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From the 1/21/2022 release of VAERS data:

Found 1,049,249 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 101 out of 10,493

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VAERS ID: 1997524 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chills, Injected limb mobility decreased, Injection site erythema, Injection site inflammation, Injection site swelling, Injection site warmth, Joint range of motion decreased
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Fluoxetine 20mg (generic Prozac), Atomoxetine 25mg (generic Strattera)
Current Illness: None
Preexisting Conditions: PCOS, mild asthma
Allergies: Lactose intolerance
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Skin redness, swelling, warm to the touch, approximately 2inch in diameter, with the back edge of the inflammation touching the injection site, starting approximately 8 hours after the injection, ongoing as of report. Moderate burning sensation localized in tattooed areas of skin on left shoulder-blade (back) and forearm from approximately 12 hours after injection to approximately 48 hours after injection. Inability to lift elbow above shoulder on injection arm, starting approximately 12 hours after injection, continuing to approximately 36 hours after injection. Severe chills, painful shivering, starting about 12 hours following injection, lasting for less than 2 hours. Not alarming or long-lasting enough to seek treatment. Had severe chills and arm mobility issues with the Pfizer vaccine doses in the first round, expected those symptoms, and Covid Arm is a known possible side effect. --I''m only reporting because I haven''t seen anything regarding the shot making your tattoos feel like they''re on fire.


VAERS ID: 1997537 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Headache, Lymph node pain
SMQs:, Taste and smell disorders (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: n/a
Current Illness: recovering from a lingering sinus infection; had completed a course of augmentin the week of Christmas
Preexisting Conditions: arthritis
Allergies: Sulfa
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: lymph nodes in left underarm quite tender and painful - this is the most disturbing and uncomfortable side effect bad taste in mouth (like I''ve smoked a cigar), no amount of tooth brushing will eliminate it slight headache


VAERS ID: 1997559 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1997583 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, 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: None
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left armpit lymph nodes swollen and painful


VAERS ID: 1997620 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood pressure increased, Burning sensation, Chills, Dysphagia, Influenza, Injection site swelling, Pyrexia, Sensation of foreign body, Thinking abnormal, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (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 (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (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: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 90 minutes difficulty in swallowing and a feeling of a large lump in throat, slight trembling appeared. I administered a Benadryl 25mg tablet. Few hours later severe swelling at injection site, ensuing chills and fever of 101 F. Also experienced scrambled thinking, felt unclear in thoughts for over 24 hours. Normal blood pressures of 110/70 spiked to over 155/90 and caused great concern. Administered two 325 mg Tylenol throughout New Years Day. Fever continued throughout night and today am experiencing both left and right arm as if they are burning. I am calling my primary Dr. I understand many have symptoms of flu but what I experienced was above and beyond the reactions I had after 2nd Moderna.


VAERS ID: 1997644 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR ? / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Chills, Fatigue, Headache, Heart rate increased, Injection site pain, Myalgia, Neck pain, Pain, Palpitations, Pollakiuria, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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:
Other Medications: Daily Vitamin, Co-Q10, Calcium, Ginko biloba, Lutein
Current Illness: None
Preexisting Conditions: Varicose veins
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest pain over heart area, pounding, fast-beating heart, pulse 101, fever 100.3, headache, fatigue, shakes, teeth chattering, muscle aches, injection site pain radiating to left side of neck,urinating every 20 minutes.


VAERS ID: 1997648 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Headache, Hyperpyrexia, Injection site rash, Interchange of vaccine products, Lymph node pain, Lymphadenopathy, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Medication errors (broad), 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: Pfizer initial vaccination in April 2021 on second dose but was less sever (fever, headache, and body aches) and only lasted ab
Other Medications: Metoprolol Tartrate 25mg
Current Illness: Mild cold/sinus in early December
Preexisting Conditions: Afib in 2012 brought on by sleep apnea. Cpap machine and Metprolol corrected the problem.
Allergies: Penicillin
Diagnostic Lab Data: none - bed rest and alternated between acetaminophen and Motrin to reduce fever.
CDC Split Type:

Write-up: High Fever over 105 degrees, dizziness, headache, body aches, and rash in shot area (left shoulder) and lymph node area in armpit (left side only) and under breast (left side only). Left lymph node area in armpit area severely swollen and tender but minor swelling in lymph node area under left breast.


VAERS ID: 1997659 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Injection site warmth, Lymph node pain, Lymphadenopathy, Pyrexia, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Losartan, metropol, Fish Oil, Vitamin D, Multi vitamin,psyllium capsules, calcium,
Current Illness: None
Preexisting Conditions: High blood pressure, high triglycerides
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful, warm, Thumb size or larger Swollen lymph glands occipital region, left armpit, left side of left breast, under neck , under chin. In addition to the reaction I was expecting like painful, warm, left deltoid and severe chills with low grade fever.


VAERS ID: 1997667 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / UNK LA / IM

Administered by: Unknown       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: Arm pain, 32 years old, Moderna Vaccine 2 shot. 05/14/2021
Other Medications: Levothyroxine, B2, contraceptives pills
Current Illness:
Preexisting Conditions: Hypothyroisdms
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen armpit glads the day after took the vaccine


VAERS ID: 1997669 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling abnormal, Headache, Hyperhidrosis, Injection site pain, Insomnia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: Paxil, 30mg; 1 cannabis edible; Advil 200mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe muscle aches, chills, sweats, headache, dizziness, insomnia, brain fog, painful injection site. All symptoms hit at once, almost exactly 12 hours after injection. Symptoms then last for a few hours before relenting almost exactly 12 hours after they began, though a lingering headache, dizziness, brain fog and insomnia last for another few days.


