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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 103 out of 6,867

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VAERS ID: 1591212 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site erythema, Injection site pain, Injection site warmth, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-provera, Synthroid 25mcg, Ibuprofen 800mg.
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient arm is red, warm to touch, bruised at the injection site, arm swollen near the elbow. Patient reports pain at injection site and near elbow, headache. No other symptoms.


VAERS ID: 1591220 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-05
Onset:2021-08-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Pain in extremity, Panic attack
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called me yesterday afternoon and was hysterical as she said she was having chest pain and pain in her calf and was worried about a blood clot from her pfizer vaccine. I advised the patient to please get checked out immediately at the hospital and she stated she would. She then proceeded to tell me that she had some chest tightness after her first vaccine but had herself checked out by her PCP who just told her to follow up with a cardiologist. She was very anxious about getting the vaccine and it was believed that she may been having more of a panic attack than anything else. Upon talking with her further, she then further disclosed that her husband who got the 2nd vaccine the same day as she did had just died unexpectedly on Wednesday.


VAERS ID: 1591221 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is a child and was distressed at time of vaccination. She was wearing thick sweatshirt on very hot day. Approximately 10 minutes post injection, she complained of feeling hot, dizzy, nauseous, and having blurry vision. Ice packs were applied to her neck, her feet were elevated, and her sweatshirt was removed. The symptoms resolved within an additional 10 minutes.


VAERS ID: 1591222 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-06
Onset:2021-08-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baclofen, plavix, lisinopril, meloxicam, prilosec, trazodone
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received only first dose of COVID vaccine and presented to ED and was diagnosed with COVID infection leading to hospitalization


VAERS ID: 1591239 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: patient fainted shortly after receiving first dose. Was not responsive for approximately 30 seconds. Recovered very quickly in approximately 5 minutes she was ok.


VAERS ID: 1591245 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Pain in extremity, Skin warm
SMQs:, Dystonia (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: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm warm to the touch, severe soreness, muscle cramping


VAERS ID: 1591246 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspepsia
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), 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: Humira Sertraline Prenatal
Current Illness: No
Preexisting Conditions: Psoriatic Arthritis
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I began having chest pains about 24 hours after the vaccine. It felt like extreme heart burn that lasted for about two hours. It was not calmed by Tums but did alleviate after being elevated.


VAERS ID: 1591251 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-15
Onset:2021-08-19
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PROVENTIL ASPIRIN LIPITOR COREG VITAMIN D2 BASAGLAR LISPRO LISINOPRIL PERCOCET PROTONIX LYRICA PRIMIDONE REQUIP ZOLOFT SIMVASTATIN TIZANIDINE TOPAMAX
Current Illness:
Preexisting Conditions: DIABETES COPD HTN
Allergies: CARISOPRODOL NAPROXEN ETODOLAC HYDROMORPHONE
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: SOB AND COUGH


VAERS ID: 1591255 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Very tired and her muscles are hurrying every where in her body.


VAERS ID: 1591256 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Fiber-con Tylenol Montelekast Atorvastatin Eliquis LezEtracetan Donepezil Primidone Losartan Potassium Furosemide Citalopram Omeprazole
Current Illness: None
Preexisting Conditions: Congested Heart Failure, History of Stroke, Diabetic
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First two shots were Pfizer, third shot was Moderna, No treatment given.


VAERS ID: 1591257 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: as per patient mother she sent him to the hospital as of today he is home
CDC Split Type:

Write-up: as per patient mother the patient experienced severe chills, fever, lethargy and no appetite


VAERS ID: 1591259 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-21
Onset:2021-08-19
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (narrow)

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

Write-up: Patient was vaccinated for COVID as of July 2021. Patient presented to ED and is diagnosed with COVID infection leading to hospitalization. Pregnant female about 39 weeks gestation an is current asymptomatic


VAERS ID: 1591263 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-08-19
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid increased, Cellulitis, Drainage, Echocardiogram abnormal, Ejection fraction decreased, Hypokalaemia, Hyponatraemia, Limb injury, Sepsis, Tachycardia, Wound complication, X-ray limb abnormal
SMQs:, Cardiac failure (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (narrow), Osteonecrosis (broad), Chronic kidney disease (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Atrial fibrillation, controlled Breast cancer, right Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 86-year-old female with PMH of cardiomyopathy, EF of 25% on last echocardiogram May 2021, CAD, Congestive heart failure, atrial fibrillation, anticoagulated on Eliquis, HTN, immobility, hyperlipidemia, breast CA, anxiety, confusion, fracture of both wrists with surgical repair of the right distal radius back in May after a fall, resulting in extended rehab stay. Patient also has degenerative disease of the pelvis resulting in immobility and unable to bend, uses wheelchair. 86-year-old female with PMH of cardiomyopathy, EF of 25% on last echocardiogram May 2021, CAD, Congestive heart failure, atrial fibrillation, anticoagulated on Eliquis, HTN, immobility, hyperlipidemia, breast CA, anxiety, confusion, fracture of both wrists with surgical repair of the right distal radius back in May after a fall, resulting in extended rehab stay. Patient also has degenerative disease of the pelvis resulting in immobility and unable to bend, uses wheelchair. History is obtained from the chart and ER provider is documentation as patient is a poor historian. She is oriented x2. History of sundowning on previous admission. When asked any questions about medical history she defers to her daughter. Patient was triaged in the emergency room today and the daughter did not stay with the patient. I called and left a message for her. Patient denies any pain until palpation of the left heel. Patient had a follow-up appointment after discharge from rehab facility with her primary care physician who sent her to the hospital for further evaluation of a left calcaneus cellulitis. There is dried malodorous drainage on the bottom of her foot. Laboratory evaluation is significant for elevated lactic acid, hyponatremia, mild hypokalemia. Patient has been mildly tachycardic in the emergency room. Patient received IV antibiotics. Given patient''s chronic right heart failure and cardiomyopathy she was given a 500 cc bolus of fluid resuscitation in the emergency room. Sepsis is present on admission. X-ray of the lt foot revealed posterior heel wound with questionable indistinctness of the the underlying posterior calcaneal cortex which is indeterminate although could reflect findings of early osteomyelitis and would be better evaluated with MRI. Patient is a poor historian though she denies any recent fevers/chills/sweats/nausea/vomiting/productive cough/chest pain/chest pressure/palpitations/abdominal pain/diarrhea/constipation/frequency/urgency/dysuria/hematuria/hematemesis/melena. VACCINE DATE: 04/16/2021 HOSPITALIZATION DATE: 08/19/2021


