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From the 11/12/2021 release of VAERS data:

Found 875,292 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 10 out of 8,753

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VAERS ID: 1861130 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Head titubation, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient stated "I think I''m gonna pass out" 1 minute after Janssen COVID19 vaccine injection. Pt sitting down, fainted with head drop x 10 seconds. Raised up head and opened eyes after 10 seconds, was fully responsive. Noticed to be diaphoretic and flushed face that lasted for about 5 minutes. Vital signs remained normal throughout. After 5 minutes, diaphoresis and face flushing resolved completely. After 20 mins of observation, pt was able to drive home safely.


VAERS ID: 1861152 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Extra dose administered, Feeling abnormal, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: Same: Pfizer BioNtech 1&2; both during 4/21
Other Medications: None
Current Illness: Hemochromatosis
Preexisting Conditions: Hemochromatosis
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Booster reactions: Covid-like symptoms: Fever, chills, body aches, loss of apetite, "brain-fog."


VAERS ID: 1861161 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-27
Onset:2021-11-09
   Days after vaccination:286
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Ageusia, Anaemia, Angiogram cerebral abnormal, Anion gap, Anosmia, Anticoagulant therapy, Anticoagulation drug level, Arteriogram carotid abnormal, Blood albumin decreased, Blood calcium decreased, Blood creatine normal, Blood glucose normal, Blood lactic acid normal, Brain natriuretic peptide increased, COVID-19, Cerebral artery stenosis, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Cough, Differential white blood cell count abnormal, Drug level, Dyspnoea, Electrocardiogram T wave abnormal, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Headache, Hemiparesis, Hypoaesthesia, Hypoxia, Infarction, International normalised ratio increased, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin decreased, Metabolic function test, Monocyte count increased, Monocyte percentage increased, Neurological symptom, Oropharyngeal pain, Paraesthesia, Perfusion brain scan normal, Platelet count decreased, Productive cough, Prohormone brain natriuretic peptide, Prothrombin time prolonged, Pulmonary oedema, Pyrexia, QRS axis abnormal, SARS-CoV-2 test positive, Scan with contrast abnormal, Scan with contrast normal, Sinus rhythm, Slow speech, Urine analysis, Vertebrobasilar insufficiency, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet amitriptyline (ELAVIL) 10 MG tablet ascorbic acid (VITAMIN C) 250 MG tablet aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 80 MG tablet cetirizine (ZYRTEC ALLERGY) 10 MG tablet Dextrom
Current Illness:
Preexisting Conditions: Non-Hospital Central sleep apnea Stroke Deep vein thrombosis (DVT) Essential hypertension Dyslipidemia PFO (patent foramen ovale) Atrial fibrillation Hypersomnia Diarrhea GERD (gastroesophageal reflux disease) Headache Seizure Imbalance Medication overuse headache OSA (obstructive sleep apnea) Insomnia Allergic rhinitis Menorrhagia with regular cycle Morbid obesity Chest pain At risk for falls At risk of decubitus ulcer Depression Disorder of thyroid Hyperlipidemia Memory impairment Migraine headache Pulmonary embolism Coronary artery disease involving native coronary artery of native heart without angina pectoris
Allergies: Cephalexin [Cephalosporins] Keflex Macrobid [Nitrofuran Derivatives] Morphine Seasonal
Diagnostic Lab Data: WORK UP: Labs: Labs Reviewed COVID-19 PCR - Abnormal; Notable for the following components: Result Value Ref Range Status COVID-19 PCR Detected (*) Not Detected Final Comment: COVID-19 (SARS-CoV-2) RT-PCR test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. See website for additional information. This test was performed at Laboratory, a certified Facility. All other components within normal limits COMPLETE BLOOD COUNT (CBC) W/DIFFERENTIAL - Abnormal; Notable for the following components: Hemoglobin 11.8 (*) 12.0 - 16.0 g/dL Final Hematocrit 36.8 (*) 37.0 - 47.0 % Final Mean Cell Hemoglobin 26.5 (*) 27.0 - 33.0 pg Final Platelet 134 (*) 140 - 400 x10*3/uL Final Lymphocyte Automated 12.2 (*) 20.0 - 50.0 % Final Monocytes Automated 17.2 (*) 2.0 - 12.0 % Final Lymphocyte Absolute Count 0.86 (*) 1.00 - 4.00 x10*3/uL Final Monocyte Absolute Count 1.21 (*) 0.00 - 0.90 x10*3/uL Final All other components within normal limits COMPREHENSIVE METABOLIC PANEL - Abnormal; Notable for the following components: Anion Gap 8 (*) 9 - 18 mmol/L Final Glucose Level 138 (*) 70 - 99 mg/dL Final Calcium Level Total 8.1 (*) 8.6 - 10.4 mg/dL Final Albumin Level 3.1 (*) 3.5 - 5.0 g/dL Final All other components within normal limits PROTIME-INR - Abnormal; Notable for the following components: Prothrombin Time 13.0 (*) 9.7 - 12.6 second(s) Final INR 1.3 (*) 0.9 - 1.2 Ratio Final Comment: Low intensity anticoagulation therapeutic range: 2.0-3.0 High intensity anticoagulation therapeutic range: 2.5-3.5 INR value is clinically relevant ONLY when patient is on warfarin. All other components within normal limits APTT - Normal LEVETIRACETAM LEVEL - Normal PRO B NATRIURETIC PEPTIDE BLOOD LVL - Normal POCT GLUCOSE NOVA METER AUTO - Normal Narrative: Operator: POCT ISTAT LACTATE CARTRIDGE VENOUS - Normal Narrative: Operator: POCT ISTAT CREA CARTRIDGE - Normal Narrative: Operator: URINALYSIS Imaging: DR CHEST 2 VIEWS FRONTAL AND LATERAL Final Result Imaging findings suggestive of pulmonary edema, however a early infection isn''t excluded. CT PERFUSION BRAIN WITH IV CONTRAST STROKE CODE Final Result No CT perfusion evidence of infarct core or critical hypoperfusion. CT ANGIO HEAD NECK WITH IV CONTRAST STROKE CODE Final Result 1. No significant change from prior CT angiogram of 7/16/2021. Specifically, there is no new intracranial large vessel occlusion. 2. Again noted is severe chronic stenosis of the left middle cerebral artery proximal M1 segment, moderate stenosis of the distal right middle cerebral artery M1 segment, and small caliber posterior circulation. 3. No high-grade stenosis of the cervical carotid or vertebral arteries. CT HEAD WITHOUT IV CONTRAST STROKE CODE Final Result 1. No acute intracranial abnormality. Specifically, no acute intracranial hemorrhage and no CT evidence of acute transcortical infarct. 2. Multifocal sites of chronic infarction, as detailed above. The above impression points were discussed with Dr. by Dr. on 11/9/2021 at 12:25 PM. IR CONSULT TO INTERVENTIONAL RADIOLOGY (Results Pending) Procedures EKG: ECG performed for the indication of possible cva. Rhythm: Normal sinus rhythm Rate: 70 Left axis deviation. Non-specific T wave changes Electronically Signed By: DO 11/09/21 1512 Electronically signed by DO at 11/9/2021 3:12 PM ED to Hosp-Admission (Current) on 11/9/2021 ED to Hosp-Admission (Current) on 11/9/2021
CDC Split Type:

Write-up: Patient is a 57 y.o. woman with PMH significant for paroxysmal AFib on Xarelto, sick sinus syndrome, diastolic congestive heart failure, history of CVA with residual left-sided weakness obstructive sleep apnea on CPAP and seizure disorder presented to emergency department for right-sided weakness, tingling numbness and slow speech. According to patient she started having symptoms yesterday evening. Also she was having cough with expectoration and shortness of breath, sore throat, headache, loss of sensation of taste and smell and fever on Monday. Given the symptoms she presented to emergency department for further evaluation. In emergency department she were tested positive for COVID-19. CT imaging of head, angiogram of head and neck showed chronic findings. Neurology evaluated patient and recommended to rule out acute stroke. At the time of interview patient is complaining of right-sided weakness, slowing of speech, shortness of breath, cough, on and off fever, loss of sensation of taste and smell, soreness in throat and headache. Patient seen evaluated. Presents for today(11-9-21) for evaluation of stroke-like symptoms. Took upon presentation to the bedside code stroke was activated. Patient is still having some symptoms however symptoms are not quite focal. As last well known is 1800 yesterday and is well as her being on anticoagulation she is not a candidate for tPA. CT head shows no acute CVA. There are multiple focal sites of chronic infarction. CT perfusion reveals no evidence of infarct core critical hypoperfusion. CT angiogram head neck shows no new intracranial large vessel occlusion. There is severe chronic stenosis of the left middle cerebral artery proximal M1 segment and moderate stenosis of the distal right middle cerebral artery. Complete blood count reveals normal white count. Hemoglobin mildly anemic 11.8. Platelet count 134. COVID screen is positive. Patient was hypoxic initially 87% upon my arrival to the room when she 1st presented. She did require 2 L supplemental oxygen. She was started on Decadron 6 mg. Chest x-ray did show possible of point vascular congestion versus early infection. BNP only 799. She remained stable condition saturating well on 2 L at this time no acute respiratory distress. She will be admitted to the hospitalist for stroke workup along with further treatment of her COVID-19.


VAERS ID: 1861171 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Malaise
SMQs:

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 noted
Current Illness: none noted
Preexisting Conditions: none noted
Allergies: none noted
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Mother called office to report child "not feeling well". Reports child able to attend school as normal


VAERS ID: 1861176 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Lethargy, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Mild, Systemic: Diarrhea-Medium, Systemic: Exhaustion/Lethargy-Medium, Systemic: Nausea-Medium, Systemic: Weakness-Medium.