VAERS ID: 1997674 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Poor quality sleep, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Surgical adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body rash, that moved to face 3 days after vaccine. Elevated resting heart rate at night (10 beats higher than average), restless sleep for 4 days following vaccine


VAERS ID: 1997680 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032 H 21 A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Cough, Dizziness, Dysphagia, Productive cough
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Infective pneumonia (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: Multiple vitamin, vitamin C, potassium, magnesium,
Current Illness: None
Preexisting Conditions: None recognized by a doctor difficulty breathing was once diagnosed as asthma but doctor said it is now not asthma
Allergies: Tetracycline, aspirin,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, chest tightness, heart flutters difficulty swallowing difficulty breathing coughing up phlegm dizziness occurred moments after the shot all other symptoms started after the shot and are continuing three days later


VAERS ID: 1997681 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-27
Onset:2021-12-31
   Days after vaccination:338
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM

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

Write-up: pt admit to hospital with incidental finding of COVID19 s/p 2 doses of Moderna on 12/30/20 & 1/27/21. No immunocompromised state or medications.


VAERS ID: 1997700 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Troponin increased
SMQs:, Myocardial infarction (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain and troponinemeia


VAERS ID: 1997702 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-28
Onset:2021-12-31
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 3 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elinest B12 injections
Current Illness: None
Preexisting Conditions: None
Allergies: Cipro, Keflex, ZPack, Zofran, Adderall
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus in left ear. There is no treatment. After the second dose it lasted 24 hours, and I had an ENT doctor examine my ear. He found nothing to be wrong. After the booster, third dose, it has lasted for 2 days now. Both times the tinnitus occurred approximately 4 weeks after the vaccine. I have never experienced tinnitus prior to the vaccine.


VAERS ID: 1997733 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Recently recovered from COVID
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Patient is going to contact PCP to get evaluation
CDC Split Type:

Write-up: Red dot rash around the posterior and anterior abdomen


VAERS ID: 1997734 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: received the shot and had no symptoms the first day. however the next day i did feel somewhat tired and had a red bump on my left arm and it hurt and looked like an ant bump. however later on that day i did feel as if i was being poked under my left arm and it hurt there for another 24 hours or so. I took some advil to help the pain and it did. was told that i should report that because its not part of the regular symptoms that can happen.


VAERS ID: 1997786 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary mass, Pain, Tenderness
SMQs:

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

Write-up: Woke Friday morning with large mass left armpit. About the size of a tennis ball. Sore to touch. It is now Sunday afternoon and size has started to decrease slightly. Soreness has went away. Have taken ibuprofen and staying hydrated.


VAERS ID: 1997835 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K2IA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Headache, Lethargy, Nausea, Pyrexia, Sinus congestion
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First Dose of Moderna vaccine - Severe Flu like symptoms.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: High Fever (102.5), Headache, Lethargy, Loss of Appetite, Nausea, and Sinus Congestion


VAERS ID: 1997837 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K214 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site inflammation, Injection site pain, Injection site swelling
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen, inflammation, tenderness at injection site. Swollen area is baseball size 2 days after injection.


VAERS ID: 1997847 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-17
Onset:2021-12-31
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chills, Computerised tomogram head, Differential white blood cell count, Dizziness, Electrocardiogram, Full blood count, Headache, Hypoaesthesia, Metabolic function test, Musculoskeletal pain, Myalgia, Nausea, Neck pain, Pain in extremity, Paraesthesia, Pyrexia, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Synthroid, Lisinipril, Lasix, Omeprezole, Vitamin D, Flonase, Tylenol
Current Illness: N/A
Preexisting Conditions: Hypertension, Hashimotos, Hypothyroidism, Multilevel Spondylosis, Fibromyalgia, Osteoarthritis, Anxiety
Allergies: N/A
Diagnostic Lab Data: CT scan of head EKG Chest X-ray CBC & Diff CMP panel
CDC Split Type:

Write-up: Low grade fever, chills, lightheaded, 24 hours. On day 14 awakened with vertigo, nausea, tingling sensations on right face around eye, cheek, ear and head, pain in right side head, neck, trapezius muscle,shoulder blade, right arm, numbness in right hand, right foot.


VAERS ID: 1997859 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-12-31
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic 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? No
Previous Vaccinations:
Other Medications: Birth Control Patch Buspirone
Current Illness: NKA
Preexisting Conditions: NKA
Allergies: NKA
Diagnostic Lab Data: RAPID SWAB POSITIVE 12/31/21
CDC Split Type:

Write-up: asymptomatic


VAERS ID: 1997865 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Chills, Flatulence, Headache, Insomnia, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lipodystrophy (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: Moderna vaccines 1 and 2
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, radiating over 48 hours to underside of arm, armpit and breast; fever over 101 degrees; chills; headache; body aches: mild nausea; gas; insomnia


VAERS ID: 1997901 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Fall
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Noninfectious diarrhoea (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: n/a
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient''s wife reports her husband became very weak and fell in his office and lost control of his bowels, he remained conscious thru the experience but was too weak to call out for help, the event resolved spontaneously and no follow up to primary has been planned


VAERS ID: 1997916 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hot flush, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Chills, fever, fatigue, 45, 02/21/2021, Pfizer Covid-19 vaccine
Other Medications:
Current Illness:
Preexisting Conditions: Psoriatic arthritis, fibromyalgia, Hashimoto''s thyroiditis, Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hot flashes, extreme fatigue, nausea


VAERS ID: 1997920 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-12-20
Onset:2021-12-31
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER UNKNOWN / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Mechanical urticaria, Rash, 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: Headache, Circular rash
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chronic Spontaneous Urticaria (hives) and Dermatographia Large rashes covering both thighs, and bumps in random areas on palms, soles of feet, arms, chest, back, and lower legs. Treatment with antihistamines (diphenhydramine and loratadine taken at separate times) both are effective at reducing symptoms. Patient was also tired for day following vaccination