VAERS ID: 1591269 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Neck pain, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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: Ni
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neck in severe pain and stiffness No particular side 20% movement Unable to life head up or down or un rotation without severe pain.


VAERS ID: 1591270 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-08-19
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, COVID-19, COVID-19 pneumonia, Decreased appetite, Hypophagia, Pyrexia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (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: advanced dementia, BPH, seizure disorder
Allergies: SULFADIAZINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 75-year-old male with a past medical history of advanced dementia, BPH, seizure disorder who presents for COVID and fever. Patient has had decreased appetite and not taking p.o. recently so they sent him to the emergency room. I have attempted to reach his daughter but no in his answered the phone, therefore I left a telephone message. Patient himself is nonverbal therefore all my information is being taken from ER records. We have minimal information except for his medications. There is no information regarding his code status. In the emergency room he had a temperature of a 100.2? and found to have COVID pneumonia but he is not hypoxic at this time. He has mild renal failure with a BUN of 33 and creatinine of 1.3. His baseline is unknown.


VAERS ID: 1591284 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-08-19
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested PCR positive for COVID 8/19/21 after being fully vaccinated.


VAERS ID: 1591286 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-08-19
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea exertional, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: aspirin 81 mg oral tablet, 81 mg= 1 TAB, PO, QPM (Every evening) Cinnamon 500 mg oral capsule, 1000 mg= 2 CAP, PO, QPM (Every evening) Fish Oil 1000 mg oral capsule, 1000 mg= 1 CAP, PO, QPM (Every evening) gabapentin 300 mg oral capsule, 30
Current Illness:
Preexisting Conditions: non-Hodgkin lymphoma, esophageal cancer, currently under chemotherapy, DIABETES, GERD, PERIPHERAL NEUROPATHY
Allergies: IVP DYE
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a very pleasant 81-year-old male with history of non-Hodgkin lymphoma, esophageal cancer, currently under chemotherapy, patient has history of diabetes, oral diabetic medications, chronic GERD, peripheral neuropathy, patient was tested positive for COVID-19 infection 2 weeks ago, he was staying at home, did not require supplemental O2, however over the past 2 days his symptoms have been getting worse, he has been feeling more shortness of breath with exertion, and he developed low oxygen levels for which he presented to the emergency department for further evaluation. Chest x-ray in the emergency department showed multifocal pneumonia, patient initially required high-flow oxygen but currently weaned down to 4 L O2 with bedside pulse ox 95-96%. He received antibiotics and steroids in the emergency department, he currently feels better. He is currently hemodynamically stable and normotensive. He is afebrile. He lives with his wife. Patient denies any known exposure to COVID-19 in the community. He reports that he completed 2 doses of Moderna vaccination 7 months ago. He currently denies any chest pain, nausea, vomiting, lightheadedness, dizziness or focal weaknesses.


VAERS ID: 1591287 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion XL Topirimate Metformin Glipizide Atorvastatin Vit D
Current Illness: Intestinal Infection
Preexisting Conditions: Fatty Liver
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I went to store to get a booster Tetanus shot in order to update my vaccination and presented them with the order from my doctor for it. They had me sign the paperwork to receive the tetanus booster. The pharmacist took me into a back room in order to inject me and he brought with him two syringes, one was tetanus and one was the covid-19 vaccine for the next customer. He injected my left arm and told me I was all set. As I was going to exit the room the pharmacist told me he had made a mistake and injected me with the COVID-19 vaccine meant for the next customer. He asked me if i had already been vaccinated and I told him that I had already received both doses of Pfizer on April 22, 2021 and May 13, 2021. He then told me it should be fine as they are recommending booster shots and he had injected Pfizer into me by accident. Then he proceeded to inject my right arm with the tetanus booster. He told me I was all set to leave. As I was walking out I decided to turn around and get paperwork proving he had injected me with a third dose because I hadn''t consented to the third dose and was unsure of the repercussions. I asked him to give me some sort of record in writing that he had done it. He gave me a store important details on the vaccination paper and filled out my vaccination card that I had gotten a third dose. He then made me sign the paper stating I wasn''t allergic to the vaccine or had adverse reactions to vaccine AFTER he had already given me the shot. About 2 hours after the fact both of my arms began feeling sore and I''m worried of the adverse affects of the third accidental dose.