VAERS ID: 1861180 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-11-09
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Aortic arteriosclerosis, Arteriosclerosis, Asthenia, Atrophy, Bladder catheterisation, Blood creatinine increased, Blood urea increased, COVID-19, COVID-19 pneumonia, Cardiomegaly, Cerebellar infarction, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Chest discomfort, Chest pain, Chronic obstructive pulmonary disease, Computerised tomogram head normal, Confusional state, Cough, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased, Exposure to SARS-CoV-2, Extremity contracture, Fatigue, Gait disturbance, Haemoglobin decreased, Hypotension, Hypoxia, Lung opacity, Melaena, Mental status changes, Myocardial ischaemia, Paranasal cyst, Pleural effusion, Prohormone brain natriuretic peptide increased, Pulmonary vascular disorder, Pyrexia, SARS-CoV-2 test positive, Scan with contrast abnormal, Somnolence, Toxic encephalopathy, Transaminases increased, Troponin increased, Ultrasound Doppler abnormal, Unresponsive to stimuli, Urinary retention, Urine analysis, Vascular dementia, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (narrow), Ischaemic central nervous system vascular conditions (narrow), 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), Dementia (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler apixaban (ELIQUIS) 5 MG tablet cholecalciferol (VITAMIN D3) 25 MCG
Current Illness:
Preexisting Conditions: Non-Hospital Elevated prostate specific antigen (PSA) Family history of malignant neoplasm of prostate Gross hematuria Tobacco abuse CAD in native artery Cardiomyopathy, nonischemic Atrial flutter Pleural effusion AF (paroxysmal atrial fibrillation) Essential hypertension Dyslipidemia Diabetic neuropathy Balance problem PAD (peripheral artery disease) Chronic combined systolic and diastolic heart failure Ischemic ulcer of toe of right foot, limited to breakdown of skin Bladder mass--left UPJ Indirect inguinal hernia--right Type 2 diabetes mellitus with diabetic nephropathy Chronic cerebrovascular accident (CVA) Lumbar spinal stenosis
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time EJECTION FRACTION ECHO [351930270] Collected: 11/09/21 1726 Order Status: Completed Updated: 11/10/21 0723 EJECTION FRACTION ECHO 40 % CV Echo Limited with Contrast [351930256] Collected: 11/09/21 1726 Order Status: Completed Updated: 11/10/21 0723 Narrative: LIMITED ECHOCARDIOGRAPHY REPORT Study Date: 11/09/2021 DOB: 06/05/1950 Patient Class: Inpatient Gender: Male Age: 71 yrs Height: 185 cm Weight: 97 kg Resting HR: 70 BSA: 2.2 m2 Resting BP: 133/70 mmHg Reason For Study: Chest pain, nonspecific, . History/Symptoms: Covid 19,Pleural Effusion,Tobacco Abuse,Dyslipidemia,Arrhythmia (Atrial Flutter),Cardiomyopathy (not specified),Coronary artery disease,Arrhythmia (Atrial fibrillation),Hypoxia Electronically signed on 11/10/2021 07:23 AM Interpretation Summary Limited TTE: Left ventricular systolic function is mild to moderately reduced. The left ventricular ejection fraction is 40%. There is mild to moderate global hypokinesis of the left ventricle. The right ventricle is not well visualized. No significant valve dysfunction on limited interrogationg. Today''s study was compared to one performed on 06/15/2021. The LVEF was 40% on the prior report. STUDY PERFORMED/QUALITY: AORTIC VALVE: A two-dimensional transthoracic The aortic valve is not well echocardiogram with color flow and visualized. There is moderate aortic spectral flow Doppler was performed in valve sclerosis. There is no aortic limited views only. The technical valve stenosis. quality of the exam was fair. The apical views were difficult to obtain MITRAL VALVE: and are suboptimal in quality. Due to There is no mitral valve stenosis. limited acoustic windows, Definity was administered. The study was done portable in the ER. TRICUSPID VALVE: There is no tricuspid stenosis. LEFT VENTRICLE: The left ventricle is normal in size. There is normal left ventricular wall thickness. Left ventricular systolic function is mild to moderately reduced. The left ventricular ejection fraction is 40%. The LV ejection fraction was determined utilizing visual estimation. There was insufficient diastolic data to allow for diastolic function assessment. There is mild to moderate global hypokinesis of the left ventricle. LEFT ATRIUM: The left atrium is not well visualized. The interatrial septum is not well visualized. RIGHT ATRIUM: Right atrium not well visualized. RIGHT VENTRICLE: The right ventricle is not well visualized. PERICARDIUM/PLEURAL: No pericardial effusion. INFERIOR VENA CAVA: The IVC is dilated ($g2.1 cm) with normal collapse during patient sniff ($g50% collapse). The estimated RA pressure is 8 mm Hg (5-10 mm Hg)). Left Ventricle Tricuspid Valve EDV(MOD-sp4): 155.5 ml RAP systole: 15.0 mmHg ESV(MOD-sp4): 90.8 ml EDV(MOD-sp2): 156.7 ml ______________________________________________________________________________ Great Vessels IVC diam: 2.2 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 11/10/2021 07:23 AM All sources of data reside in Cardiology DR CHEST SINGLE VIEW [351835714] Resulted: 11/09/21 1416 Order Status: Completed Updated: 11/09/21 1418 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/9/2021 1:28 PM TECHNIQUE: Single view chest INDICATION: cough, cp, sob COMPARISON: 6/25/2021. ENCOUNTER: Not applicable _________________________ FINDINGS: The heart is enlarged. There is crowding of the perihilar pulmonary vasculature. Peripheral opacities, which appear overall worse compared to the prior plain film performed on 6/25/2021. Patchy left basilar opacity is noted. Probable trace left pleural effusion. No pneumothorax. Postsurgical changes from patient''s prior cardiac surgery. Atherosclerotic calcifications involving the thoracic aorta. _________________________ Impression: Worsening airspace opacities compared to the prior examination consistent with COVID 19 pneumonia. CT HEAD WITHOUT IV CONTRAST [351835713] Resulted: 11/09/21 1328 Order Status: Completed Updated: 11/09/21 1330 Narrative: EXAMINATION: CT Head without Contrast EXAM DATE: 11/9/2021 12:16 PM TECHNIQUE: Noncontrast axial CT from the skull base to the vertex with multiplanar reformats. INDICATION: Mental status change, unknown cause, altered mental status. COMPARISON: MRI 6/19/2021. HAND DOMINANCE: Unknown ENCOUNTER: Not applicable _________________________ FINDINGS: Mild generalized atrophy. Advanced chronic white matter small vessel ischemic changes. Small chronic infarctions in the left parietal lobe and left cerebellum. No evidence of acute hemorrhage, infarction, mass, hydrocephalus or herniation. Right globe lens extraction. Small mucous retention cysts in the inferior maxillary sinuses. Mastoid air cells are clear. No acute fracture. ___________________________ Impression: No acute abnormality. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture [351835725] Collected: 11/09/21 1411 Order Status: Completed Specimen: Blood, Venous Updated: 11/10/21 1501 Cult Blood Peripheral No Growth 24 hours Peripheral Blood Culture [351835726] Collected: 11/09/21 1405 Order Status: Completed Specimen: Blood, Venous Updated: 11/10/21 1501 Cult Blood Peripheral No Growth 24 hours COVID-19 PCR [351835716] (Abnormal) Collected: 11/09/21 1147 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/09/21 1250 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) RT-PCR test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms.
CDC Split Type:

Write-up: a 71 y.o. male who presents today with PMH past medical history of atrial fibrillation, coronary artery disease status post CABG, chronic systolic heart failure, urinary obstruction, type 2 diabetes, hypertension, peripheral vascular disease. Per significant other at the bedside she reports that he has more melena alert oriented times 1-2 however has been less responsive and increasingly drowsy and fatigued over the past 5-7 days. Significant other reports that he had an episode of decreased responsiveness today, was able to arouse and did not lose consciousness during this episode. Patient reports his blood pressure was low and he had a fever at home although she is unable to report the actual temperature. Patient significant other reports that he does have a sick contact their son who was recently at a religious Camp reportedly had contact with a COVID positive member and then stayed with them following the camp recently. Patient endorses cough, mild shortness of breath which was progressive. Patient also reportedly woke up with chest discomfort starting morning of admission that improved after initial fluid resuscitation in the ER. Symptoms of increased confusion appear to have started 5-7 days ago but unclear exactly when symptom onset is. Emergency department Patient hypotensive improving with some mild IVF resuscitation. Placed on 3LPM with initial hypoxemia on arrival. Labs notable for creatinine 1.78, BUN 45, mild transaminitis, initial troponin 178 downtrending to 155 with proBNP 4219, hemoglobin 12.2, urinalysis not suggestive, COVID-19 PCR positive. Patient was administered Decadron, DuoNeb and approximately 1 L in IV fluid however emergency department reports he may have gotten 1 L in transit. Acute Hypoxic Respiratory failure COVID-19 pneumonia COPD not previously on O2 -Cont decadron -Wean oxygen as tolerated -OT/PT, CM -Given unclear symptom onset and confusion will hold on remdesivir -severe respiratory precautions -x-ray imaging as noted with worsening airspace opacity AKI -baseline creat 1.0 -monitor off off diuretics, hold aditional IVF -Trend BMP following initial fluid resuscitation Chest pain, likely demand ischemia from hypotension on admission Chronic compensated systolic heart failure CAD s/p CABG Paroxysmal Afib -cont eliquis -Consult cardio, appreciate reccs -trops as noted, CP resolved in ED w/ BP improvement -Check Echo -continue metoprolol at lower dose, increased dosing as tolerated given hypotension on admission -hold lisinopril Acute on chronic Toxic Metabolic Encephalopathy Alcohol use disorder Vascular dementia (aaox1-2 at baseline) -CT head on admission negative for acute change -significant other reports he has a normally alert oriented times 1-2 but has been less responsive over the past few days but appears back to baseline in emergency department on my evaluation -continue monitor mentation however likely related to above Generalized weakness Bilateral lower extremity contractures Gait anormalities Lumbar stenosis Peripheral neuropathy Diabetic + likely ETOH PT OT, Care Management PVD Continue home medications HTN Hold home lisinopril, continue metoprolol XL a decreased dosing. Type 2 Diabetes On Basal bolus insulin.Cont lantus 20U, recently DC''d on 30U and ISS Titrate as needed. Diabetic diet. Possible urothelial neoplasm seen on CT Urinary tension -urology as an outpatient -continue 2 times a day straight catheterization with coude Inguinal hernia containing appendix -consult gen surgery-no need for surgery at this time. Dispo: To home when medically stable Diet: Diabetic VTE ppx: eliquis Code: FULL


