterol, ketoconazole shampoo, psyllium wafer1. Diastolic dysfunction 2. Anxiety with depression 3. Obstructive sleep apnea 4. Major neurocognitive disorder and mood disorder with psychotic features. 5. Frontotemporal dementia, following with neurology and underwent neuro-psych evaluation in fall 201. Diastolic dysfunction 2. Anxiety with depression 3. Obstructive sleep apnea 4. Major neurocognitive disorder and mood disorder with psychotic features. 5. Frontotemporal dementia, following with neurology and underwent neuro-psych evaluation in fall 20202/25/2021doxycycline, ibuprofen, levaquin, morphine, penicillin, cephalexin, tolmetin2021VAERSSYMPTOMS2021VAERSVAX
106245703/01/2021WI81.081MPatient admitted for fatigue, dry throat, generalized weakness, dyspnea on exertion. Durion hospitalization was identified to have an acute ischemic CVA -- unclear time of symptom onset, possibly evening of 2/9 or morning of 2/10. Time course suspicious foYY3U02/02/202102/09/20217PUBacetaminophen alprazolam Execdrine Hydroxyzine ibuprofen203/01/2021NKDA2021VAERSSYMPTOMS2021VAERSVAX
106911403/03/2021WI81.081Fimmediately after vaccine injection upper body went into convulsion, uncontrolled jerking and tremor of all extremities. Difficulty BreathingN02/12/202102/12/20210EKG, Thiroid Scan, Lung X-Ray, Blood Work, Urin Test, 4 hrs Observation at this facilityPHMLosartan 50 mg, Amlodipine 2mg, Warfarin 4mg Multi Vitamin, Potassium, Fish Oil Omega 3, Vitamin D3, Glucosamine + Chondroitin Sulfate, Lutein + Zeaxanthion.chronic Afib, Ostero ArthritisHeart Arrhythmia, chronic AfibTdap203/03/2021YYSensitive to all medication, Anaphylactic Shock to Bee Sting and Penicilline in combination with Streptomicine2021VAERSSYMPTOMS2021VAERSVAX
107425803/05/2021WI81.081FPatient developed macular, erythematous, burning rash of the neck, trunk, and extremities about 10 hours after the vaccine. No urticaria. No wheezing. No oral or ocular lesions. No GI or GU symptoms. No fever. No myalgia. No fatigue.U03/04/202103/04/20210CBC, Comp Met Panel, Tryptase, ANA, C4PUBCeftin, Lopressor, Norvasc, TMP, Pravastatin, Prilosec, Vitamin C, Colace, Zyrtec, Caltrate+DUTICKD, Breast CA, GERD, OA, RLS, HTN, Hiatus Hernia203/05/2021YSulfa, Macrobid, PCN, Tramadol, Solifenacin2021VAERSSYMPTOMS2021VAERSVAX
107775803/06/2021WI81.081MPer neurology consult: "Patient was at his baseline until when he received his 2nd dose of SARS-CoV-2 vaccination. He complained of dyspnea and fear of impending doom after waking up the following morning with some disorientation. He was found to be in AYYU03/01/202103/02/20211PVT203/06/20212021VAERSSYMPTOMS2021VAERSVAX
111012603/18/2021WI81.081FPt states she received vaccine around 10am. States "it ached going in and then was ok until noon". Reports she took Ibuprofen with no effect. States left arm "ached" and rated pain 8/10 at that point. Reports she took a 45 minute nap and after waking, coulY03/09/202103/09/20210NonePUBUnknownUnknownUnknown203/18/2021None2021VAERSSYMPTOMS2021VAERSVAX
111147203/18/2021WI81.081MI?m 81 years old and had my first Moderna Covid-19 vaccination on March 4th. Within a few days I developed a continuous very high pitch ring in both ears. I had never experienced this before, and thought it would go away. Then I asked my wife why she thougN03/04/202103/06/20212NonePVTLisinopril 20mg Hydrochlorothiazide 25mg Simastatin 40 Amlodipine 10 Aspirn 81mgNoneNone203/18/2021None2021VAERSSYMPTOMS2021VAERSVAX