VAERS ID: 1591312 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye movement disorder, Gait disturbance, Hyperhidrosis, Pallor, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After receiving the vaccine patient began to perspire profusely, turned pale, and began to tremble. Eyes rolled within eyes sockets revealing whites of eyes. Never loss consciousness. Stood up with the help of others and was unable to step forward. Brought to the ground on a mat and laid down . Was brought in front of a portable fan. Room was warm(gymnasium at middle school) and outside temp was high 80''s. Ice pack applied on back of neck , BP 92/68, AP 65 and O2 was 98%. Drank water and sat up on mat, talking to her mother. No transport to EMS. Attended to by EMS on site. After several minutes sat in chair next to mother and ate some crackers. Continued to sit 30 minutes after episode and waked out of gymnasium on her own.


VAERS ID: 1591332 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-02
Onset:2021-08-19
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chest pain, Cough, Dyspnoea, Fatigue, Nausea, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Case is symptomatic, cough, fever, no taste or smell, running nose, nauseas, body ache, sore throat, shortness of breath, chest pain and fatigue. tested positive 8/19/2021


VAERS ID: 1591350 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Hyperhidrosis, Nausea, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None-although stated has had hypotensive fainting from sitting to standing position in the past
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 7-10 minutes after vaccine administration, Pt. got up to make second dose appointment. When he returned to his chair, he felt light-headed, dizzy, disoriented, sweaty, nauseous, and started dry-heaving. Pt.''s blood pressure was normal. I monitored the PT.''s blood pressure, put an ice pack on his neck, gave him saltines. Pt. started to feel better after about 15 minutes or so. Pt.''s Mom was with him and drove him home. Pt. stated when he was little he would faint from hypotensive events from sitting to standing. I called PT.''s MD this morning and they were going to follow-up with PT. today. I followed-up with PT. last night and PT. was doing well.


VAERS ID: 1591365 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-21
Onset:2021-08-19
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports persistent severe leg pain radiating down front and back of both legs from hip area down to knee starting the morning of 8/19/2021. No reported pain in lower legs below knee.


VAERS ID: 1591381 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 4 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Patient came to our pharmacy on 8/19/21 at 4:15pm. He filled out our required VAR, where he reported that he had not received any previous Covid vaccine. Since he reported this, we did not check the Registry System. We gave him a new completed Vaccination Record Card and gave him his Moderna vaccine. After giving the vaccine, I told the patient he needed to wait the required 15 minutes in the waiting area. I then went to put his information into Registry System, and noticed that he received a Pfizer vaccine on 3/22/21 at pharmacy. I then asked the patient about this, asked him if he did get a vaccine there on that date and he told me that he did not get that vaccine there on that date. He stated that "if I did, I couldn''t remember." The patient then asked if he should get the second Moderna vaccine. We told him that we would have to report this incident in VAERS, and call Pfizer to see what the required action should be. We verified his phone number and told him that we would give him a call once we had an answer; he verbalized understanding and thanked us before leaving. Seeing the previous Pfizer dose, and that the patient''s address, we wanted to investigate further. We had our medical staff nurses check the Immunization Registry and found that patient received another Pfizer vaccine on 3/22/21 (the same day he received the Pfizer vaccine) and he also received a third Pfizer vaccine on 4/13/21. So the Moderna vaccine he received from us was his 4th total Covid vaccine.


VAERS ID: 1591388 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-26
Onset:2021-08-19
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

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: Atenolol atorvastatin lisinopril nitroglycerin aspirin gabapentin magnesium gluconate omeprazole levothyroxine
Current Illness:
Preexisting Conditions: CAD hypothyroidism hyperlipidemia
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive COVID test


VAERS ID: 1591389 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       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: N/A
Current Illness: N/A
Preexisting Conditions: Maythurners Syndrome (compression of left iliac) so patient has stints opening that back up
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Armpit swollen up to the size of a softball (assuming lymph node swelling); Achy pain yesterday; Sore, especially to the touch today; still swollen


VAERS ID: 1591391 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Mouth swelling, Pruritus, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reported rash and itching about 2 hour after vaccination. She took Diphenhydramine 50mg to help with the allergy. Rash started with both arms and eventually spread throughout body. 08/19/2021 from 2:00pm to 4:30pm, shot give at approximate 2:15pm. Patient last called around 4:30 pm to ask about reporting and commented that mouth and tongue felt swollen. Pharmacist referred patient hospital or urgent care if symptoms worsened.