VAERS ID: 1997950 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Headache, Influenza like illness, Musculoskeletal discomfort, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (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: As noted previous screen, after first Covid Vaccine in Spring 2021 Commonly noted achey, flulike for 24 hrs after shot
Other Medications: Norvasc, Benicar, Sythroid, Crestor, Baby ASA, Colace, Tylenol pm, Magnesium, Tumeric, CoQ10, Colace, Advil as needed
Current Illness: Back and knee orthopedic issues(mod-severe arthritis) Recent Bilateral Cortizone injections to knees
Preexisting Conditions: Hypertension, Hyperlipidemia, CAD, Hypothyroidism, Cervical Stenosis,
Allergies: none
Diagnostic Lab Data: None. Advil, hot tub rest
CDC Split Type:

Write-up: Within 12 hours of Booster, both my knees were in extreme pain (which have had zero pain since getting cortizone injections Bilaterally a month earlier) The pain seemed to "mimic" the exact pain( behind the knees) I had BEFORE injections. Lasted about 2 days and then gradually went away. The right knee has a mild discomfort that has remained. I did also have other more common expected issues including headache, general aches, flu-like again for only 24 hrs and then went away. I had these common ones with the first vaccine, BUT not the knee issue.


VAERS ID: 1997961 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth, Vaccination site reaction
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Raspberries, amoxicillan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid Arm. First 24 hours my arm didn?t really hurt. Then became red near injection site, warm to touch, firm, and itchy. So far it has been over three days.


VAERS ID: 1997963 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal dreams, Asthenia, Chills, Decreased appetite, Delirium, Dreamy state, Genital pain, Hallucination, Headache, Hyperacusis, Lethargy, Malaise, Myalgia, Pain, Pain in extremity, Pruritus, Pyrexia, Rash, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I got my second dose of the Pfizer vaccine on 05/18/21 and I was sick for 5 days with the same symptoms I experienced yesterday
Other Medications: Bupropion 150 mg
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Starting at around midnight I was feeling unwell. I got a fever by 12:45ish and had extreme chills. I took a Tylenol went to bed at 1:30am. I kept waking up in my sleep I had very strange dreams of the same dream all night. I woke up delirious. I was still experiencing chills, full body pain, pain in my genitals, fever, hallucinations, hearing voices, like being a dreamlike state without being asleep, headache, arm soreness and loss of appetite. I took more Tylenol throughout the day to help with symptoms. Next day I woke up feeling better but still very lethargic and I seem to now have this rash that keeps popping up and going away on different parts of my body. It?s like itchy little white bumps. I no longer have a fever or chills on day 2, just the rash, sore arm, muscle pains and like I have no energy at all. Still no appetite as well.


VAERS ID: 1997988 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

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

Write-up: Patient came in for Pfizer third dose booster and the nurse, confused about the Booster guider between Pfizer and Moderna , offered the patient Moderna Booster instead of Moderna. Patient is only 17 years old.


VAERS ID: 1998023 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), 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), 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? Yes
Hospitalized? No
Previous Vaccinations: Swollen lymph nodes in neck on left side
Other Medications: 5-HTP
Current Illness: Sinus infection, persistent cough (non-COVID related)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficulty swallowing and tounge swelling.


VAERS ID: 1998031 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular 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: I had a headache, lightheaded, dizzy, mild fever. 53 yrs. Old. 03/19/2021, 04/21/2021. Injection shot, Moderna-Covid.
Other Medications: Janumet XR, Atorvastatin, Advil
Current Illness: No
Preexisting Conditions: Diabetes and Bouts with Carpel Tunnel.
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: My symptoms started the day after I got the Moderna Booster shot. I woke up at 11:00 a.m. and I had been running a fever overnight so I was sweaty. But I also woke up with a bad headache and felt lightheaded and dizzy for most of the day!!! The only thing I took for it was a couple Advil. But it only lasted one day!! So on Saturday I felt better! It that was it!!


VAERS ID: 1998064 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Chest pain, Chills, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ferrous sulfate supplement
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced chest pain, especially on exertion, for 2 days after receiving COVID booster vaccination. Received vaccine on 12/30/21, adverse event began on 12/31/21, continued on 1/1/22. Less in severity on 1/1/22. Accompanied by body aches, injection site soreness and slight chills on 12/31/21. Vaccinated with Pfizer for initial series in December 2020 and January 2021 and received Moderna as booster in December 2021. 23 weeks pregnant at time of booster vaccination, estimated date of delivery April 2022. First pregnancy. Of note I am a pharmacist for a health system.


VAERS ID: 1998526 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Contusion, Insomnia, Nausea, Pain, Peripheral swelling, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid 150mg, Modafinil 200mg 2x per day
Current Illness: None
Preexisting Conditions: Hypothyroid; Hashimoto''s
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Entire upper arm swollen, hot and severe pain. I cannot sleep. Had high fever morning after. Horrible cognition the day after. Nausea still 4 days later. Pain, swelling and hot. Now bruised arm, literally.


VAERS ID: 1998649 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-16
Onset:2021-12-31
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Immunodeficiency, Intensive care, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated, not boosted. COVID infection breakthrough with inpatient hospital stay in ICU. Immunocompetent


VAERS ID: 1998827 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-17
Onset:2021-12-31
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer 3/20 and 4/17. Positive on 1/1/22


VAERS ID: 1998867 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna, 49, 2/3/21, abnormal vaginal bleeding , LLQ pain , elevated WBC
Other Medications: Levothyroxine 125mg, Amlodipine 5mg, Cymbalta 30mg, Vitamin D 5,000 iu , ibuprofen
Current Illness: none
Preexisting Conditions: HBP, Hypothyroid, Anxiety
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: "Moderna Arm " Painful, warm, red, swollen upper arm, near injection site and distally covering 1/3 of upper arm. Fever, body aches, generally unwell


VAERS ID: 1998911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-12-31
   Days after vaccination:308
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 LA / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID case.