111852203/20/2021WI81.081FA week after the first dose, I experience Tintinis. I thought my hot water heat was amiss because I heard a gurgling sound like water rushing through the pipes. I have heard a loud rushing sound and also a sound of high frequency. The sound seem to rotaN01/30/202102/08/20219My ear doctor did not care how my Tintinis started?just that I had it.SCHLatanoprost 0.005%. Aspirin. 81 MC. 3x a week Levothyroxine 50MCG. Calcium Citrate Vitamin. 1 daily Simvastatin 10 MG. Cholecalciferol. 1 daily Timolol Maleate 0.5%. Multiple--203/20/2021YSulfa2021VAERSSYMPTOMS2021VAERSVAX
112667803/23/2021WI81.081MPatient developed COVID-19 symptoms and tested positive on 3/21/2021 after getting vaccinated on 3/20/2021. Patient has a history of COVID - he tested positive on November 16 of 2020. Patient's records also list "Acute respiratory failure with hypoxia (YU03/20/202103/21/20211UNKPrednisone, albuterol, Eliquis, atorvastatin, PriLOSECCoronary atherosclerosis,Chronic kidney disease, history of skin cancer, hypertension, DM type 2, GERD, hyperlipidemia203/23/2021Tramadol, Rosuvastatin, Penicillins, Atorvastatin2021VAERSSYMPTOMS2021VAERSVAX
113812203/26/2021WI81.081FHospitalization within 6 weeks after receiving vaccineY402/20/202103/13/202121PHM203/26/20212021VAERSSYMPTOMS2021VAERSVAX
118290704/08/2021WI81.081MSlight fever 1 point elevated. Muscle, body aches, fatigue, tiredness, slight headache, joint pain, sore Rt. arm, sore injection site. Side effects have subsided after approximately five (5) days. None of the side effects were considered severe!Y04/03/202104/04/20211NoneMILVerapamil 240mg, Omeprazole 20mg, Losartan 100mg, Pravastatin NA 40mg, Proglitazone 30mg, Levothyroxine 112mcg. Tylenol 500mg x 2, Probiotic 2 tabsSinusitisControlled type II diabetes, hypertension,204/08/2021Metformin, Lipitor2021VAERSSYMPTOMS2021VAERSVAX
119506504/11/2021WI81.081MDiagnosis - Left forehead shingles with left eye involvement Allodynia of left face and left front scalp about 4/7/21 Left eye soreness and slight redness 4/8/21 Raised red blemishes on left forehead 4/9/21N03/27/202104/07/202111NonePVTSimvastatin Lisinopril/HCTZ Testosterone Gel Imipramine Aspirin 81mg Vitamin D Multivitamin CalciumSkin cancerHypertension204/11/2021YIV Iodine - Flushing2021VAERSSYMPTOMS2021VAERSVAX
122351004/17/2021WI81.081Fpatient hospitalized secondary to fever, generalized weakness and myalgias and had a fall. she was hospitalized for 2 days.Y2Y02/15/202102/16/20211Component Latest Ref Rng & Units 2/16/2021 2/16/2021 PVTCurrent Outpatient Medications Medication Sig Dispense Refill ? ALPRAZolam (Xanax) 1 MG tablet TAKE 1 TABLET BY MOUTH AT BEDTIME AS NEEDED 44 tablet 5 ? Synthroid 50 MCG tablet Take 1 tablet by mouth daily before breakfast. 90 tablet 1 ? linonePast Medical History: Diagnosis Date ? Blind left eye ? Depression ? DJD (degenerative joint disease) of lumbar spine ? H/O cold sores ? Hypothyroid ? Low grade mucinous neoplasm of appendix 02/27/2020 ? Mass of colon 02/2020 ? Migraine ? Personal hi204/17/2021Allergies Allergen Reactions ? Sulfa Antibiotics Rash ? Augmentin [Amoclan] Gastrointestinal Intolerance ? Dilantin [Phenytoin] Rash2021VAERSSYMPTOMS2021VAERSVAX
122556604/18/2021WI81.081MPatient had a sudden change in status one week after receiving his first Moderna Covid 19 vaccine. He had sudden onset of tachypnea RR = 40/min, apparent severe pain, greatly elevated blood pressure, with normal heart rate (on beta blocker), diaphoresis. Y02/27/2021YN02/11/202102/18/20217None, due to hospice status. Received symptom management at home only.SENmetoprolol succinate, apixaban, clopidogrel, sertraline, tamsulosin, finasteride, famotidine, senna, ducolaxparonychia, dental cariesfronto-temporal dementia with motor neuron disease, ischemic cardiomyopathy, benign prostatic hypertrophy204/18/2021quinolone antibiotics2021VAERSSYMPTOMS2021VAERSVAX