VAERS ID: 1591392 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Patient came to our pharmacy on 8/19/21 at 4:15pm. She filled out our required , where she reported that she had not received any previous Covid vaccine. Since she reported this, we did not check. We gave her a new completed Vaccination Record Card and gave her her Moderna vaccine. After giving the vaccine, I told the patient she needed to wait the required 15 minutes in the waiting area. I then went to put her information, and noticed that she received a Pfizer vaccine on 3/22/21 at . I then asked the patient about this, asked her if she did get a vaccine there on that date and she told me that she did not get that vaccine there on that date. She stated that "if I did, I couldn''t remember." The patient then asked if she should get the second Moderna vaccine. We told her that we would have to report this incident in VAERS, and call Pfizer to see what the required action should be. We verified her phone number and told her that we would give her a call once we had an answer; she verbalized understanding and thanked us before leaving. Seeing the previous Pfizer dose and that the patient''s address was somewhere else, we wanted to investigate further. We had our medical staff nurses check the and found that patient received another Pfizer vaccine (the same day she received the Pfizer vaccine aLso received a third Pfizer vaccine on 4/13/21 in. So the Moderna vaccine she received from us was her 4th total Covid vaccine.


VAERS ID: 1591403 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Arthralgia, Back pain, Blood test, Chest X-ray, Dyspnoea, Electrocardiogram, Neck pain, Pain in jaw, Painful respiration, Pulmonary pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Osteonecrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline Omega 3 One A Day Multi Vitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EKG Chest X-ray Bloodwork
CDC Split Type:

Write-up: Woke up in severe pain in heart, back, neck, shoulders, jaw, lungs - very difficult and painful to breathe. Went to ER several hours later.


VAERS ID: 1591404 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-05
Onset:2021-08-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Vitamin b, vitamin d, and women''s 1 a day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache 2 days later for 3 days. Yesterday 8-19 at 4 pm had chills, fever, and aches


VAERS ID: 1591407 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Musculoskeletal chest pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Frequent soreness in left pectoral muscle & left shoulder. Left pectoral muscle feels very sore and soreness has spread to ribs on left side


VAERS ID: 1591409 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-10
Onset:2021-08-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin D, Calcium, Zinc, Magnesium
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Cortison, NSAIDS, Alupent
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reports has a hive below where shot was given. Client reports hive is 1 inch by 2 inches, slightly itches. Referred to follow-up with PCP regarding hive. Client reports has called her physician and was referred to call local health department to have VAERS completed.


VAERS ID: 1591411 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-12
Onset:2021-08-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discomfort, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: (Not applicable)
Current Illness: (None)
Preexisting Conditions: (None)
Allergies: (Not applicable)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden, intense itchiness and discomfort at site and surrounding area (including intramuscular) of injection site with surface (approximately 2 inches in diameter around injection site) that became hot, reddened, and raised


VAERS ID: 1591415 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Condition aggravated, Dizziness, Fatigue, Malaise, Migraine, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: LEVOTHYROCINE, CYMBALTA, GABAPANTINE, TURMERIC, TYLENOL
Current Illness: HIPOTHYROID, FIBROMYALGIA, CHRONIC MIGRAINES
Preexisting Conditions: HIPOTHYROID, FIBROMYALGIA, CHRONIC MIGRAINES
Allergies: PENNICILLIN.
Diagnostic Lab Data:
CDC Split Type:

Write-up: THE MORNING AFTER BEING VACCINATED I WOKE UP NAUSEOUS AS DAY PROGRESSED I STARTED FEELING TREMORS , A MIGRAINE , FEELING CLAMMY , COLD SWEAT AND AN UNWELL OVERALL FEELING, EXHAUSTED. ON 8/20/21 STILL FEELING EXHAUSTED AND CLAMMY AND SOME LIGHT HEADINESS


VAERS ID: 1591435 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Private       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: Tri-Sprintec 1 tab orally daily
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Medication error- 16 year old Pt received a 1st dose of Moderna which is only licensed for 18 year and older


VAERS ID: 1591436 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-11
Onset:2021-08-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain
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: Amlodipine.
Current Illness:
Preexisting Conditions: High blood pressure, type 2 diabetes.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headaches, sore arm at injection site. Took Tylenol.


VAERS ID: 1591468 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not to my knowledge
Current Illness: not to my knowledge
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pfizer Booster shot was given outside of CDC guideline on 8/19/21 at around 10:30 am. His second Pfizer shot was given on 3/10/21 and technically he was not eligible for a booster until 11/21. My Distric Manager, discussed this matter with the patient in person and the patient seemed to be ok''ed with it. At the time of the vaccination, the patient physically appeared fine and he was seen shopping in the store later.


VAERS ID: 1591470 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate irregular
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest pain/irregular heartbeat


VAERS ID: 1591480 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product reconstitution quality issue, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: The vaccine doses were administered with diluent volume greater than 1.8ml and syringe containing air bubbles.


VAERS ID: 1591486 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site reaction, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Red, warm, raised area to direct injection site measuring 8 cm width by 4 cm height 1 day following injection


VAERS ID: 1591496 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-08-19
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

Administered by: Other       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: 8/19/21 SARS CCoV2 PCR Positive
CDC Split Type:

Write-up: Vaccine breakthrough. Admitted 8/19/21 to hospital with COVID$g


VAERS ID: 1591506 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product reconstitution quality issue, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: The vaccine doses were administered with diluent volume greater than 1.8ml and syringe containing air bubbles.