VAERS ID: 1998928 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Unknown  
Location: Minnesota  
Vaccinated:1979-02-07
Onset:2021-12-31
   Days after vaccination:15668
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLD, T2DM, SLE
Allergies:
Diagnostic Lab Data: + COVID PCR
CDC Split Type:

Write-up: Acute COVID infection


VAERS ID: 1998948 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-12-31
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test on 12/31/2021
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1998956 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-01
Onset:2021-12-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity, DM, HTN
Allergies:
Diagnostic Lab Data: COVID + 12/31/2021
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1998964 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-02
Onset:2021-12-31
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cough, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alogliptin 12.5 mg po daily aripiprazole 30 mg po daily Fluphenazine 1 mg po TID glimeperide 1 mg po daily Metformin 500 mg po daily Ingrezza 40 mg po daily Trazodone 100 mg po QHS prn
Current Illness:
Preexisting Conditions: Diabetes, HIV Positive.
Allergies: NKDA
Diagnostic Lab Data: 12/31/2021 - SARS-CoV-2 Antigen (++)
CDC Split Type:

Write-up: 55 yr old male with pmh of dm and hiv diagnosed a year ago for last 2 days. presented to er c/o multiple episodes of vomiting . pt tested positive for covid 19 pneumonia i er . he has had cough but no congestion / body aches or abd pain or diarrhea . pt received his second moderna vaccine 2 weeks ago .


VAERS ID: 1998972 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-12-31
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dysstasia, Glassy eyes, Lethargy, Pyrexia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (Tylenol Extra Strength) 500 mg Tablet Directions: 2 tablet oral twice a day with breakfast and dinner (Active) famotidine (Pepcid) 20 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) gabapentin 300 mg Capsu
Current Illness:
Preexisting Conditions: As Listed Common Dyslipidemia, HTN; Addt''l Med History atrial fibrillation, SVT. Significant Surg Hx As Listed Addt''l Surgical History SVT ablation (?date), hysterectomy, hernia repair. Smoking Status Never Smoker
Allergies: NKDA
Diagnostic Lab Data: 12/31/2021 - SARS-CoV-2 Antigen (++)
CDC Split Type:

Write-up: Patient is an 86 year old female with PMH of HTN, HLD, GERD, spinal stenosis, atrial fib, CHF who presents to ED for c/o cough and lethargy. Patient is a poor historian. History is obtained from son-in-law. As per son-in-law patient developed fever 2 days pta up to 101. Patient was given an at home covid test and patient was positive. Today patient took a nap and when she woke up she had trouble standing, she was lethargic, her eyes looked glassy and she had a cough with wheezing and her O2 saturation was 90%, which prompted the family to call 911. Patient denies chest pain.


VAERS ID: 1998988 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-27
Onset:2021-12-31
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 antibody test, 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amitriptyline 10 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) ascorbic acid (vitamin C) 500 mg Tablet Directions: 1 tablet oral daily (Active) baclofen 10 mg Tablet Directions: 0.5 tablet oral twice a day (Active) cho
Current Illness:
Preexisting Conditions: multiple sclerosis on Ocrevas (next dose July), Hashimoto''s disease, sarcoidosis. rheumatoid arthritis , hypertension , Migraine, headaches, Panic disorder, Chronic pain, spasticity . Significant Surg Hx Lymph node removed from neck left side -for sarcoidosis diagnosis.
Allergies: Latex
Diagnostic Lab Data: 12/31/2021 - SARS-CoV-2 Antigen (++), IgM 0.01; IgG 0.01
CDC Split Type:

Write-up: 60-year-old female with a PMH significant for multiple sclerosis,Hashimoto''s disease, sarcoidosis, rheumatoid arthritis and hypertension who came to ER with C/O of shortness of breath. Was found to be COVID 19 positive. No chest pain, shortness of breath. No CP,N/V/D.


VAERS ID: 1998990 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-12-31
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 RA / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID case.


VAERS ID: 1998992 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-12-31
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test on 12/31/2021.
CDC Split Type:

Write-up: COVID vaccine breakthrough case.


VAERS ID: 1999001 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-12-31
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Packed red blood cell transfusion, SARS-CoV-2 antibody test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Myelodysplastic 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol 100 mg po daily amlodipine 10 mg po daily aspirin 81 mg po daily carvedilol 25 mg po BID clonidine 0.3 mg po BID Hydralazine 100 mg po BID Magnesium 400 mg po BID Famotidine 20 mg po daily Prednisone 5 mg po daily Tacrolimus 0.5
Current Illness:
Preexisting Conditions: Common Dyslipidemia, HTN, Renal Failure; kidney transplant, history of BK virus; Appendectomy; s/p renal transplant; fistula left arm; Former Smoker.
Allergies: percocet and testosterone
Diagnostic Lab Data: 12/31/2021 - SARS-CoV-2 Antigen (++) IgM 0.33; IgG 0.02; IgG2 QT-SPIKE 71.10.
CDC Split Type:

Write-up: 61-year-old male with PMH of ESRD-HD dependent s/p previous failed renal transplant 2016, HTN, gout, osteoarthritis, low back problems, and anemia who tested positive for COVID-19 on Sunday 12/26. He had dialysis that day and also came to the ED and received 1 unit of PRBCs. Since that time he is not had dialysis, he states his dialysis center could not accommodate him and he did not want to drive up North. He has had progressive shortness of breath over the last 2 days which is significantly worse this morning prompting his visit to the ED.


VAERS ID: 1999005 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-12-31
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 - / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID case.


VAERS ID: 1999009 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-25
Onset:2021-12-31
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: "ACTIVE - AMLODIPINE TABLET 5MG BY MOUTH DAILY" "ACTIVE - SYNTHROID 1 TABLET BY MOUTH DAILY
Current Illness:
Preexisting Conditions: As Listed Common Dyslipidemia, HTN; Addt''l Med History lung and thyroid cancer. Significant Surg Hx As Listed Addt''l Surgical History lobectomy. Smoking Status Never Smoker.
Allergies: NKDA
Diagnostic Lab Data: 12/31/2021 - SARS-COV-2 Antigen (++)
CDC Split Type:

Write-up: C/o sorethroat and mild cough. no CP,SOB,N,V,D.