VAERS ID: 1861184 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Malaise
SMQs:

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 noted
Current Illness: none noted
Preexisting Conditions: none noted
Allergies: none noted
Diagnostic Lab Data: none noted
CDC Split Type:

Write-up: Mother called office to report child "not feeling well" and that he was able to attend school as per normal routine


VAERS ID: 1861204 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-11-09
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Accessory spleen, Acute kidney injury, Acute respiratory failure, Angiogram pulmonary abnormal, Aortic arteriosclerosis, Aortic stenosis, Aorticopulmonary septal defect, Arteriosclerosis coronary artery, Atelectasis, Back pain, Bacterial disease carrier, Bacterial test, Blood creatine increased, Blood glucose increased, Blood potassium increased, C-reactive protein, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Coronary artery disease, Crying, Dyspnoea, Ejection fraction normal, Emotional disorder, Fibrin D dimer, Glycosylated haemoglobin, Gram stain positive, Haemolysis, Hepatic cirrhosis, Legionella test, Lung consolidation, Lung disorder, Lung infiltration, Lung opacity, Lymphadenopathy, Malaise, Metabolic function test, Mitral valve incompetence, Oxygen saturation decreased, Pleural effusion, Pneumonia, Productive cough, Pulmonary arterial hypertension, Pulmonary artery dilatation, Pulmonary oedema, Renal function test, SARS-CoV-2 test positive, Scan with contrast abnormal, Spinal fusion surgery, Spinal osteoarthritis, Sputum culture positive, Staphylococcus test positive, Streptococcus test negative, Tachycardia, Tachypnoea, Thyroid cyst, Thyroid mass, Tissue infiltration, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemolytic disorders (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Congenital, familial and genetic disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 325 MG tablet ACIDOPHILUS LACTOBACILLUS PO albuterol (PROVENTIL, VENTOLIN, PROAIR) 108 (90 Base) MCG/ACT inhaler bisacodyl (DULCOLAX) 10 MG suppository buPROPion (WELLBUTRIN SR) 100 MG 12
Current Illness: COPD
Preexisting Conditions: Non-Hospital Tobacco use GERD (gastroesophageal reflux disease) Aortic stenosis Pulmonary emphysema, unspecified emphysema type (HCC) Recurrent major depressive disorder (HCC) Psychophysiological insomnia Abdominal ascites Decompensated hepatic cirrhosis (HCC) Ascites Fall at home, initial encounter Hypophosphatemia
Allergies: PenicillinsHives Sulfa Drugs
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time CT ANGIO THORAX WITH IV CONTRAST Resulted: 11/10/21 1730 Order Status: Completed Updated: 11/10/21 1732 Narrative: EXAMINATION: CT Angiography of the Thorax EXAM DATE: 11/10/2021 4:10 PM 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: 80 mL of Isovue-370. 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: COVID 19, respiratory failure, recent back surgery. Evaluate for pulmonary embolism. COMPARISON: Chest radiograph performed November 9, 2021, CT thorax performed September 26, 2021, CTA thorax performed July 5, 2020. ENCOUNTER: Not applicable. ____________________ FINDINGS: Base of Neck & Axillae: There are small cysts and/or nodules in both lobes of the thyroid gland that are nonspecific. There are no enlarged mediastinal lymph nodes. Mediastinum & Hila: There is a borderline enlarged lymph node in the lateral aspect of the aortic pulmonic window that has a short axis measurement of 11 mm. There is a slightly enlarged lymph node in the subcarinal space that has a short axis dimension of 12 mm. There is no significant hilar adenopathy. Cardiovascular: Heart size is borderline to mildly enlarged. There is no pericardial effusion. There is no evidence of right heart strain. There is moderate calcific coronary artery disease. The patient is status post CABG. The thoracic aorta is mild to moderately atherosclerotic with no aneurysm or dissection. Pulmonary Arteries: There is fair opacification of the pulmonary arteries. The arteries in the lower lung zones are degraded by streak artifact from the patient''s metallic spinal fusion hardware. Given this limitation, no evidence of pulmonary embolism. The main pulmonary artery is dilated at 35 mm suggesting a degree of pulmonary artery hypertension. Lungs & Airways: The trachea and central bronchi are patent. There is no significant bronchial wall thickening. There are areas of patchy and confluence groundglass opacity throughout both upper lobes intermixed with areas of airspace disease. There is groundglass opacity in the right middle lobe. There is fairly diffuse heterogeneously dense airspace disease in both lower lobes probably representing a combination of extensive pneumonia and atelectasis. The appearance suggests diffuse bilateral pneumonia. The appearance is nonspecific but there are commonly reported findings associated with COVID 19 pneumonia. Pleural Space: There is no pleural effusion. There is no pneumothorax. Upper Abdomen: Nodularity along the liver margins consistent with cirrhosis. Probable large accessory spleen medial to the spleen. This was present on prior studies and appears similar. Chest Wall & Musculoskeletal: Extensive contrast infiltration of the subcutaneous fat overlying the right pectoralis muscle region. There has been instrument fusion of the lower thoracic spine. Degenerative changes of the thoracic spine are also noted. ____________________ Impression: 1. No evidence of pulmonary embolism. 2. There is extensive groundglass opacity intermixed with large areas of airspace opacity throughout both lungs as described above. The appearance suggests diffuse bilateral pneumonia. The appearance is nonspecific but there are commonly reported findings associated with COVID 19 pneumonia. More extensive airspace disease in the lower lobes may represent a superimposed bacterial pneumonia. Correlate clinically. 3. Cirrhosis. DR CHEST SINGLE VIEW Resulted: 11/09/21 1812 Order Status: Completed Updated: 11/09/21 1814 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/9/2021 5:44 PM TECHNIQUE: Single view chest INDICATION: Cough, shortness of breath COMPARISON: Chest radiograph 9/4/2021. ENCOUNTER: Not applicable _________________________ FINDINGS: Postsurgical changes of the thorax. Enlarged cardiomediastinal silhouette. Bilateral scattered pulmonary infiltrates with a left mid and lower lung consolidations. Small left pleural effusion. No pneumothorax is identified. _________________________ Impression: Cardiomegaly and small left pleural effusion. Bilateral pulmonary infiltrates predominating in the left mid and lower lung. Imaging features can be seen with COVID-19 pneumonia, though are nonspecific and can occur with a variety of infectious and noninfectious processes. Pulmonary edema is not excluded. Procedure Component Value Ref Range Date/Time Sputum Culture (Abnormal) Collected: 11/10/21 2011 Order Status: Completed Specimen: Body Fluid from Sputum Updated: 11/11/21 1257 Bacterial culture, sputum Further Incubation Required Many Staphylococcus aureus Abnormal Gram stain Moderate WBCs Many Gram Positive Cocci Few Gram Negative Rods MRSA Screen PCR (Abnormal) Collected: 11/11/21 0923 Order Status: Completed Specimen: Swabbed Collection from Nares, Bilateral Updated: 11/11/21 1222 MRSA Screen PCR Detected Abnormal Not Detected 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. Streptococcus Pneumoniae Antigen, Urine (Normal) Collected: 11/10/21 2011 Order Status: Completed Specimen: Urine, Voided Updated: 11/10/21 2210 STREPTOCOCCUS PNEUMONIAE ANTIGEN Negative Negative, Invalid Legionella Antigen, Urine (Normal) Collected: 11/10/21 2011 Order Status: Completed Specimen: Urine, clean catch Updated: 11/10/21 2210 Legionella Ag Urine Negative Negative COVID-19 PCR (Abnormal) Collected: 11/09/21 1722 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/09/21 1839 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) RT-PCR test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. See website for additional information. This test was performed at Laboratory. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional from Spectrum Health about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP). If you do not have a PCP, visit website.
CDC Split Type:

Write-up: Acute on chronic hypoxic respiratory failure Covid pneumonia Small left pleural effusion COPD Wears 1L NC at baseline, desat to the 50s at facility, requiring HFNC 95% FiO2 Covid positive here 11/9, vaccinated with Moderna x2 in the spring, Covid+ 11/2 at facility Decadron 6 mg daily (started on 11/2 at facility) CXR with cardiomegaly, small left pleural effusion, bilateral pulmonary infiltrates predominating in left mid and lower lung, can be seen with COVID-19 pneumonia, pulmonary edema not excluded Check and trend d-dimer and CRP, initial Cr 1.5 (AKI), consider VQ to evaluate for PE, unable to obtain CTA due to AKI S/p albuterol and duoneb, Continue home breathing treatments Scheduled and prn levalbuterol Encourage proning Prn mucinex (productive cough), check sputum culture AKI CXR - pulmonary edema not excluded Hold diuretics for now Diet ordered, repeat renal function in am Denies N/V/D CAD s/p CABG in 2011 HLD EF 73%, Mild aortic stenosis, trace MR Not on aspirin due to bleeding in the past per chart review Continue statin Tobacco use Previously smoking 1/2 ppd No cigarettes last 10 days NASH cirrhosis Hold spironolactone and lasix for AKI Continue cipro for ppx Depression Continue home Cymbalta and Wellbutrin Hypertension Hold diuretics for AKI, does not appear to be on any other anti-hypertensives at this time DM2 insulin-dependent with hyperglycemia Continue lantus 40 units BID + high dose corrective insulin a1c 8% Back pain S/p spinal fusion on 09/28 with Doctor, has been at SNF for rehab Gabapentin - renally dose Low dose prn oxy for severe pain - caution with respiratory failure Depression Continue home Cymbalta and Wellbutrin Insomnia Continue trazodone nightly GERD Continue PPI VTE prophylaxis Lovenox, monitor closely for any signs of bleeding Code status DNR/DNI per discussion with patient HISTORY OF PRESENT ILLNESS: Patient is a 77 y.o. male history of COPD with chronic hypoxic respiratory failure on 1 L nasal cannula at baseline, NASH cirrhosis, tobacco abuse, depression, hypertension, type 2 diabetes mellitus insulin dependent, insomnia, GERD, coronary artery disease s/p CABG in 2011 presents with chief complaint shortness of breath. He presents from rehab facility where he has been for PT/OT after a recent back surgery in September. Pt endorses SOB, cough productive of sputum, and decreased oxygen saturation. Pt states he has felt unwell for 4 days. I spoke on the phone with a nurse at his facility who states his oxygen saturation dropped as low as 50% at one point and otherwise had been in the 80s occasionally. He was Covid positive on 11/2 and started on decadron daily at that time. His oxygen had been increased as high as 5L at the facility. Pt denies f/c/s. He tells me he has been crying a lot and feels very emotional. Denies chest pain, abdominal pain, N/V, dysuria, diarrhea. States he has had a good appetite and denies swallowing difficulty. Denies feeling wheezy. Denies orthopnea. Pt arrives to ER tachycardic, tachypnea, 71% on room air, placed on HFNC 55L O2 95% FiO2. vPh 7.44. glucose 258. CXR with cardiomegaly, small left pleural effusion, bilateral pulmonary infiltrates predominating in left mid and lower lung, can be seen with COVID-19 pneumonia, pulmonary edema not excluded. Received albuterol and duoneb treatments. Admit to INPT for acute on chronic hypoxic respiratory failure in the setting of Covid pneumonia. ER also ordered 6 mg decadron. CMP then results with potassium of 6.3, and AKI with Cr 1.5 (0.7), hemolysis noted so will repeat. Repeat BMP shows improved potassium down to 5.4. calcium gluconate was ordered by ER staff as well as lokelma. A fluid bolus was ordered by ER staff but this is discontinued as there is concern some pulmonary edema could be worsening his respiratory status.


VAERS ID: 1861242 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-05
Onset:2021-11-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Communication disorder, Coordination abnormal, Dysarthria, Electric shock sensation, Facial paresis, Fall, Feeling abnormal, Hemiparesis, Hyperaesthesia, Hypoaesthesia, Lip swelling, Pain, Pain in extremity, Paraesthesia, Sensation of foreign body, Swelling face, Weight bearing difficulty
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

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: Ibuprophen Dexametasone Albuterol Montelukast
Current Illness: pcos
Preexisting Conditions: asthma
Allergies: seasonal allergies, generalized allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into legs and arms Sharp, jabbing, throbbing or burning pain Extreme sensitivity to touch Pain during activities that shouldn''t cause pain, such as pain in my feet when putting weight on them or when they''re under a blanket Lack of coordination and falling Brainfog Problems speaking or communicating Muscle weakness on right side of the face Face and lips swelling Brainzaps Feeling as if you''re wearing gloves or socks when you''re not


VAERS ID: 1861251 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, 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: buproprion magnesium asporotate trazodone
Current Illness: none
Preexisting Conditions: none
Allergies: celebrex compezine
Diagnostic Lab Data: consulted with pharmacy where I received vaccine consulted with second pharmacist who recommend event be reported.
CDC Split Type:

Write-up: large palm-sized red, swollen area at injection site. This area is very hard and warm-hot to the touch. It increased in diameter from Tuesday morning through Weds. night. Today, Thursday site is red, hot, itchy with swelling noticeable under clothing. Tylenol helps with general soreness of area. Using topical steroid to help with itching, no improvement with that.


VAERS ID: 1861253 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Feeling hot, Heart rate increased, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (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: Yes, with 1st dose of Covid-19 vaccine. Pfizer on 03/15/2021, age:47.
Other Medications: None on the day prior to vaccination.
Current Illness: No chronic illness.
Preexisting Conditions: Covid-19 in December 2020. Intermittent tachycardia at times.
Allergies: Sulfa, PCN, Ativan.
Diagnostic Lab Data: Took Atenolol 12.5 mg for tachycardia. Rapid heart rate subsided within 15 min. No EKG, went home. Took Aspirin 81 mg. Will have Holter Monitor placed.
CDC Split Type:

Write-up: Symptoms experienced within 3-5 minutes of vaccine administration: rapid heart rate of 130=140 bpm, regular rate, palpated right radial pulse. Chest heaviness, lightheaded, feeling warm. The above symptoms were experienced with the 1st dose, too.


VAERS ID: 1861256 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERFH8028 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Chills, Cognitive disorder, Headache, Insomnia, Joint range of motion decreased, Lethargy, Pain, Pyrexia, Slow speech
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix #2 6 inch of redness and itching
Other Medications: Cozaar 100mg Fish Oil 1200mg/750 Potassium Citrate 1080mg Vit D3 2000U Riboflavin 100mg Simvastatin 20mg Colace 100mg Toprol XL 50mg
Current Illness:
Preexisting Conditions: Hypertension hypercholesterol migraine Kidney stone 2009
Allergies: Sulfa serum sickness Tenormin rash Advil increases BP Macrodantin rash Dexilant severe vertigo Cipro increase BP Methocarbamol fever and chills Erythromycin spastic colon
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Unable to lift arm, Chills fever 100.5, unable to sleep , Headache Dysequilibrium, slow to answer questions, Unable to text phone #s for help, couldn''t spell properly. 11/10 lethargy , fever 101.5 . 11/11 lacking energy and body aches


VAERS ID: 1861316 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-02
Onset:2021-11-09
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inderal 10 mg oral tablet Lasix 40 mg oral tablet, 40 mg= 1 tab(s), PO (oral), qDay Procardia XL 30 mg oral tablet, extended release, 30 mg= 1 tab(s), PO (oral), qDay Vytorin 10 mg-40 mg oral tablet
Current Illness: unknown
Preexisting Conditions: HTN (hypertension) Morbid obesity Psoriasis
Allergies: NKA
Diagnostic Lab Data: Abbott rapid test
CDC Split Type:

Write-up: COVID +


VAERS ID: 1861378 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle disorder, Respiratory arrest
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscles went taut and breathing stopped. Patient placed on floor and EpiPen administered into her left leg. Emergency services called and patient cleared by them.


VAERS ID: 1861379 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, 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:

Write-up: Child in not 5 years old and was given the dose for a 5 year old. He does weigh 64 pounds. No adverse event occurred. Patient did well.


VAERS ID: 1861380 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-01
Onset:2021-11-09
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 11/9/2021
CDC Split Type:

Write-up: Client vaccinated with Moderna vaccine for Covid on 3/1 and 3/29/2021 at a CVS pharmacy. Had contact with Covid+ person on 11/4 and client tested + on 11/9. Symptoms started 11/10 - nasal congestion and low grade fever.


VAERS ID: 1861382 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-18
Onset:2021-11-09
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, 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:

Write-up: Patient received initial dose from our facility. On date noted received a call from the local Health Department saying they were going to administer the Pfizer pediatric dose but the patient''s card said they had received an adult dose from us. After further questioning, it was determined that patient''s father had lied about his age when they received the first dose. The actual birth date was 08-18-2011. Local health dept. confiscated the first Covid card. At this time we cannot determine if the pediatric dose was given.


VAERS ID: 1861406 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ECDOH6369 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Urticaria, Vaccination site erythema, Vaccination site pruritus, Vaccination site reaction, Vaccination site swelling
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra and multivitamins
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Raised welts, redness, and severe itch appearing in at least five different spots on arm that received vaccine. Also caused pre-existing scar tissue on same arm to swell.


VAERS ID: 1861439 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: N/A
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: The age is 12 years old, and the patient was given the kids dose for ages 5-11


VAERS ID: 1861441 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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? Yes
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:
CDC Split Type:

Write-up: diarrhea, fever, lethargy going for 3 days now. Not sure if this is vaccine related or some type of gastroenteritis.


VAERS ID: 1861468 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 1 - / IM

Administered by: Senior Living       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:

Write-up: Moderna Covid Vaccine administered to wrong age group person.