123739704/21/2021WI81.081FCLIENT HURT HER ANKLE COMING OUT OF HER BED ON 4/10/21 AND DEVELOPED A BIG BRUISE, SWELLING, AND COOL TO TOUCH THAT DIDN'T HEAL AND REQUIRED A UREGENT CARE VISIT ON 4/21/21. SYMPTOMS HAVE STAYED THE SAME , NOT PROGRESSIVELY GETTING WORSE. CLIENT WENT TO 04/09/202104/10/20211ULTRASOUND AT URGENT CARE DETERMINED NO BLOOD CLOTS IN EITHER LEG PER FAMILY REPORTPUBHIGH BLOOD PRESSURE, HIGH CHOLESTEROL204/21/2021YY2021VAERSSYMPTOMS2021VAERSVAX
124305904/22/2021WI81.081MCOVID after vaccinationY02/10/202103/07/202125PVTNorco 5/325mg 1.5 tabs q6hr, PRN for pain Albuterol 90mc/inh 2 puffs inhalation QID Aspirin 81 mg Daily Atorvastatin 80mg Daily Symbicort 160/4.5 2 puffs inhalation BID bumetanide 1 mg - 2 tabs qAM and 1 tab qPM Duloxetine 90 mg daily escitChronic Liver Disease Coronary srteriosclerosis in native artery mycardial infarction Type 2 diabetes COPD Hypertension204/22/2021Ace Inhibitors Metformin2021VAERSSYMPTOMS2021VAERSVAX
128253905/03/2021WI81.081MNew onset atrial fibrillationN04/12/202104/12/20210atrial fibrillation with rapid ventricular rhythm on EKG 5/3/2021PVTalbuterol, furosemide, lisinopril, metoprolol, oxybutnin, pravastatinasthma, prostate cancer, hypertension, hyperlipidemia205/03/2021YNone2021VAERSSYMPTOMS2021VAERSVAX
129257405/06/2021WI81.081MClient was feeling generally weak, off balance and chilled starting on 5/1. Subsequently, he developed body aches and a non productive cough. He has no sore throat, chest pain, or shortness of breath. On 5/4 the client presented to the emergency departmentY03/23/202105/01/202139UNK205/06/20212021VAERSSYMPTOMS2021VAERSVAX
131421505/13/2021WI81.081FPatient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination.Y604/06/202104/14/20218OTH205/13/2021Y2021VAERSSYMPTOMS2021VAERSVAX
132369805/17/2021WI81.081FPatient received the second Pfizer vaccine 4/5/2021. On 5/6 tested positive for COVID-19. She had tested positive in January as well but is had been greater than 90 days so this is considered a new illness per CDC guidelines.Y04/05/202105/06/202131PUBUnknownUTI, anemia, new cancer dxUnknown205/17/2021Unknown2021VAERSSYMPTOMS2021VAERSVAX
145063707/06/2021WI81.081FBleeding from private area, went to walk-in clinic vitals were bad. Sent to Hospital, was kept for 7 hours. Was prescribed antibiotics. Vomiting, nauseous.N03/04/202103/07/20213None.PVTLisinopril and water pill.NoneNone.207/06/2021YCaffeine.2021VAERSSYMPTOMS2021VAERSVAX
148179107/18/2021WI81.081FMastitis in size of "egg" and "hot"; Lipoma; turned to brown like sun burn; Received antibiotics and she had harsh reaction to it; Itchy arm; "ed and itchy little dots" at the site of the injection which also relocated on her arm and turned to brown like "U05/28/2021UNKAMLODIPINE; CRESTOR; DIOVAN; HYDROCHLOROTHIAZIDE; METFORMIN; TRIAMCINOLONE; AMOXICILLIN AND CLAVUNATE POTASSIUMAllergy to antibiotic (Allergy to Erythromycin); Allergy to antibiotic (Allergy to Cefoxitin); Drug allergy (Allergy to Viax); Drug allergy (Allergy to Valdecoxib); Drug allergy (Allergy to Codeine); Drug allergy (Allergy to Celebrex); InfectionUSMODERNATX, INC.MOD20212207/15/20212021VAERSSYMPTOMS2021VAERSVAX
151992808/02/2021WI81.081MNoneY07/31/2021N07/30/202107/31/20211NoneSENAspercream, Morphine and Tramadol both PRN, Aspirin 81mg, Baza Protec Cre, Ferrous Sulfate Elx-220/5ml, Ipratropium/sol Albuter, metoprol 25mg, MI-Acid SUS, Nystatin Pow 10000, Robafen Syp 100/5ml, Milk of Mag, Isosorb Mono 30mg, OmeprazoleClosed right hip fracture Acute respiratory failureDNR Hypertension Dementia5701208/02/2021None2021VAERSSYMPTOMS2021VAERSVAX