VAERS ID: 1999026 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-01
Onset:2021-12-31
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension Liver mass Obesity, Class I, BMI 30-34.9 Tobacco user Type 1 diabetes mellitus
Allergies:
Diagnostic Lab Data: COVID+ 12/31/21
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1999036 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-20
Onset:2021-12-31
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / SYR

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

Write-up: Itchy and sensitive skin developed about 11 days after receiving the Moderna booster. When skin is irritated or scratched, hives develop immediately. If left untouched, the hives abate in 15 to 30 minutes. Hives will develop all over the body, including the palms of hands, abdomen, neck, head, legs, and feet. Treating hive severity with over the counter antihistamines.


VAERS ID: 1999041 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-12-31
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension Hypothyroidism Tobacco user
Allergies:
Diagnostic Lab Data: COVID+ 12/31/2021
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1999046 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-12-31
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID Positive test 12/30/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1999142 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Chills, Hypoaesthesia, Myalgia, Pyrexia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Levothyroxine
Current Illness:
Preexisting Conditions: Thyroid disease
Allergies: Sulfamethaxole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, muscle aches, arm numbness, underarm pain and swelling.


VAERS ID: 1999153 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-01
Onset:2021-12-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arrhythmia, Cardiac discomfort, Fatigue, Headache, Heart rate increased, Heart rate irregular, Lymphadenopathy, Myalgia, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (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: Vit D, B complex, multi-vitamins. Forteo.
Current Illness: None.
Preexisting Conditions: Osteoporosis.
Allergies: All strains of Penicillins. Highly sensitive to Benadryl.
Diagnostic Lab Data: At home rapid Covid test last night was negative
CDC Split Type:

Write-up: Muscle aches, fatigue, headache, swollen glands, upset stomach, fever 102.4 at the highest. Symptoms started approximately 5 1/2 to 6 hours after vaccine. And lasted 60 hours. My heart has some irregular beating and some hard beating this morning and yesterday. I did have Covid over 90 days ago. Was treated with monoclonal antibodies. Recovered at home. The symptoms I had over the weekend felt very much like Covid symptoms. I sincerely was concerned that I had Covid again. Although obviously not from the vaccine itself. I did an at home rapid test which was negative. And this morning since my fever broke at 7 AM I have felt much better. The only lingering symptom I currently have is a headache some slight fatigue and the feeling that my heart is not quite right. I do have a heart murmur anyway, but this feels like additional heart arrhythmia. I have messaged my doctor.


VAERS ID: 1999183 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was identified at the time of vaccination to be under the age of 17 after being administered the Janssen vaccine. No signs or symptoms of adverse effects was reported by the family over the course of 3 days. No reported treatment or hospitalization was required from the parent/guardian at this time.


VAERS ID: 1999206 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-19
Onset:2021-12-31
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax, Lumbar vertebral fracture, Muscular weakness, Pulmonary mass, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient admitted overnight of 12/31/21 due to L lower extremity weakness with concern for stroke. Was given tPA and admitted for further management. Also noted to have lung mass and L1 fracture noted on chest CT. Patient tested positive upon admission.


VAERS ID: 1999239 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Limb mass, Peripheral swelling, Skin induration, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: A lump in my arm started 2 days after injection (booster). It was a hard lump that was warm to the touch. It got smaller each day. I am on day 5 and it?s much smaller. Started the size of a tennis ball, at day 5 it?s the size of a quarter.


VAERS ID: 1999284 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Bio identical hormone replacement therapy Daily multivitamin Vitamin D supplement
Current Illness: None
Preexisting Conditions: None
Allergies: Doxycycline Proactive skin care
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart Arrhythmia (irregular heart beat including flutters, rapid heart beat at rest)


VAERS ID: 1999309 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-12-31
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen vaccine n 3/25/21 and patient hospitalized for COVID resp failure on 12/31/21


VAERS ID: 1999318 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-21
Onset:2021-12-31
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04IJ2IA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Blood lactic acid normal, Blood test abnormal, Chest X-ray normal, Chest pain, Computerised tomogram thorax, Dyspepsia, Electrocardiogram normal, Eye swelling, Hypersensitivity, Insomnia, Joint swelling, Peripheral swelling, Pruritus, Swelling, Swelling of eyelid, Troponin T normal, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations: Covid arm after the first two Moderna shots, 37 years old- resolved on their own with no treatment
Other Medications: Azurette
Current Illness: headaches during period
Preexisting Conditions: migraines, history of iron deficiency (resolved now)
Allergies: sulfa drugs (as a baby), sensitivity to prednisone
Diagnostic Lab Data: At ED on 1/2, EKG, Chest Xray, CT chest pulmonary angiogram with contrast all normal. Bloodwork consistent with an allergic reaction/hives- lactic acid and Troponin T tested after IV and deemed to be back to normal.
CDC Split Type:

Write-up: Woke up on 12/31 to full-body itchy hives, centered around lower torso but radiating out everywhere else, with some swelling (including of the eyes)- no known cause, no known recent other exposure or allergens. Started to have heartburn on the evening of 1/1 with a wave of pain up and down the center of my chest, that kept me up all night. On 1/2, went to the Emergency Department for this chest pain as well as the hives (this was now the 3rd day they persisted and seem to be spreading). ED provided IV benadryl, pepcid, and fluids. Itching and swelling and heartburn seemed to be managed by that IV. Discharged after a few hours, told to treat with OTC drugs like allegra/zytrec and benedryl. Hives still persist- woke up with swelling of wrists, thighs, eyelids on 1/2.