VAERS ID: 1861476 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       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: Fluoxetine - 20 mg Quillichew - 20 mg Loratadine - 10 mg
Current Illness: none
Preexisting Conditions: ADHD Depressive Disorder
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pediatric patient given adult dose of Pfizer Covid vaccine


VAERS ID: 1861492 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 1 - / IM

Administered by: Senior Living       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:

Write-up: Administered Moderna Covid Vaccine to unauthorized age group.


VAERS ID: 1861511 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015F21A / 1 LA / IM

Administered by: Senior Living       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:

Write-up: Administered Moderna Vaccine to unauthorized age group.


VAERS ID: 1861514 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Photophobia
SMQs:, Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headache with photophobia and dizziness for 3 days. Still unresolved


VAERS ID: 1861517 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling in lymph nodes under left arm. Patient was advised to go to the ER by her physician.


VAERS ID: 1861540 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-07
Onset:2021-11-09
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Ear discomfort, Ear pain, Exposure to SARS-CoV-2, Headache, Nasal congestion, Pain, Pyrexia, Sinus operation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ?Anusol-HC 2.5 % Cream 1 application to affected area Rectal as needed ?Aspir-81 81 MG Tablet Delayed Release 1 tablet Orally twice a week, Notes: twice weelky ?Atenolol 25 mg Tablet 1 tablet Orally once a day ?Calcium + D 600-200
Current Illness: none
Preexisting Conditions: Hx of melanoma, Right leg, s/p excision 1998. Tobacco abuse. FCD breast. GERD. Hx of HA. High cholesterol. HTN. S/P nasal septoplasty and sinus surgery 5/2011. Chronic sinusitis.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, fever, body aches, diarrhea, ear pain, nasal congestion, post nasal drainage, ear fullness. starting 11/9/21. Husband recently tested positive for COVID


VAERS ID: 1861566 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Decreased appetite, Fatigue, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: None
Current Illness: Mild cold and mild hand-foot-mouth disease a few weeks prior to vaccination. Fully resolved with no symptoms at time of vaccination.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the morning of 11/11 (roughly 36 hours after vaccination), patient woke up and was very fatigued, complained of abdominal pain and headache and had loss of appetite. Later in the day he was nauseous and vomited. He slept most of the day. Now about 12 hours later these symptoms are improving.


VAERS ID: 1861574 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-11-09
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Osteopenia, Pain, Pyrexia, Sinus congestion, Sinus operation, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteoporosis/osteopenia (narrow), Hypersensitivity (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:
Other Medications: ?Zinc + Vitamin C ?Calcium 1 tab Oral ?Multi Vitamin - Tablet 1 tablet Orally Once a day ?Sleep Aid 25 MG Tablet 1 tablet at bedtime as needed Orally as needed, Notes: PRN Discontinued ?Vitamin B 12 1 tablet Orally once a day
Current Illness: none
Preexisting Conditions: Lumbar osteopenia 8/06, 8/08. Fibromyalgia. Dyslipidemia. Osteoarthritis - hands, neck. GERD.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, cough, fever with temp last night 101 F, body aches, sinus congestion, post nasal drainage, sneezing. starting on 11/9/21


VAERS ID: 1861580 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. After 2 days, patient presented intermittent diarrhea and headache.


VAERS ID: 1861581 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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: No
Current Illness: No
Preexisting Conditions: No
Allergies: Eggs peanuts
Diagnostic Lab Data: Saw primary physician for physical to make sure ok
CDC Split Type:

Write-up: There was no adverse event however a 5 yo received a shot for 12 and over. According to protocol vaers needs to be notified


VAERS ID: 1861598 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic valve incompetence, Borrelia test negative, Cardiac valve disease, Cardiogenic shock, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased, Hypotension, Left ventricular dysfunction, Lung assist device therapy, Mitral valve incompetence, Pericardial effusion, Respiratory viral panel, SARS-CoV-2 antibody test negative, Systolic dysfunction, Tachycardia, Tricuspid valve incompetence, Viral test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, motrin, zyrtec, zofran, miralax
Current Illness: Yes, abdominal pain preceded the vaccination on 11/5 and diarrhea on 11/7. He had increased fatigue/lethargy prior to receiving the vaccine.
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: Initial TTE - 11/10/21 Summary * Structurally normal heart. * Moderate tricuspid regurgitation. * Moderate mitral regurgitation. * Normal RV pressures based on TR jet velocity and septal contour. * Normal LV size and wall thickness though moderately depressed systolic function (mmode SF 26%, mmode EF 49%, 2D EF 42%, Bullet EF 42%). * Trivial pericardial effusion posteriorly, along RV free wall. Echo 11/11/21 - Summary * Patient with history of ECMO placement (November 10, 2021). Transesophageal echocardiogram to evaluate ECMO cannulae. * Globally qualitatively severely depressed biventricular systolic function. * Aortic cannula tip is in mid ascending aorta. * Trivial+ aortic insufficiency. * Moderate mitral valve regurgitation from central coaptation defect. * Venous cannula tip in the RA and IVC junction. 11/10/21 - SARS-CoV-2 antibodies negative; Respiratory panel negative; Lyme screen negative
CDC Split Type:

Write-up: About 3 hours after receiving the vaccine, he presented in cardiogenic shock with tachycardia and hypotension. He was found to have severe LV dysfunction and is currently on ECMO. I would like to stress that he did have symptoms preceding receiving the vaccine, but felt that given the clinical decompensation that it should be reported and investigated.


VAERS ID: 1861608 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Fatigue, Headache, Influenza like illness, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Tendinopathies and ligament disorders (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: Moderna 2nd dose, 3/29/21, age 65. Same adverse event as previously described
Other Medications: Levothyroxine .088mcg Alendronate 70mg Calcium citrate 900 mg Vitamin D 1500 IU Zinc 7 mg Copper .75 mg Manganese 2 mg
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Ampicillin Nickel
Diagnostic Lab Data: None
CDC Split Type:

Write-up: As with 2nd dose, the day of was fine, following day horrible. Could not stand because of extreme dizziness. Fainted both for 2nd and 3rd doses. Lasted all day. Second day like having mild flu. Third day better, still some arm pain, fatigue, headache.


VAERS ID: 1861609 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-22
Onset:2021-11-09
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Rash, Rash erythematous, Skin disorder, Skin warm
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dupuytren''s disease
Preexisting Conditions: Asthma
Allergies: Penicillin, Z-pak, Erythromycin
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: After the second Moderna vaccine, I developed a rash on my back. Seven months later, it is still there. A few days ago, I started to get bright red hot spots on my head, ear, neck and then it moved to my flank. It started first with a feeling of being bit, like a bug bite. I sought medical attention with another dermatologist. She agreed this was from the vaccine. She said she has seen other patients with similar skin issues/rashes. She prescribed OTC allergy medicine and topical lotion.


VAERS ID: 1861614 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Flushing, Hyperhidrosis, Loss of consciousness, Posture abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 2 minutes after injection of Janssen COVID19 vaccine, pt stated "I think I''m gonna pass out."Pt slowly dropped head down with eyes closed, lasted for 10 seconds. During this times, HR was 80''s sp02 98%. He regained consciousness after 10 seconds and was fully alert. He was noted to be diaphoretic and had flushed skin. This lasted for the next 5 minutes. After monitoring for 15-20 minutes, pt symptoms resolved spontaneously and was able to drive home safely. Followed up with pt a day later, pt stated he feels "good" but remembers having chest heaviness the morning after clinic visit that lasted for 3 hours. Pt instructed to f/u with PCP as soon as possible for further evaluation. Pt denied CP, SOB, dizziness, headache, rashes, abdominal pain.


VAERS ID: 1861649 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Delirium, Fatigue, Headache, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: following the second dose in May, 2021, but not as bad
Other Medications: Verapimil and Lozaratan
Current Illness: n/a
Preexisting Conditions: High blood pressure
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue, extreme body aches, fever (102.5-100.5) and chills (the shaking from chills was not a good match with the body aches), intense headaches when coughing or bending over, delirious night. I have gone through 4 childbirths and this was worse! It has been almost 48 hours since the side effects began and I am only now starting to feel a bit better.


VAERS ID: 1861651 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F63527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: swollen lymph nodes under armpit


VAERS ID: 1861812 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dysphagia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Synthroid, Zetia, cortisone, Hydrochlorothiazide, Pepcid, Losartan, Neurontin
Current Illness: No
Preexisting Conditions: Cancer
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: 80-year-old female receives her first dose of Pfizer at 5:30pm. After completing her 30 minute''s in the observation area the paramedic approaches to ask her how she feels or if she has itching and she refers to feeling difficulty swallowing. Patient was taken to the observation area and incidents in a wheelchair to take vital signs which were: 130.80 mmHg, Sat.99% with clear lungs on auscultation,19 breaths, no upper airway edema and respiratory stridor. The case was consulted with Doctor at 6:17pm which indicated administering 4 mg of Dexamethasone IM in the buttock left upper outer. The patient was kept under observation and after 30 minutes she indicated that she was not felt the aforementioned symptoms. Before being discharged, her vitals were taken again which were: 130/80mmHg, 19 breaths with clear lungs on auscultation, no upper airway edema, 83 with a strong and regular pulse.