154782908/12/2021WI81.081FThis spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (It is hot to the touch), RASH (traveled down to her arm as well), VACCINATION SITE PRURITUS (It itches), VACCINATION SITE RASH (It has a rash/ about 4U01/29/202101/29/20210UNKUSMODERNATX, INC.MOD20210208/10/20212021VAERSSYMPTOMS2021VAERSVAX
154910908/12/2021WI81.081FThe client came to the clinic and requested her "first" Pfizer vaccine and stated she did not have a vaccine card. Her electronic record was looked up, but none was found. Her last name was entered incorrectly at check-in. The client added an "e" in the spY08/11/202108/11/20210PUB208/12/20212021VAERSSYMPTOMS2021VAERSVAX
155528308/13/2021WI81.081FArm red; Arm swollen; Arm warm; This spontaneous case was reported by a consumer and describes the occurrence of INJECTION SITE ERYTHEMA (Arm red), INJECTION SITE SWELLING (Arm swollen) and INJECTION SITE WARMTH (Arm warm) in an 81-year-old female patient U01/30/202102/07/20218UNKComments: No medical history reported.USMODERNATX, INC.MOD20210208/10/20212021VAERSSYMPTOMS2021VAERSVAX
157245608/16/2021WI81FDiarrhea; Extreme Tiredness; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea) and FATIGUE (Extreme Tiredness) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no.N01/20/202101/20/20210UNKMedical History/Concurrent Conditions: No adverse event (No medical history provided)USMODERNATX, INC.MOD20210208/12/20212021VAERSSYMPTOMS2021VAERSVAX
158070708/18/2021WI81.081FDRY COUGH; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (DRY COUGH) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007M20A) for COVID-19 vaccination. The patient'sY01/27/202101/30/20213UNKMedical History/Concurrent Conditions: Arthritis; Blood pressureUSMODERNATX, INC.MOD20210208/13/20212021VAERSSYMPTOMS2021VAERSVAX
159234708/20/2021WI81.081FSymptoms started out like an allergy within a week. Extreme tired, headache, congestion and overall feeling unwell. Made a video appt. with Dr. describing sinus infection symptoms. Took antibiotic for a week, but symptoms worsened. Three weeks after the YY20YN02/06/202102/15/20219EKG Stress TestPVTBlood Pressure CholesterolCOPD High Blood Pressure High Cholesterol208/20/2021YYPenicillin2021VAERSSYMPTOMS2021VAERSVAX
160038908/21/2021WI81.081Mnausea; This spontaneous case was reported by a consumer and describes the occurrence of NAUSEA (nausea) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 001B21A and 012M20A) for COVID-19 vaccination. The patU02/13/202103/13/202128UNKMedical History/Concurrent Conditions: No adverse eventUSMODERNATX, INC.MOD20210208/17/20212021VAERSSYMPTOMS2021VAERSVAX
161236408/22/2021WI81.081MMissed 2nd shot and asking for 2nd shot which will be passed 42 days; This spontaneous case was reported by a health care professional and describes the occurrence of PRODUCT DOSE OMISSION IN ERROR (Missed 2nd shot and asking for 2nd shot which will be pasY03/11/2021UNKMedical History/Concurrent Conditions: No adverse reactionUSMODERNATX, INC.MOD20210208/17/20212021VAERSSYMPTOMS2021VAERSVAX
162684608/24/2021WI81.081FLeft Arm Had A Lump; Left Arm Was Very Itchy; Left Arm Was Red; Mastitis; Deathly Sick; Sleeping All Night; Not Eating Or Drinking A Lot; Very Dizzy; This spontaneous case was reported by a consumer and describes the occurrence of MASTITIS (Mastitis), ILLNN05/28/202106/04/20217UNKAMOXCLAV [AMOXICILLIN;CLAVULANIC ACID]; FISH OIL; TYLENOL; AMLODIPINE; CRESTOR; DIOVAN; HYDROCHLOROTHIAZIDE; METFORMIN; TRIAMCINOLONEHypertension; LipomaMedical History/Concurrent Conditions: Mastitis (breast infections infection flared up 4-jun-2021)USMODERNATX, INC.MOD20212208/16/20212021VAERSSYMPTOMS2021VAERSVAX