VAERS ID: 1999331 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Dizziness, Fatigue, Memory impairment, Pain, Pyrexia, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tizanidine, Dexilant, Prozac, probiotic, trumeric, Claritin, cuvitru
Current Illness: Sinusitis prior too
Preexisting Conditions: Selective Antibody Deficiency
Allergies: Effexor, Wellbutrin, Zoloft
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, bodyaches. fatigue, memory fog, lack of focus, fever, visual changes. since second vaccine


VAERS ID: 1999332 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 4 LA / IM

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

Write-up: Patient presented to pharmacy requesting COVID vaccine booster shot. A vaccination card was presented indicating Pfizer administered on 2/26/21 and 3/26/21. Confirmed that patient did want to change to Moderna from Pfizer for a booster dose. After administration and observation, the patient''s dose was reported to the local Immunization Service. It was discovered that the patient received a third dose of Pfizer on 8/27/21 from his family physician. Due to the New Year''s holiday weekend, we were not able to confirm vaccination with the office or patient until 1/3/22. Both confirmed a third dose was administered on 8/27/21, It was explained to the patient that this dose was out of series and not indicated. He was asked to report any adverse effects which may occur.


VAERS ID: 1999344 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin ER 500 mg, Losartan/HCTZ 100/25 mg, Amlodipine 5 mg, Saxenda injection,
Current Illness: None
Preexisting Conditions: Diabetes mellitus Type 2
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that the morning following the vaccination, her right underarm was swollen and very tender to touch and believes it to be a swollen lymph node caused by the vaccine. Patient reported the incident to the pharmacy on 1/3/2022 and to her medical provider, Dr. for documentation in her medical chart.


VAERS ID: 1999359 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-12-31
   Days after vaccination:347
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Headache, Nasal congestion, Oropharyngeal pain, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Taking Levothyroxine Sodium 88 (mcg) Tablet take 1 tablet by mouth every day , Taking Aspirin 81 MG Tablet Delayed Release 1 tablet Orally Once a day, Taking Atorvastatin Calcium 10 MG Tablet 0.5 tablet Orally Once a day, Taking Metoprolol
Current Illness: none
Preexisting Conditions: 11/90 Hypothyroid---I 137, HTN, 3/97 HRT, 6/04 Adenomatous colon polyp; last colonoscopy 2016, normal, Increased triglycerides, Cholecystitis status post cholecystectomy 6/6/14, CHF: Echocardiogram on 6/10/14 shows LVEF 60%, pseudonormalization of diastolic filling consistent with diastolic dysfunction, moderate pulmonary hypertension
Allergies: Diphther,pertuss,tetanus Vac: severe swelling; , Penicillins: rash; , Ampicillin: rash; , Erythromycin: gi upset; , Aspirin: hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: include headache on and off, sore throat, nonproductive cough on and off, chills, nasal congestion, post nasal drainage. starting 12/31/21


VAERS ID: 1999403 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-12-31
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid +


VAERS ID: 1999439 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-12-31
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid + test
CDC Split Type:

Write-up: covid vaccine breakthrough


VAERS ID: 1999459 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-07
Onset:2021-12-31
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/31/2021
CDC Split Type:

Write-up: Breakthrough Case **Lot number for 2nd dose not found on website *** 1st vaccine dose was administered at Health Management Group -


VAERS ID: 1999467 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node / arm pit on left arm - same side as injection site


VAERS ID: 1999470 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-12-31
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/31/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999478 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-26
Onset:2021-12-31
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid+ test
CDC Split Type:

Write-up: covid vaccine breakthrough


VAERS ID: 1999479 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-27
Onset:2021-12-31
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/31/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999516 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-24
Onset:2021-12-31
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Headache, Myalgia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sleep apnea, Type 2 Diabetes, Hypertension
Allergies:
Diagnostic Lab Data: COVID+ PCR on 12/31/21.
CDC Split Type:

Write-up: COVID Breakthrough. Patient presented to the hospital on 12/31/21 with "several days" of shortness of breath that has been worsening. She also has cough, myalgias, and headache. The patient is positive Covid-19.


VAERS ID: 1999535 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-30
Onset:2021-12-31
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, COVID-19, Fatigue, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension, hx of renal transplant
Allergies:
Diagnostic Lab Data: COVID+ 12/31/21 by PCR
CDC Split Type:

Write-up: COVID Breakthrough. Patient came in on 12/31/21 with mild fevers, fatigue, and bradycardia.


VAERS ID: 1999551 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-11
Onset:2021-12-31
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/31/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999554 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events but should have had Pfizer.


VAERS ID: 1999563 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-12-31
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Blood glucose abnormal, COVID-19, Decreased appetite, Malaise, Nausea, Renal function test abnormal, SARS-CoV-2 test positive
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness:
Preexisting Conditions: acute renal failure, HTN, Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro detected on 12/31/2021
CDC Split Type:

Write-up: tested positive for COVID after feeling unwell for a month, with nausea and decreased appetite. hx of chronic diarrhea and has abnormal labs for glucose and kidney function. Likely asymptomatic, incidental finding


VAERS ID: 1999578 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-12-31
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/31/2021
CDC Split Type:

Write-up: Breakthrough Case **Patient pregnant with EDD of unknown ***Unknow if patient was pregnant at time vaccine administration


VAERS ID: 1999581 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-10
Onset:2021-12-31
   Days after vaccination:324
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 RA / IM

Administered by: Work       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? No
Previous Vaccinations:
Other Medications: None Documented
Current Illness: None documented
Preexisting Conditions: None Documented
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. Booster given 12/27/2021. Disability coverage for the patient was 9/13/2021.


VAERS ID: 1999626 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Exposure during pregnancy, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt seen in ER 12/31/2021 by Dr.. Vaccine reaction, initial encounter noted. Pt pregnant 28 and 3/7 weeks, c/o myalgias, fatigue, some degree of headache, afebrile in ER. Had 3rd Covid vaccine today, concern with fetal growth. Husband tested positive Covid 2 days prior. Pt had growth 2 days ago and showed appropriate growth - next appoint next week with OB GYN provider. Tylenol as needed for discomfort, keep appointment next week.