VAERS ID: 1591521 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Dyskinesia, Erythema, Loss of consciousness, Musculoskeletal stiffness, Mydriasis, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (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:
Other Medications: pt reported having smoked some marijuana earlier in the day
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Called to scene, 2 staff members, including obs RN assisting pt - pt unconscious upon arrival, pale, cool, clammy skin, pupils dilated, HRR, regular RR. Assisted staff to lay patient supine on floor. Pt still unconscious, but no other changes. In less than 2 minutes supine, pt with sudden change in consciousness - face red, muscles tense, jerked away. Appeared seizure-like momentarily, RR called. Pt then resumed consciousness, confused initially, but then awareness resumed as RR team arrived. 911 also called by another staff member. VSS - BP 121/71, HR 58, SpO2 99%. Stable once sitting upright. RR team assessed, paramedics on scene. Determine pt stable and able to dismiss teams without further intervention. Pt stayed in observation for an additional 40 minutes until recovered. Had one bout of emesis, but reported feeling better after. Given Gatorade and snacks to consume once nausea improved. Escorted to first floor where pt had friends waiting. Encouraged to rest and rehydrate until fully recovered.


VAERS ID: 1591522 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA WAG915160 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Diarrhoea, Dizziness, Dyspnoea, Feeling cold, Hyperhidrosis, Nausea, Peripheral swelling, Pyrexia, Rash, Swelling face, Syncope, Tremor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same symptoms
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: asthma copd
Allergies: pollen dust pet hair
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately dizzy lightheaded, loss of balance, arm is swollen, face is swollen, fever over 101, breathing issues, urine inconstancy, fainted, shaking, chills, sweating diahreah naseau rash


VAERS ID: 1591524 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: The vaccine doses were administered with diluent volume greater than 1.8ml and syringe containing air bubbles.


VAERS ID: 1591525 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Erythema, Pain in extremity, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: Citalopram, Phentermine, Topiramate
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Penicillin
Diagnostic Lab Data: No tests or labs have been done.
CDC Split Type:

Write-up: I had common side effects, until Thursday. Thursday morning, I woke up and my arm hurt, but I figured that was common, until I got to work and the RNs in my clinic said that my entire upper arm was red, swollen, and bruised looking and there were white looking bumps that were raised. They were very concerned. They told me to go home and take benadryl right away, and if it continued to spread or did not get better, I needed to go to urgent care. After taking benadryl, the swelling and bruising went away, but it remained red. Today, Friday, 8/20, I now have these little white looking spots on my right arm, and it is now also red, but not swollen or bruised looking. I was told to keep an eye on both arms for swelling/bruising, and if it happens again in either arm, or if any part of either arm gets hot in either way, to go immediately to urgent care. I was instructed to report this as it is not a common side effect.


VAERS ID: 1591526 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / SYR

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

Write-up: Red rashes, itchy feeling


VAERS ID: 1591531 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Vaccine was administered after BUD (beyond use time) time.


VAERS ID: 1591533 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       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: Covid Pfizer Vaccine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received Pfizer vaccine to early Parent reported he was 12 years old but has 16 days to his birthday.


VAERS ID: 1591536 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood alkaline phosphatase increased, Blood creatinine decreased, Blood glucose increased, Computerised tomogram head normal, Drug screen negative, Electrocardiogram normal, Full blood count normal, Mean platelet volume normal, Metabolic function test, Red cell distribution width normal, Seizure, Urine analysis
SMQs:, Liver related investigations, signs and symptoms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanfacine 1 Mg nightly, Lactulose 10 gm/15 mL BID, Polyethylene glycol powder q 12 days.
Current Illness: No illnesses
Preexisting Conditions: Behavior concerns, Conduct disorder, Encopresis with constipation and overflow incontinence, Fecal impaction of rectum, Slow transit constipation.
Allergies: No known allergies
Diagnostic Lab Data: Urine drug screen-negative; UA normal; CMP glucose 117, creatinine 0.46, alkaline phosphatase 404, all other results in panel normal; CBC RDW-CV 12.0, RDW-SD 35.1, MPV 9.5, all other results normal; CT cranial-no acute intracranial findings; EKG Normal.
CDC Split Type:

Write-up: 8/19/21 @ 1654 in the afternoon, call received from parent that child was at the emergency department of Hospital. Had a reaction to vaccine or medication prior to arrival. Reported patient had a bad seizure. Pt advised to discontinue guanfacine, see primary care provider, and neurology follow up. Discharged home.


VAERS ID: 1591557 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Lymph node pain, Lymphadenopathy, Rash, Rash vesicular, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol as needed, Flovent
Current Illness: Seasonal allergies
Preexisting Conditions: Alopecia areata, asthma
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Son received vaccine at 2pm. At 10-11pm, he felt a rash on back of his head. He also had a tender lymph node directly below rash. Rash was blisters on back of skull. On 8/20/21, his neck tender with movement and has several enlarged lymph nodes right neck. He was taken to doctor and diagnosed with Shingles outbreak and prescribed antiviral medication.