165597508/30/2021WI81.081MPain in left shoulder and arm terrebile pain went to clinic next day.Am on steroids but still can't raise left arm completlyN08/26/202108/26/20210On PresedonePVTMetoprol, Atrovostin, Amlodopine, Losartin, Tamsulson, Finistrade, Omperozale, IsosorbideNonegood had a by pass 7 years ago but blood pressure and cholosterel is good208/30/2021Penicellin Diclofenec2021VAERSSYMPTOMS2021VAERSVAX
166285609/01/2021WI81.081MIn August, I started feeling lethargic. I had lose of energy. I was confused at time. My wife noticed it. I went to the doctor. They did a COVID-19 test, which came out positive. They did blood work.Y02/24/202108/03/2021160COVID-19 test blood workPVTvsafe209/01/2021Ybees2021VAERSSYMPTOMS2021VAERSVAX
170014709/15/2021WI81.081FPresented on the evening of 8/28/2021 following a fall with bilateral leg pain as well as weakness and deconditioning. She was also noted to be bradycardic with heart rates in the 50s. Unfortunately her COVID-19 PCR test on 8/31/21 came back positive. TY15Y04/09/202108/31/2021144PVTCOPD, chronic respiratory failure on 3 L at night, paroxysmal atrial flutter, CAD209/15/20212021VAERSSYMPTOMS2021VAERSVAX
171532509/20/2021WI81.081FModerna COVID-19 Vaccine EUA - On Sept.15, I was given the injection, and felt nothing! No needle pick, nothing. Felt fine the rest of the night. Got up twice during the night to use the bathroom and get a drink of water, as I read to stay HYDRATED! AwoY09/15/202109/16/20211NonePVTI took 300mg Imatinib Mesylate that morning. At noon I took 600 mg Caltrate + D3, one Perservision tablet, and 1 - 1200mg fish oil with 360 mg Omega-3.Just seasonal allergies and I took Zyrtek, when needed for that, but rarely. I didn't take any the day of my Moderna vaccination.I have leukemia - Chronic Myeloid Leukemia (CML)2nd shot of Moderna on 3/10/2021209/20/2021None2021VAERSSYMPTOMS2021VAERSVAX
172664109/23/2021WI81.081MPatient contracted COVID after being fully vaccinatedY04/09/202107/21/2021103PVTacetaminophen, albuterol, budesonide, Calcium-vitamin D, diltiazem, formoterol, furosemide, guaifenesin, magnesium oxide, menthol topical, metoprolol, multivitamin, Fish oil, ondansetron, miralax, potassium chloride, prednisone, rivaroxabancoronary atherosclerosis, hypertension, hyperlipidemia, asthma, atrial fibrillation, heart failure, emphysema209/23/2021No known allergies2021VAERSSYMPTOMS2021VAERSVAX
172747309/23/2021WI81.081MPatient recieved first COVID vaccine dose 2/9 and second dose 3/9/2021. COVID positive: 9/20/2021 HOSPITAL COURSE: Patient admitted under observational status for generalized weakness, lethargy, increased confusion and inability to be cared for at home Y102/09/202109/20/2021223UNK209/23/20212021VAERSSYMPTOMS2021VAERSVAX
174086109/28/2021WI81.081FExtreme knee joint pain that began a few hours after her Covid vaccine in January and again in February with her second injection. Patient states that she started having the severe leg pain and cramps a few hours after her first and then her second Covid vYN01/25/202102/15/202121NonePVTShe does not take any daily medications they are all as needed.hyperlipidemia209/28/2021Statins2021VAERSSYMPTOMS2021VAERSVAX
175330510/01/2021WI81.081FPatient states that after receiving the 3rd dose Booster Pfizer 09/29/2021, started experiencing symptoms 10/01/2021 of rash across the back and abdominal area. Primary communications 10/01/2021 suggested self-treating with Benadryl. No other symptoms noteN09/29/202110/01/20212N/A.PHMN/AN/AN/A210/01/2021YN/A2021VAERSSYMPTOMS2021VAERSVAX