VAERS ID: 1861830 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Fatigue, Feeding disorder, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Both Medea a injections now. Second so much worse
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever is currently at 102. Exhausted. Can eat due to stomach cramps


VAERS ID: 1861878 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA BOOSTER / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Coordination abnormal, Dizziness, Dizziness postural, Feeling abnormal, Feeling cold, Headache, Hypersomnia, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: Pantoprazole
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my Moderna booster Tuesday around 11 am. Fine during the day. Around 8 pm I started to have chills and kept getting more and more; headache came on around 10 pm. Went to bed at 11 freezing; couldn?t get warm. Woke sometime during the night to go the bathroom; still freezing. When I got up I was very dizzy and felt I was going to faint. I laid on the foot of our bed and can?t say for sure if I passed out. I was still very light-headed when I woke at 7 (Wednesday, 10th) and felt faint if I tried to get up. Chills were a lot less. No headache. By 9 I got out of bed, slight chills but not feeling faint. Just felt out of it. Spent the day on the couch sleeping almost all of it. Tried to make coffee around 10 and instead of pouring water in the pot I poured it on the counter. Looked at it and left it. Around 6pm I was feeling better with no more chills. Thursday (11th) I noticed my left underarm/armpit is very sore. Feel fine otherwise.


VAERS ID: 1862108 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lymphadenitis, Nausea, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (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: Swollen arm and/ armpit
Other Medications: Lisinipril Escalitapram Vitamin d Vitamin c Fish oil Claritin d
Current Illness: Sinusitis
Preexisting Conditions: Arthritis (hips) Fibromyalgia
Allergies: Penicillin Bactrim Sulphur drugs
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Swollen arm Swollen armpit Fatigue Nausea


VAERS ID: 1862116 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Headache, Lymphadenopathy, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Obesity
Allergies: Allergy - Ceftin(antibiotic)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever - 38.6C for 48 hours, headache, chills, swollen glands on side shot was administered, red welt at site of shot


VAERS ID: 1862358 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experiences redness and swollen arm with bruising.


VAERS ID: 1862390 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213021A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Blood test, Nausea, Pyrexia, Urine analysis, X-ray
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, chlorhexidine, simvastatin, Metropropol, Omeprazole, metformin, Victoza, duloxetine, montelukast, zinc, Allegra, guaifenesin, aspirin, melatonin, probiotic, D?, apple cider with B12, multiple vitamin
Current Illness: MS, Diabetes
Preexisting Conditions: MS, Diabetes, hypertension
Allergies: Tetanus, sulfa, penicillin, spinach
Diagnostic Lab Data: 11/10/2021 battery of blood work, urine sample, x-ray
CDC Split Type:

Write-up: 104 fever, nausea, BP 160/98, heart rate 98, Oxygen 90, blood sugar 258


VAERS ID: 1862526 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Somnambulism
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular 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:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None so far if I''m dizy again tonight we''ll be going
CDC Split Type:

Write-up: For my 1st and 2nd shot I had absolutely No Shire affected it all. Is on Tuesday the 9th my wife and I both got Is our 3rd shot. Both nights I was very dizzy and tell several times something I have never done in my entire life and last night I believe I was sleepwalking is sleepwalking and almost a 100% about the The sleep walking. Is my wife also God is shot at the same time and also I''m still dizzy. I figured it was important to let you know about thow about this is definitely weird for the both of us do you need any other information or my records give me a call and you can have whatever you need but I just got my physical about a month ago which included an echo cardio Graham and everything so I have a pretty good Update records that may possibly help you but you can have anything you want or don''t care


VAERS ID: 1862535 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-29
Onset:2021-11-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / N/A RA / SYR

Administered by: Unknown       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3 acid 1gm capsule Flaxseed oil 1200mg Lisinopril 5mg tab
Current Illness:
Preexisting Conditions: Chronic kidney disease
Allergies: Year round allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Recurring urticaria body wide


VAERS ID: 1862539 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site mass, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: Same adverse event with second dose of covid vaccine in January 2020
Other Medications: Vitamin D 25000 units once weekly Vitamin B12 intramuscular 1X monthly (last dose prior to covid booster was more than month before)
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lump at site of injection, feels hard and warm to touch but not hot. Slightly itchy at times. This also happened with my second dose of the vaccine and did not go away for 6-8 weeks last time. Mild tenderness at site but not painful necessarily.


VAERS ID: 1863792 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, 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:

Write-up: pt rcvd adult dose of COVID-19 Pfizer vaccine. Pt was a little achy the 1st day but doing great per dad on day 2.


VAERS ID: 1863794 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-08
Onset:2021-11-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site bruising, Pain in extremity, Tremor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (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: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No medical testing or reporting occurred. Treated trembling / shaking at home as it did not continue more than the two episodes.
CDC Split Type:

Write-up: Trembling and teeth chattering like she had the chills. She reported not feeling cold, but couldn''t stop trembling for approximately 10 minutes. Kept wrapped in a blanket to keep warm and eventually the shakes stopped. The trembling happened again about 30 minutes after the first episode, for approximately 5-10 minutes again after going back to bed. They stopped and did not reoccur. No other side effects noted other than a typical sore arm after a vaccine, along with a very small bruise around the injection site. The bruise is still present.


VAERS ID: 1863379 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-09
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Body temperature increased, Chest pain, Chills, Myalgia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211109; Test Name: Body temperature; Result Unstructured Data: 99.7 F, Increased
CDC Split Type: USJNJFOC20211124913

Write-up: BLURRED VISION; CHEST PAIN/ FELT LIKE A TRUCK SITTING ON STERNUM; JOINT PAIN; CHILLS; MUSCLE PAIN; TEMPERATURE 99.7; This spontaneous report received from a consumer concerned a male of unspecified age. 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, and batch number were not reported) dose was not reported, administered on 09-NOV-2021 15:30 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 09-NOV-2021, the patient experienced chest pain/ felt like a truck sitting on sternum. On 09-NOV-2021, the patient experienced joint pain. On 09-NOV-2021, the patient experienced chills. On 09-NOV-2021, the patient experienced muscle pain. On 09-NOV-2021, the patient experienced temperature 99.7. Laboratory data included: Body temperature (NR: not provided) 99.7 F. On 10-NOV-2021, the patient experienced blurred vision. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from temperature 99.7, chills, chest pain/ felt like a truck sitting on sternum, blurred vision, muscle pain, and joint pain. This report was non-serious.


VAERS ID: 1863802 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RA / IM

Administered by: Private       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: Pt received an adult dose of Covid Pfizer vaccine. Have attempted to contact the parent x2 days to check on the patient.
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt rcvd adult dose of Covid-19 Pfizer vaccine. Unable to reach parent x 2 days. Left voicemail x2.


VAERS ID: 1863819 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-30
Onset:2021-11-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein increased, Red blood cell sedimentation rate increased, Urticaria, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, Mirena
Current Illness: none
Preexisting Conditions: migraine
Allergies: cats, grass
Diagnostic Lab Data: ESR of 22, CRP 100, WBC of 16
CDC Split Type:

Write-up: urticarial rash and polyarthralgias 11 days after vaccination


VAERS ID: 1864525 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature decreased, Burning sensation, Chills, Fear, Feeling cold, Headache, Heart rate increased, Hyperhidrosis, Hypoaesthesia, Muscle contractions involuntary, Muscle twitching, Night sweats, Pain in extremity, Palpitations, Paraesthesia, Pyrexia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), 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? No
Previous Vaccinations: Covid 19
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: PCN. Celiac disease
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 15 minutes after the first, second and third dose of the moderna vaccine I had muscle twitching and tingling in my legs. I didn?t place much thought about it the first two times and the muscle fasciculations subsided within a week. After all three doses I also had a massive headache within 2 hours of taking the vaccine. Tylenol helped the first two times, however not so much after the 3rd dose. Since the third dose I have severe muscle fasciculations in my legs and arms that persist, also with the sensation of pins and needles. Additionally, Tuesday night I woke up in a night sweat- completely soaking my bed and pjs, my heart pounding and beating so fast that I thought I was going to have to call 911. (my average heart beat is low 40) I was running a fever of 102 while taking Tylenol q/4 hrs. The night sweat occurred again Wednesday night (I never have experienced night sweats before). The fever finally broke Thursday morning. Thursday I experienced chills all day despite having no fever. I was running cold around 96. In the afternoon I was standing at my computer and my toes and feet went completely numb, with the exception of my big toe. This scared me. I have never experienced this before. I am healthy, not diabetic etc. In an effort to warm up I went for a walk to see if I would gain the feeling in my feet/toes. The was walk initially painful on my feet. Finally 40 minutes into the walk I started to regain the feeling in my toes. They burned and tingled. Today, Friday morning I am reporting this as I did not sleep once again last night due to severe muscle fasciculations and tingling which is now also in my arms and hands.


VAERS ID: 1864527 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-09
Onset:2021-11-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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:

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1858181 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-10-20
Onset:2021-11-09
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: None, perfectly healthy
Current Illness: No illnesses, did have an ultrasound in April for pain in the right side of my uterus but never heard back results
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got my period 2 weeks early and started it by peeing out dried blood clots. After about an hour, I started my normal period cycle but it was extremely heavy and significantly more painful than usual. I''m now on my second day and my period is still heavier than it normally is, I''m going through Super tampons that normally last me 8 hours in 4


VAERS ID: 1850017 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type: 051f21a

Write-up: muscle aches in back and legs, headache, nausea, and lightheadedness


VAERS ID: 1850093 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular 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: Amlodipine Alprazolam as needed
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vertigo


VAERS ID: 1850180 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-31
Onset:2021-11-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Irregular period. Was having period when received the Covid vaccine. Period ended at normal time. Got period again 5 days later.


VAERS ID: 1850352 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C12A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
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: Nothing reported at the time of visit
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No adverse reaction at the time of injection. After given injection it was noted the patient only being 17 years old.