VAERS ID: 1591577 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ergocalciferol Jardiance Methocarbamol Linzess Zyrtec Valtrex Vitamin B12 Biotin Atorvastatin Calcium Sumatriptan Succinate Gabapentin Fluticasone Propionate amlodipine Besylate hydrochlorothiazide metformin Januvia Ozempic
Current Illness: Other fatigue, localized swelling mass and lump of neck, low back pain, essential hypertension, TM, excessive daytime sleepiness, Vit D Deficiency
Preexisting Conditions: Essential primary hypertension, morbid obesity d/t excess calories, DM2, constipation by delayed colonic transit, migraine w/o aura and w/o status migrainosus, BMI 40-44.9, other hyperlipidemia.
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient administered 0.3ml of Pfizer vaccine that was diluted with only 0.8ml diluant.


VAERS ID: 1591594 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Hyperhidrosis, Hypoaesthesia, Paraesthesia, Pharyngeal hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Patient was having perspiration and tightness in the chest, eventually began to have numbness and tingling in the throat and face


VAERS ID: 1591612 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: J&J COVID-19 Vaccine
Current Illness: None known
Preexisting Conditions: None known
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient misinformed medical staff upon arriving claiming he had not be vaccinated yet and requested to be given J&J. Upon entering the patient information to system it was discovered he had already received both doses of Pfizer.


VAERS ID: 1591616 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pfizer vaccine was mixed incorrectly with less than 1.8 mL''s being added to the vial therefore vaccine was more concentrated with 0.3 mL given. No adverse events noted.


VAERS ID: 1591624 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Respiratory arrest, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: Women?s multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I lost consciousness, had a seizure and stopped breathing. My husband had to administer rescue breathing to get me to start breathing again.


VAERS ID: 1591626 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Fatigue, Injection site swelling, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Swelling at Injection Site-Mild, Systemic: Chills-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Severe, Systemic: no appetite-Severe, Systemic: Weakness-Severe


VAERS ID: 1591627 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, wellbutrin, atorvastatin
Current Illness: unknown
Preexisting Conditions: decreased hearing bilateral, depression, GERD, mixed hyperlipidemia, statin therapy, arthritis, prediabetes
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient administered 0.3ml of Pfizer, that was diluted with 0.8ml diluent


VAERS ID: 1591635 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Pharyngeal paraesthesia, Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Approximately 10 minutes after administration of Moderna vaccine, patient complains with throat swelling, tingling throat, and itching in throat. Patient face flushed. Patient vitals monitored. EPIPEN administered along with Benadryl 50 mg IM. 911 contacted to have patient evaluated. Patient stated was feeling better but still felt some swelling in throat area. Patient declined transport to hospital via EMS. Wife did take patient to ER per follow up call. Nurse followed up with patient on 08/20/2021. Patient states was in ER for 3 hours and feeling went away right before left facility.


VAERS ID: 1591640 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: Pfizer vaccine was mixed incorrectly with diluent amount added being less than 1.8 mL''s. therefore concentration of vaccine was higher than indicated with 0.3 mL''s given. No adverse side effects noted.


VAERS ID: 1591669 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-08-19
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia, Pyrexia, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pneumonia FEVER RESPIRATORY DISTRESS


VAERS ID: 1591687 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / -

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

Write-up: U07.1 - COVID-19


VAERS ID: 1591688 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lymphadenopathy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Anastrozole, lisinopril 10, calcium+ d3 1800/ pseudoephedrine
Current Illness: None
Preexisting Conditions: Hypertension, breast cancer 2/2021
Allergies: Pseudoephedrine, codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme dizziness, nausea, fever, aches, lymph nodes in neck on side of vaccination. Vaccine given in r arm, brst cancer was in left side.


VAERS ID: 1591701 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-19
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Malaise
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive covid case with symptoms


VAERS ID: 1591719 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Muscle spasms
SMQs:, Dystonia (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: None
Current Illness: None
Preexisting Conditions: Degenerative disc desease. Arthritis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Muscle spasms in left front upper leg. Muscle spasms in left upper arm both within 30 min of shot. Lasted one hour then stopped. Swelling around injection site (muscle in right shoulder).


VAERS ID: 1591761 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flulaval 2017 and Flulaval 2018
Other Medications: Anastrazole 1mg Pravastatin 40mg
Current Illness:
Preexisting Conditions: H/o double mastectomy High cholesterol
Allergies: Previous history of tachycardia and bronchospasm to FluLaval in 2017 and 2018
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received covid-19 vaccine at 1745 and began experiencing cough and shortness of breath at 1800 and was given 3 puffs of albuterol. Patient was transported to the ED and was satting 100% on room air. Patient was given oral diphenhydramine and prednisone in the ED and discharged home on 4 more days of prednisone.


VAERS ID: 1591763 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis
SMQs:

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

Write-up: Cellulitis of left arm


VAERS ID: 1591768 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fear of injection, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After receiving the vaccine the patient was asked to wait 15min during which time his wife alerted me that he had lost consciousness. I assesed the situation and instructed my technician to call 911. The patient was breathing normally but was very pale. I assisted him and he regained consciousness withing less than a minute. He stated that he had a phobia of needles.EMS arrived and checked vitals, the patient walked out of the store on his own.


VAERS ID: 1591776 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression
SMQs:, Dementia (broad), Hostility/aggression (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: SILDENAFIL
Current Illness:
Preexisting Conditions:
Allergies: BACTRIM
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT REPORTS BECOMING VIOLENT YESTERDAY AFTER RECEIVING THE VACCINE. STATES HE BROKE AN END TABLE AND IS NORMALLY NOT VIOLENT


VAERS ID: 1591786 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Private       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: Pt was given both doses of covid vaccine but did not have adverse reactions in office. pt waited 30mins for possible side effects.