VAERS ID: 1999630 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-12-31
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Lung infiltration, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient admitted through ED with hx of lung cancer and COPD, who was recently discharged from hospital after several days of stabilization and treatment, presenting again with cough, fever, and shortness of breath. The patient found negative for COVID-19. His chest x-ray and CT scan of chest showed new infiltrate and the patient was admitted for further treatment of pneumonia Second test 2 days later resulted positive


VAERS ID: 1999634 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-22
Onset:2021-12-31
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro detected on 12/3/2021
CDC Split Type:

Write-up: symptomatic, mild hypoxia, testrd positive for COVID on 12/31/2021


VAERS ID: 1999674 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-12-31
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Influenza A virus test, Influenza B virus test, Pain, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHF, Obesity
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) and Influenza AB by Nucleic Acid Amplification, POC covid detected on 1/2/2022
CDC Split Type:

Write-up: body aches and fatigue for 2-3 days fever on admission 1/2. as of 1/3 has been discharged


VAERS ID: 1999802 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / UNK LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elliquis, Diltiazem, Folic Acid, Atorvastatin Calcium , Metoprolol, Propalenone, Pioglitazone, Sertraline, Vitamin B-12, Albuterol. Lantus & Novolog insulin.
Current Illness: Heart failure and Chronic kidney disease.
Preexisting Conditions: Anemia, depression.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Intense itching in my arms, lower back. Then I noticed little welts on my right arm. I also had some larger welts on my left thigh at the location of a skin graft, anterior location.


VAERS ID: 1999811 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Impaired work ability
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe arm pain/Fatigue
Other Medications: Singular, Zyrtec, Berry. Vitamin B, Vitamin D, Flexeril, Potassium, Lomotil, Motion sickness medication, Pro Air Inhaler Biotin, Ibuprofen, Zinc, Vitamin C
Current Illness: Nasal Allergies
Preexisting Conditions: Back Pain, Hypertension, Headache
Allergies: Compazine-dystonic Reaction Varicela Vaccine-Large Whelp
Diagnostic Lab Data: Placed call to Doctors requesting another form of treat. Still awaiting call back.
CDC Split Type:

Write-up: About 2 Hours after receiving vaccine slight headache Then bout 4 hours later, Severe Headache that has lasted 4 days so far. Poor response to usual medications taken for Headache. Today, @ 1700 still Headache when I think it is better, Moves to a different part of my head. Had to miss work today due to Headache .


VAERS ID: 1999817 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-12-22
Onset:2021-12-31
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

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

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

Write-up: About a week after his booster dose he started to break out in a full body rash. It has progressively gotten worse. He called today to ask what to do. I referred him to a physician and stated I would send the report.


VAERS ID: 1999880 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Fatigue
SMQs:, Neuroleptic malignant syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: xarelto
Current Illness:
Preexisting Conditions: blod clots
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: low grade temp, fatigue


VAERS ID: 2000009 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Back pain, Fatigue, Neck pain, Pain in extremity, Pyrexia, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (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: OTC allergy med, daily vitamin, collagen
Current Illness: None
Preexisting Conditions:
Allergies: Light sensitivity to some lotions
Diagnostic Lab Data: None, treated at home
CDC Split Type:

Write-up: Fever over 101 from 2pm on 12-31 until around 11am on 1/2, swollen armpit with pain to the underarm, shoulder, neck and back, fatigue. Rash also developed on thigh, not sure if that?s related. Fever is now gone but armpit is still swollen with arm and back pain. Rash mostly went down when fever did.


VAERS ID: 2000083 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-12-31
   Days after vaccination:351
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Headache, Pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: VITAMIN B12 NOS
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: left chest on my heart had sharp pain / stabbing then stopping then stabbing then stopping/Heart sharpness; She was thinking what she ate last night caused her pain; headache that wasn''t bad; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (left chest on my heart had sharp pain / stabbing then stopping then stabbing then stopping/Heart sharpness), PAIN (She was thinking what she ate last night caused her pain) and HEADACHE (headache that wasn''t bad) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031H21A, 013L20A and 039K20A) for COVID-19 vaccination. Concomitant products included VITAMIN B12 NOS for an unknown indication. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 31-Dec-2021, the patient experienced CHEST PAIN (left chest on my heart had sharp pain / stabbing then stopping then stabbing then stopping/Heart sharpness), PAIN (She was thinking what she ate last night caused her pain) and HEADACHE (headache that wasn''t bad). At the time of the report, CHEST PAIN (left chest on my heart had sharp pain / stabbing then stopping then stabbing then stopping/Heart sharpness) and PAIN (She was thinking what she ate last night caused her pain) had resolved and HEADACHE (headache that wasn''t bad) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication include another vitamin. No treatment medications were reported.


VAERS ID: 2000293 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Dizziness, Electrocardiogram, Extrasystoles, Palpitations, Ventricular extrasystoles
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypokalaemia (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: women multi vitamin daily magnesium
Current Illness: none
Preexisting Conditions: endometriosis
Allergies: sulfa drugs
Diagnostic Lab Data: self administered EKG and palpation of pulse
CDC Split Type:

Write-up: cardiac arrhythmia , multiple PVC''s, bigeminy. symptoms of palpitations, occasional dizziness, per cardiologist start taking propranolol


VAERS ID: 2000296 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Lymphadenopathy, Pain, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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 as above but no swelling of lymph nodes. Age 42 Vax date of 5/15/21. Moderna
Other Medications: Omeprazol Cetrizine
Current Illness: Typical sinus drainage and a bit of a stuffy nose
Preexisting Conditions: Acid reflux, seasonal allergies
Allergies:
Diagnostic Lab Data: At home rapid covid test with negative results
CDC Split Type:

Write-up: Dizzy,extreme tiredness,diarrhea, vomiting, body aches, lymph nodes in right under arm swollen (and still after four days) all symptoms lasted approximately 36 hrs except the swelling


VAERS ID: 2000324 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-12-31
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8736 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: A 16 year old patient received the Moderna vaccine as Booster; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received the Moderna vaccine as Booster) in a 16-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013H21B, EW0182 and ER8736) for COVID-19 vaccination. No Medical History information was reported. On 18-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 31-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 31-Dec-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received the Moderna vaccine as Booster). On 31-Dec-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (A 16 year old patient received the Moderna vaccine as Booster) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant and treat medications were given to patient.