VAERS ID: 1850410 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-04
Onset:2021-11-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Incorrect route of product administration, Injection site bruising, Mobility decreased, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (broad), Drug abuse and dependence (broad), Tendinopathies and ligament disorders (broad), 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: No prescriptions supplements- probiotic, she is vegetarian, B12 complex, flonaz, vitamin D
Current Illness: no
Preexisting Conditions: nope
Allergies: macrodantin 40 years ago px for bladder infection
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nurse administered vaccine too high per patient. Says the moderna gave her a headache for a few hours within a few hours. However, within 2 hours from vaccination she had extreme pain, some bruising at injection site, difficult to lift arm up, was taking ibuprofen q 4 hours for pain. Wonders if nurse hit a nerve bundle. Is getting better now. Advised to be seen by a doctor. Doesn''t know if she will as it is getting better but her objective is education for this nurse on location of vaccine administration. She had received flu vaccine ~4 days prior.


VAERS ID: 1850443 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Adverse reaction, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram normal, Impaired work ability, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: ECG Portable
CDC Split Type:

Write-up: Pt is a 22 yo M who was getting second dose of Moderna vaccine. Afterward pt started to feel mildly itchy, lightheaded, and had some chest tightness and mild SOB. SpO2 was 97%, and HR was 88. Pt had not issues with the first vaccine. Evaluated pt in the Immunizations clinic. Do not believe that pt is having an anaphylactic reaction to the vaccine, however, may be having some kind of adverse reaction. ECG was normal and shows no signs of myocarditis. However, myocarditis can present itself 1-2 weeks after the vaccine. Told pt to go to ED if sx significantly worsen and that he can take some time off from work. When he returns to work he should be on LD until his sx completely resolve. Told pt to return to the clinic if they do not.


VAERS ID: 1850449 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2020-12-28
Onset:2021-11-08
   Days after vaccination:315
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L02A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L02A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/8/21 tested positive for covid on binax rapid antigen test
CDC Split Type:

Write-up: developed symptoms including sneeze, cough, stuff nose 11/8/2021 and tested positive for covid


VAERS ID: 1850511 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-15
Onset:2021-11-08
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had breakthrough covid infection


VAERS ID: 1850512 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Immunodeficiency, Laboratory test, Lymphadenopathy, Pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Test results revealed swollen lymph nodes, diagnosed with Lymphadenopathy
CDC Split Type:

Write-up: Following the shot , I had aches in body and pain in chest on left side


VAERS ID: 1850538 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Ear pain, Erythema, Injection site erythema, Injection site mass, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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:
Other Medications: Zyrtec for seasonal allergies
Current Illness: had COVID-19 around October 8th (one month prior)
Preexisting Conditions: unknown
Allergies: seasonal allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received 1st Moderna vaccine on Thursday afternoon. On Friday night, patient noticed redness and swelling at the injection site in left arm. On Saturday morning, noticed increased redness. By Saturday night, swelling had also increased to a golf ball-sized mass. Patient also began to experience itching in various spots on body (spot on wrist, multiple spots on legs, top of head), as well as pain in ears and joint pain. On Sunday night, took Benadryl which helped relieve itching somewhat. Informed the pharmacy that performed vaccination on Monday morning.


VAERS ID: 1850548 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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: Resulted from second dose on Feb 2021, and now from booster that was given on 11/6/2021. Vaccine was Moderna
Other Medications: Metformin, losartan
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left eye has blurred vision


VAERS ID: 1850573 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Paranasal sinus discomfort
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am experience nasal pressure in side my nose. I experienced this with the first shot on March 13 about 30 minutes later. Today I felt the same pressure about 5 minutes after receiving my booster. I didn?t have this reaction with the second shot. The first and second shot I received in the left arm; while the booster I took in the right arm.


VAERS ID: 1850580 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Denies use
Current Illness: Denies any past medical history or illnesses
Preexisting Conditions: Denies any previous medical history
Allergies: Denies any allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had syncopal episode 5 minutes after vaccine admin while sitting in chair. Pt reports being nervous prior to vaccine administration. Bp monitored. 911 called per protocol. Pt declined EMS transport. Walking and talking when leaving clinic after being observed by nurses and EMS staff onsite.


VAERS ID: 1850596 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-11-08
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Mental status changes, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ischemic cardiomyopathy, paroxysmal afib, hypertention
Allergies:
Diagnostic Lab Data: COVID PCR + on 11/8/2021
CDC Split Type:

Write-up: COVID breakthrough case. Patient presented to the Emergency Department on 11/7/21 with altered mental status, fatigue, and fever. He tested positive for COVID on 11/8/2021.


VAERS ID: 1850603 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-01
Onset:2021-11-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling
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? 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:

Write-up: Swelling of upper lip.


VAERS ID: 1850608 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-11-08
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, COVID-19, Chills, Cough, Gait disturbance, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Albuterol (Eqv-ProAir HFA) 90 mcg/inh inhalation aerosol, 2 Puff, Inhalation, Q6H (Every 6 hours), PRN DuoNeb 0.5 mg-2.5 mg/3 mL inhalation solution, 3 mL, NEB, 4 times a day furosemide 20 mg oral tablet, 20 mg= 1 TAB, PO, Daily lisinopr
Current Illness: unknown
Preexisting Conditions: COPD Former Smoker
Allergies: Mushroom
Diagnostic Lab Data: COVID19 Rapid test positive 11/8/2021
CDC Split Type:

Write-up: Patient tested positive for COVID 19, Antigen 11/8/2021 Admitted to hospital on 11/7/2021 Complaint of gait issues for the last 2 days, weakness He also has report of temp up to 102, occasional chills, cough and congestion


VAERS ID: 1850628 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunodeficiency, Interchange of vaccine products
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: on blood thinner
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client was inadvertently given Pfizer booster vaccine and was supposed to get a Moderna booster vaccine


VAERS ID: 1850631 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site induration, Injection site mass, Injection site pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Ibuprofen and ice pack
Current Illness:
Preexisting Conditions: Asthma
Allergies: Sulfa drugs teslon pearls
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm red and itchy very hard lump at injection site


VAERS ID: 1850636 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-11-03
Onset:2021-11-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 - / -

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Night sweats, Oropharyngeal pain, Pain, Pyrexia, Streptococcal infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: c/o fatigue, body aches, chills, night sweats and sore throat. fever spiked at 104F 3 days later. diagnosed w/ strep throat 11/8/2021


VAERS ID: 1850651 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pallor, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (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: unknown
Current Illness: none disclosed
Preexisting Conditions: None
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 3 minutes of receiving the vaccine, pt projectile vomitted, we very pale. BP 90/55, HR 100, t98. Mother with patient. He slowly pinked up and seemed better. Repeat BP 110/60. Mother notified PCP. School nurse gave chewable benadryl.


VAERS ID: 1850656 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Feeling hot, Headache, Nausea
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? 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: This was an 8 year old who came thru drive thru COVID vaccination site accompanied by his father. He received Pfizer pediatric dosage in left deltoid around 915 am. While being observed in holding area, he started to state he felt warm, had headache and was nauseated. He had no other symptoms. No shortness of breath, chest pain, tingling, itching or swelling. He was not tachycardic. No diaphoresis or sweating. No hives. He was given an ice pack to his neck and observed for an additional 30 minutes. He was offered Acetominophen but his symptoms of feeling warm and headache resolved. The episode was about 10 minutes. He still had some nausea but improved significantly (50% improvement). After observation period, his father felt comfortable taking him home and observing for any worsening or recurring symptoms. He was instructed to immediately seek medical care if symptoms returned or worsened or did not resolve.


VAERS ID: 1850664 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-06
Onset:2021-11-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 100.7, chills, fatigue, sore throat onset 2 days after 1st dose


VAERS ID: 1850670 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: DAIRY, KEFLEX
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: FEVER 102, COMES DOWN WITH TYLENOL. SORE ARM


VAERS ID: 1850706 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: Flu Vaccines
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergies to flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated and informed to wait 15 minutes post vaccine prior to departing. Patient left approx. 10 minutes after vaccine was administered and walked to her vehicle. Upon arriving at vehicle, became lightheaded, had itchy arms, had a scratchy throat. Walked back to vaccination clinic and an outpatient response team was called, patient transported to ED.


VAERS ID: 1850721 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       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? Yes
Hospitalized? No
Previous Vaccinations: influenza-- by history
Other Medications: none has Epi-pen but did not deploy it.
Current Illness: none
Preexisting Conditions: history of environmental allergies
Allergies: prior adverse reactions to vaccines
Diagnostic Lab Data: none
CDC Split Type:

Write-up: transient urticaria


VAERS ID: 1850752 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 4 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
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: A booster shot administered as requested. Upon entering vaccination record, it was discovered the resident already received a booster on 10/7/2021. No adverse effects reported.


VAERS ID: 1850792 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Joint range of motion decreased
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Alprazolam Zolpidem Melatonin
Current Illness: None
Preexisting Conditions: Obesity Pre-diabetes Insomnia
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe pain and limited use of entire right arm


VAERS ID: 1850839 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient called nurse triage line, advised patient to go to emergency department to be seen.
CDC Split Type:

Write-up: shortness of breath, chest pain


VAERS ID: 1850841 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-11-08
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood magnesium, Cardiac disorder, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Glomerular filtration rate decreased, Hypokalaemia, Hyponatraemia, Laboratory test, Metabolic function test, Pain in extremity, Swelling, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (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: Estradiol vaginal cream
Current Illness: Collagenous colitis, Recurrent UTI
Preexisting Conditions: IBS
Allergies: Acetaminophen, Percocet
Diagnostic Lab Data: EKG, CMP, VAS lower extremity, CMP, troponin, CBC, magnesium, d-dimer, CXR were all done on 11/5/2021
CDC Split Type:

Write-up: The patient reported to the ER on 11/5/2021 with increasing chest pain, SOB, leg pain, and swelling. At ER she was found to have reduced cardiac conductivity, reduced GFR, hypokalemia, and hyponatremia.