VAERS ID: 1591790 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: After vaccine patient felt nausea, anxious, and light headed. Vitals were taken: BP 170/92, pulse 60, O2 98%, temp 98.0, respiration 24. Provided water and advised to take deep breaths. Monitored for 15 minutes Patient stated he felt better. Advised if he encountered symptoms'' again call emergency services. He was cleared.


VAERS ID: 1591818 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Impaired work ability, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins
Current Illness: 48 hour summer cold 1.5 weeks before
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: 16 hours later 8/19 extreme chills , fatigue, body aches everywhere and fever up to 102.5 that would not reduce. 8/20 low grade fever . and body aches I went back to Pharmacy 8/20 at 11 am and talked to pharmacist who said this was normal. Missed 1.5 days of work


VAERS ID: 1591860 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-08
Onset:2021-08-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Levothyroxine, bupropion, armour, fluoxetine, birth control, fish oil, vitamin c, vitamin D
Current Illness:
Preexisting Conditions: Depression, hypothyroid, TBI
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore left arm, tightness in chest, sharp chest pains.


VAERS ID: 1591867 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-10
Onset:2021-08-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Dyspnoea, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Vitamin C, Nature Made Men''s multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Saw my doctor for it today. No tests or labs done. Will observe.
CDC Split Type:

Write-up: 6" x 3" rash on lower left side of back, several other smaller rashes similar in shape and color in proximity. Some itching but not severe. Showed up about 8-9 days after first dose of Moderna. Also, felt shortness of breath during exercise 8-9 days after first dose of Moderna. Woke next day with feelings of chest compression/tightness and coughing.


VAERS ID: 1591881 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip pruritus, Lip swelling, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none reported
Preexisting Conditions:
Allergies: penicillin, and he stated he was allergic to some cholesterol medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that his palms and lips got really itchy and swelled some. He went to this doctor and they prescribed him prednisone.


VAERS ID: 1591884 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-08-19
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Unknown       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: Hospitalized for COVID 19 post vaccination.


VAERS ID: 1591898 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine,Adderall, valium, bupropion, synthroid, famotidine, vitamin D, TNF infusion
Current Illness: None
Preexisting Conditions: Rhemotoid arthritis
Allergies: Quinolones
Diagnostic Lab Data: Urgent care Dr visit--Keflex orderd
CDC Split Type:

Write-up: Swollen at site, confirmed by urgent care Dr. Possible cellulitis


VAERS ID: 1592004 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Analgesic drug level, Blood alcohol, Blood lactic acid, Chest X-ray, Computerised tomogram head, Computerised tomogram spine, Culture urine, Differential white blood cell count, Drug screen, Electrocardiogram, Fibrin D dimer, Full blood count, Human chorionic gonadotropin, Laboratory test, Mental status changes, Metabolic function test, Troponin I, Unresponsive to stimuli, Urine analysis, X-ray of pelvis and hip
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Facility Lab Tests Completed Lab Tests Completed ACETAMINOPHEN BLOOD ALCOHOL COMPREHENSIVE METABOLIC PANEL D-DIMER QUANTITATIVE DRUG SCREEN RAPID, URINE HCG SCREEN URINE LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LACTIC ACID SALICYLATE TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Facility Imaging Orders Placed Today Imaging Tests CT HEAD WITHOUT CONTRAST CT SPINE CERVICAL WITHOUT CONTRAST EKG XRAY CHEST PORTABLE - XRAY PELVIS 1 OR 2 VIEWS
CDC Split Type:

Write-up: unresponsiveness, altered mental status naloxone was given in ED


VAERS ID: 1592019 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Pain in extremity, Paraesthesia oral, Taste disorder
SMQs:, Taste and smell disorders (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I was told that I had an adverse reaction to MMR as an infant, the result was no more MMR vaccines. However, I have never seen t
Other Medications: None
Current Illness: None
Preexisting Conditions: Exercise induced asthma
Allergies: Unproven
Diagnostic Lab Data:
CDC Split Type:

Write-up: Funny taste in mouth, then tongue and lips started tingling and feeling weird like when Novocain wears off at the dentist. Took Benadryl which solved the problem. Very tired and sore arm.


VAERS ID: 1592024 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient said 16 days later, has entire arm from elbow up painful but bruise to where it looks black.


VAERS ID: 1592027 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Breakthrough period
Other Medications: Calcium, fish oil, prenatal, biotin
Current Illness: 8 weeks postpartum when adverse event happened - delivered a healthy baby boy
Preexisting Conditions: Eczema
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough period 2 days after 2nd dose of vaccine and headache on my lower back right side of my head (right posterior scalp) Also got a breakthrough period 1.5 weeks after first dose.