VAERS ID: 2000331 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: 5 years old was given the booster dose of the Moderna COVID 19 vaccine (0.25 mL); This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (5 years old was given the booster dose of the Moderna COVID 19 vaccine (0.25 mL)) in a 5-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 068H21A) for COVID-19 vaccination. No Medical History information was reported. On 31-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 ml. On 31-Dec-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (5 years old was given the booster dose of the Moderna COVID 19 vaccine (0.25 mL)). On 31-Dec-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (5 years old was given the booster dose of the Moderna COVID 19 vaccine (0.25 mL)) had resolved. Concomitant medications was not provided by the reporter. Treatment information was not provided.


VAERS ID: 2000371 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Feeling abnormal, Nasal congestion, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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:
Current Illness: Allergy.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20220102; Test Name: Tested positive with rapid test; Test Result: Positive ; Result Unstructured Data: Tested positive with rapid test
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Body aches; congestion; Had a fever; didn''t feel good; Felt tired; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (didn''t feel good), PAIN (Body aches), NASAL CONGESTION (congestion), FATIGUE (Felt tired) and PYREXIA (Had a fever) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Allergy. On 31-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Dec-2021, the patient experienced FEELING ABNORMAL (didn''t feel good) and FATIGUE (Felt tired). On 01-Jan-2022, the patient experienced PAIN (Body aches), NASAL CONGESTION (congestion) and PYREXIA (Had a fever). At the time of the report, FEELING ABNORMAL (didn''t feel good) and FATIGUE (Felt tired) outcome was unknown and PAIN (Body aches), NASAL CONGESTION (congestion) and PYREXIA (Had a fever) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 02-Jan-2022, COVID-19: positive (Positive) Tested positive with rapid test. Patient took concomitant products as blood pressure medicine and allergy medicine. Treatment information was not provided.


VAERS ID: 2000414 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Pain, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Valcyclovir Meloxicam Vitamin d Magnesium
Current Illness:
Preexisting Conditions: Thyroid
Allergies: Zpack IVP dye Some antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red swollen itchy ring on arm Headache Body aches


VAERS ID: 2000426 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-01
Onset:2021-12-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0701TZIA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dissociation, Dizziness, Fatigue, Lymph node pain, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen lymph node in left armpit and pain Fever, chills, muscle aches, fatigue Dizziness and feeling disconnected I have been on bed rest and Advil for the last 4 days and am still sick


VAERS ID: 2000463 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SC
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Lymphadenopathy
SMQs:, Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: lymph nod swollen up under arm and serious pain in breast on that side for days now


VAERS ID: 2000539 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-12-31
Onset:2021-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Inappropriate schedule of product administration, Product administered to patient of inappropriate age, Vaccination site pain
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Headache; Soreness at injection site; Child received Moderna Booster dose (0.25 ml); First COVID-19 dose was from Pfizer & Moderna''s COVID-19 booster dose (0.25 ml) in error for her second dose instead of Pfizer''s COVID-19 dose for children; This spontaneous case was reported by a pharmacist and describes the occurrence of HEADACHE (Headache), VACCINATION SITE PAIN (Soreness at injection site), PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Child received Moderna Booster dose (0.25 ml)) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First COVID-19 dose was from Pfizer & Moderna''s COVID-19 booster dose (0.25 ml) in error for her second dose instead of Pfizer''s COVID-19 dose for children) in a 7-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: PFIZER BIONTECH COVID-19 VACCINE (Pfyzer vaccine as a first dose) in November 2021. Past adverse reactions to the above products included No adverse drug reaction with PFIZER BIONTECH COVID-19 VACCINE. On 31-Dec-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 milliliter. On 31-Dec-2021, the patient experienced HEADACHE (Headache), VACCINATION SITE PAIN (Soreness at injection site), PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Child received Moderna Booster dose (0.25 ml)) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First COVID-19 dose was from Pfizer & Moderna''s COVID-19 booster dose (0.25 ml) in error for her second dose instead of Pfizer''s COVID-19 dose for children). The patient was treated with IBUPROFEN for No adverse event, at an unspecified dose and frequency. On 31-Dec-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Child received Moderna Booster dose (0.25 ml)) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First COVID-19 dose was from Pfizer & Moderna''s COVID-19 booster dose (0.25 ml) in error for her second dose instead of Pfizer''s COVID-19 dose for children) had resolved. At the time of the report, HEADACHE (Headache) and VACCINATION SITE PAIN (Soreness at injection site) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication was not provided. Most recent FOLLOW-UP information incorporated above includes: On 02-Jan-2022: Follow up received and it contains information about patient demographics and vaccination information and treatment information and new events were added.


VAERS ID: 2000559 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-21
Onset:2021-12-31
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propecia, 1mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Urticaria, primarily on the abdomen, chest, and chest. Currently treating w/ Benadryl and Methylprednisolone.


VAERS ID: 2000560 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-30
Onset:2021-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: Probiotics, multivitamins, birth control, allergy treatment drops, zyrtec
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Zithromax
Diagnostic Lab Data: Negative covid test on Jan. 3, 2022
CDC Split Type:

Write-up: Red, painful, swollen, hot to touch, itchy injection site lasting for 3 days Fever 100.5, chills, headache, bodyaches lasting 2 days Headache lasting 4+ days


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