VAERS ID: 1850847 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Epistaxis, Extra dose administered
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reports having a nose bleed that lasted appox. 20 minutes about an hour after getting the booster dose of Janssen.


VAERS ID: 1850870 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Severe, Additional Details: pt dizzy and fell immediately after admnistration, near fainting but responsive (talking and nodding her head) after a few seconds. raised pt''s legs above heart level as pt was laying on the floor. pt felt good enough to sit up and sit on a chair and drink some fruit juice. pt reported history of fainting to vaccines due to fright of needles/administration. advised her to call a family member to drive her home. was picked up by a family member


VAERS ID: 1850891 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: While on the bus with his father, the 8 y/o pt was given an adult dose of the Pfizer vaccine by EMT. Patient did not experience any adverse reactions, or signs / symptoms of any issues.


VAERS ID: 1850900 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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:

Write-up: Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Area up the right side of neck and face.


VAERS ID: 1850925 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 LA / IM

Administered by: School       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:

Write-up: 2nd dose of Pfizer COVID-19 vaccine administer 14 days after 1st dose not 21 days.


VAERS ID: 1850936 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-06
Onset:2021-11-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), 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? 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: patient says he had chills the night of vaccination on 11/6/2021, then vomitting several times and diarrhea, still expiriencing diarrhea


VAERS ID: 1850938 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vit d
Current Illness: anxiety
Preexisting Conditions: anxiety
Allergies: reaction to 1st dose pfizer, numbness and tingling in tongue and lips. vital signs stable. allergist suggested patient to take anti allergy prior to appt. patient denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vitals: 11/08/21 1037 11/08/21 1042 BP: (!) 155/90 125/81 Pulse: 67 66 Resp: 18 15 SpO2: 100% 100% Vital signs at 1058 BP 122/80, HR at 66, sat 99% in room air 1037 Patient c/o numbness and tingling in the lips and right fingertips. Taken to gurney. Checked vital signs. Please see vital signs. Denies pain, denies SOB, no redness, no swelling in lips, tongue or throat. No rash noted. Speaks in full sentences. No audible wheezing noted. Patient states the same thing happen on his first dose, benadryl helped per patient. 1040 bendaryl given 25mg ORAL x1 1042 patient states the numbness in the lips is going away, but numbness to fingers still present Vital signs remain stable at this time 1053 remains stable. Denies pain, denies SOB, no redness, no swelling in lips, tongue or throat. Speaks in full sentences. No audible wheezing noted. 11:00 patient states he is having chest pain. 1/10. New onset, never happened before per patient. Vital signs stable. 130/76, 64HR 100% in roomair. Afebrile. Placed in 2LNC Paramedics called Taken via gurney to ER for further eval


VAERS ID: 1850949 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
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: Child was giving the adult dosage of 0.3mL, was monitored with no adverse effects


VAERS ID: 1850950 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient''s mother falsefied DOB on consent form. Correct DOB of patient is unspecified (4 years old). DOB provided on form by mother was unspecified. Patient was not eligible for vaccine due to age but received the first dose of pfizer as a 4 year old. Discovery of error was made while billing vaccine administration fee after vaccine given. Mother admitted to falsifying DOB on consent form. As of 3 hours after administration, no adverse events have occured.


VAERS ID: 1850963 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hyperhidrosis, Hypoaesthesia oral, Lip swelling, Nausea, Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 01/24/21. 03/01/21
Other Medications: Aspirin 81 mg daily Atorvistatin Lipitor 40 mg daily Alendronate Fosomax 70 mg weekly-sun Fluticasone Arnuity 1 puff daily Gabapentin Neurontin 300 mg lunch & HS HCTZ Hydrodiuril 12.5 mg daily (am) Irbesa
Current Illness: dog bite-l hand and r thigh-6 open puncture wounds, topical ABX coverage. AND oral ABX-amoxicillin. tetanus vaccine 11/06/21
Preexisting Conditions: osteopenia hypertension hypercholesteremia skin cancer-basal, squamous, and EARLY STAGE MELANOMA vocal cord atrophy dysphonia hiatal herrnia right eye uveitis autoimmune retinopathy-right eye high myopiaa degenerative disk disease interstitial lung disease/fibrosis-autoimmune component bilat pulm nodules stable RUL granuloma nephrolithiasis hypercalcinuria hypocitranuria
Allergies: crab dorsemide lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: lips/tongue numb, tingly, swollen dyspnea diaphoretic slight nausea after leaving clinic MJCH LESS INTENSE THAN PREVIOUS TWO REACTIONS


VAERS ID: 1850970 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), 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? No
Previous Vaccinations:
Other Medications: none
Current Illness: noon
Preexisting Conditions: obesity
Allergies: allergic to bee and ant venom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very sore at injection site this morning. Took extended relief Tylenol 650mg. Starting to have numb feeling and some tingling in fingers after morning of typing. Going to a break from the keyboard and put some ice on the injection spot. Remove watch.


VAERS ID: 1850972 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       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:
Current Illness: Breast Cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient candidate to receive full dose as a moderna vaccine due to chemotherapy, received booster half dose initially. Patient was notified and agreed to additional half dose to make full dose.


VAERS ID: 1850994 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-11-08
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 80 mg oral tablet, 80 mg= 1 tab(s), PO (oral), qDay calcium citrate, 250 mg, PO (oral), qDay Ceftin 500 mg oral tablet, 500 mg= 1 tab(s), PO (oral), bid Centrum Silver Combigan ophthalmic solution, 1 drop(s), Eye(s) Affecte
Current Illness: unknown
Preexisting Conditions: Acute subdural hematoma Fall Hyponatremia
Allergies: NKA
Diagnostic Lab Data: Home COVID rapid test.
CDC Split Type:

Write-up: Shortness of breath tested positive for covid 19


VAERS ID: 1851016 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Differential white blood cell count, Dizziness, Electrocardiogram, Flushing, Full blood count, Heart rate increased, Hypertension, Immunodeficiency, Metabolic function test, Tachycardia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Vestibular disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Liptor 10 mg daily
Current Illness: none
Preexisting Conditions: High cholesterol
Allergies: sulfa, topical neomycin, kiwi, cats
Diagnostic Lab Data: Labs sent- CBC/diff, metabolic panel, and troponin (all WNL) EKG X 2 (first with tachycardia to 120''s, otherwise WNL, 2nd with HR 80''s, otherwise WNL. 1 Liter of LR given IV and I was observed for about 2 hours before being discharged home.
CDC Split Type:

Write-up: Within 15 minutes of receiving the vaccine, I became tachycardic to the 150''s (documented with Fitness Watch), with facial flushing and lightheadedness. No shortness of breath or difficulty swallowing. Pulse corroborated by vaccine nurse. walked over to Emergency Dept where at triage, my heart rate was 120s and I was hypertensive to 150''s/100''s. Labs sent- CBC/diff, metabolic panel, and troponin (all WNL) EKG X 2 (first with tachycardia to 120''s, otherwise WNL, 2nd with HR 80''s, otherwise WNL. 1 Liter of LR given IV and I was observed for about 2 hours before being discharged home. .


VAERS ID: 1851028 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-29
Onset:2021-11-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg oral delayed release tablet, 81 mg= 1 tab(s), PO (oral), qDay, Hold for Surgery atorvastatin 20 mg oral tablet, 20 mg= 1 tab(s), PO (oral), qDay losartan 25 mg oral tablet, 25 mg= 1 tab(s), PO (oral), qDay metFORMIN 1000
Current Illness: unknown
Preexisting Conditions: diabetes, obesity CYSTOSCOPY, HOLMIUM LASER CYSTOLITHOLAPAXY, SUPRAPUBIC CATHETER PLACEMENT 12/31/20 CYSTOSCOPY, BIPOLAR TRANSURETHRAL RESECTION PROSTATE 02/18/21
Allergies: NKA
Diagnostic Lab Data: abbott rapid test
CDC Split Type:

Write-up: covid positive


VAERS ID: 1851048 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Hyperhidrosis, Hypoaesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Medications predniSONE (DELTASONE) 20 MG tablet Take 2 tablets by mouth daily. EPINEPHrine 0.3 MG/0.3ML auto-injector Inject 0.3 mLs into the muscle 1 time as needed for Anaphylaxis. ketoconazole (NIZORAL) 2 % shampoo USE AS A FACE
Current Illness: Postoperative hypothyroidism; thyroid cancer; Fibroids, intramural
Preexisting Conditions: cancer (thyroid CA s/p thyroidectomy); uterine fibroids
Allergies: Adhesive (high); lac bovis (Nausea and vomiting); benzoin (Rash); lactose (diarrhea)
Diagnostic Lab Data: Pt sent to ER via ambulance for further evaluation.
CDC Split Type:

Write-up: Patient presented for 2nd COVID-19 Pfizer dose today. Patient was asked to stay for 30 minutes since she endorsed reaction to 1st Pfizer dose of red rash at site and some shortness of breath. Today, patient got 2nd dose and see below for chronological details. 10:30 am Pfizer dose given 10:40 am Pt c/o feeling trouble breathing, throat tightness, numb fingers and weakness. Patient seated and monitored while team got RN. 10:42 am Pt c/o shortness of breath and diaphoretic. This RN administered Epinephrine Injection x 1 to patient''s left outer thigh and called 911 while other RN monitored patientin exam room with head of bed elevated.


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