178818910/15/2021WI81.081MPatient scheduled for 3 dose of Moderna vaccine which was given by nursing staff. Patient did not present proof of first 2 doses. After administration of Moderna vaccine, it was discovered that first 2 doses were PfizerU10/15/202110/15/20210PVTalbuterol inhaler, arformoterol, benadryl, gabapentin, glipizide XL, duoneb, metformin, triamcinolone creamnonediabetes mellitus, neuropathy, COPD, hyperlipidemia, cognitive impairment, obesity, Stage 3a chronic kidney disease210/15/2021aspirin2021VAERSSYMPTOMS2021VAERSVAX
181522510/25/2021WI81.081FPatient contracted COVID after being fully vaccinated Shortness of breath and cough02/26/202110/25/202124110/25/2021: BMP, CCBC, Blood gas venous, BNP, Troponin Chest XrayPVTacetaminophen 500mg q6hr prn for pain albuterol q4hr prn for cough ascorbic acid 500mg daily atorvastatin 10mg HS buspirone 15mg TID calcium carbonate 600mg daily cholecalciferol 1000IU daily Codeine-guaifenesin 5mL q6hr prn for cough and cNone documentedHyperreactive airway disease, hypertension disorder, hyperlipidemia, peripheral neuropathy, type II diabetes, diverticular disease of large intestine, centriacinar emphysema, chronic diastolic heart failure, iron deficiency anemia, longstanding persistent 210/25/2021YACE inhibitors - Cough Hyzaar - Hypokalemia2021VAERSSYMPTOMS2021VAERSVAX
181730510/26/2021WI81.081FPatient got first dose of the Moderna vaccine and second dose of the Pfizer vaccine; This spontaneous case was reported by a consumer and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Patient got first dose of the Moderna vaccine and second Y02/24/202103/17/202121UNKVITAMIN D3; VIT CAcid reflux (esophageal); Blood pressure high; MSUSMODERNATX, INC.MOD20213210/25/20212021VAERSSYMPTOMS2021VAERSVAX
182871010/29/2021WI81.081MPatient hospitalized. On 10/27, patient was diagnosed with COVID-19 at his nursing home where he has been residing since discharge from the hospital in September after being treated for pneumonia with sepsis. Patient was vaccinated with Moderna on 2/9/2YN03/16/202110/28/2021226Vital stable, afebrile, initially on room air though eventually requiring 2 L Relevant Labs: Electrolytes within normal limits, CRP 5.9, D-dimer 3763, lactate 1.2, procalcitonin 0.51 CT scan with large, cumulative right pleural effusion, associated comprePVTunknownUnknownESRD on dialysis, anemia associated with CKD, hypertension, multiple myeloma, osteoporosis with back pain due to spinal compression fractures, OSA on CPAP210/29/2021Hydralazine Sulfa (sulfonamide Antibiotics)2021VAERSSYMPTOMS2021VAERSVAX
183701011/02/2021WI81.081MReceived Moderna vaccines on 2/17/21, 3/17/21. Tested positive for COVID 19 by PCR on 10/29/21. admitted to Hospital on 10/29/21 w/ SOB, hypoxia, pneumonia. Underlying obesity BMI 54. Started on Remdesivir, dexamethasone. Currently on ventilatorY03/17/202110/29/2021226UNK211/02/20212021VAERSSYMPTOMS2021VAERSVAX
184282011/04/2021WI81.081MPatient is a 82 y.o. left-handed male with hx of Afib on Eliquis, DM, HLD, HTN admitted after being found to be COVID positive and recent symptoms of diarrhea, malaise. Stroke activated due to aphasia, dysarthria of onset approximately 1415; patient was reY102/13/202111/01/2021261UNKfinasteride, omeprazole, omeprazole, sertraline, tamsulosin211/04/2021Zomepirac, Azithromycin, Metformin2021VAERSSYMPTOMS2021VAERSVAX
186076411/11/2021WI81.081FFatigue and gastro-intestinal (diarrhea)N11/09/202111/10/20211N.A.PHMvitaminsNoneNone211/11/2021none2021VAERSSYMPTOMS2021VAERSVAX