VAERS ID: 1592052 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: isosorbide,metoprolol,lisinopril,prevastatin,diltiazem,clopidegrel,asa,zyrec
Current Illness:
Preexisting Conditions: CHF,HTN,aortic valve replacement
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest pain-resolved within 2 minutes


VAERS ID: 1592075 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO168 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Decreased appetite, Dysstasia, Fatigue, Feeling abnormal, Headache, Hypoacusis, Injection site pain, Injection site swelling, Myalgia, Nausea, Pallor, Peripheral coldness, Pyrexia, Rash macular, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever reaching 103.1 by 3:00 am 8/20/21. Symptoms began around 6:00 pm on the day of the vaccine (8/19/2021) and by 11:00 pm she had all of the following symptoms: chills, cold arms and hands but forehead was very warm, face very pale, hands and arms very pale and blotchy, extreme fatigue, weakness, feeling faint, trouble standing without assistance, trouble hearing/sounds were muffled, headache, muscle ache/soreness, stomach pain, nausea, loss of appetite, sleeping more than usual, swelling on left arm at location of vaccine injection, sore and painful to touch.


VAERS ID: 1592087 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / IM

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

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

Write-up: Patient was unsure of vaccine dose number. Immtrac2 was checked. However, only dose 1 of 2 was listed. Issue was discovered on return from offsite clinic. Vaccine administered on 8/19/2021 was actually a 3rd dose. Patient had received a second dose of Pfizer vaccine on 8/4/2021.


VAERS ID: 1592106 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine
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: Metoprolol and Ramipril Excedrine
Current Illness: None
Preexisting Conditions: None
Allergies: Codine and iodine Carrots, White Beans, Celery, Pork, Brussel Sports Olives Shell Fish Fish and Green Bell Peppers.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Migraine like headache that is not letting up with 2 Excedrin, 2 Nolacrilex Gum 4mg (Nicotine) and 1 Mycratine.


VAERS ID: 1592115 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-08-19
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test positive
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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 positive PCR on 8/19/21 - completed two-dose Pfizer series on 2/4/2021
CDC Split Type:

Write-up: Pt admitted to facility due to acute hypoxic respiratory failure, tested positive for COVID-19 on 8/19/21


VAERS ID: 1592124 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Diarrhoea, Fatigue, Groin pain, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Noninfectious diarrhoea (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: Anthrax Booster shots- body aches, migraines, upset stomach.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever (103), Body Aches, diarrhea, extreme fatigue, back pain, groin pain, upset stomach, migraine.


VAERS ID: 1592131 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: Multi Vitamin
Current Illness: Positive COVID PCR test on 05Aug2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 8/19/2021 @ 8:30 pm - chills and L arm pain. Chills ended around 10:00 pm on 8/19/2021 L arm pain continues 8/20/2021 @ 7:30 am - muscle aches and chills. Taken 600 mg ibuprofen and 650 mg Acetaminophen. Once at 8:30 am and 4:30 pm. Chills ended around 4:30 pm on 8/20/2021 Muscle aches and L arm pain continue


VAERS ID: 1592134 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / N/A LA / IM

Administered by: Private       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: Abilify 5mg PO QHS, Colace 100mg PO BID, Remeron 22.5mg PO QHS, Effexor XR 112.5mg PO QAM, Vistaril 25mg PO Q six hours PRN anxiety, Albuterol inhaler 2 puffs PO Q 4 hours PRN shortness of breath, Tylenol 650mg PO Q 6 hours PRN pain/fever.
Current Illness: MDD recurrent severe without psychotic features
Preexisting Conditions:
Allergies: NKDA; Kiwi
Diagnostic Lab Data: N/A third dose
CDC Split Type:

Write-up: COVID-19 Vaccine 3rd dose administered. Resident at psychiatric residential treatment facility. Per immunization record in chart resident had not received second dose of COVID-19 Vaccine. Resident reported already receiving second dose prior to appointment. Reported she took herself to the appointment for the second dose. Resident transported to appointment to receive what we thought was second dose of COVID-19 Vaccine 8/19/2021. Vaccine administered at location. Resident notified biological Father that they received a 3rd dose of the COVID-19 Vaccine. Resident then reported godparents took them to get second vaccine. Father contacted godparents and they reported they did take the resident to get both COVID-19 vaccine doses 1 & 2 confirming that dose administered 8/19/21 would be the 3rd dose. Documentation of this not included in chart and not provided on admission. Current immunization record documented dose one. Dose 1 administered 5/28/21 pfizer EW0178 IM injection to left arm Dose 2 administered: 6/18/21 pfizer EW0181 IM injection to left arm both vaccines received. Father provided copy of vaccine administration record to RN staff. Resident return to residential treatment center after 3rd vaccine dose administered.


VAERS ID: 1592140 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-13
Onset:2021-08-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1079 / 1 RA / IM

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

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

Write-up: I have broke out in rash on my body/arms/legs. Taking antihistamines for the rash.


VAERS ID: 1592152 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D2A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: None
Current Illness: No known illness
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, bumpy skin/muscle and redness 3 inch across injection site the following day after vaccination.


VAERS ID: 1592156 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 - / IM

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

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

Write-up: Given expired vaccine, notified by pharmacy the following day


VAERS ID: 1592306 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-13
Onset:2021-08-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207421A / 1 RA / IM

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

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

Write-up: Top of feet were itching Sunday, August 15. Thursday, August 19- rash on trunk, arms, back and legs. Benadryl is helping. Rash comes back after Benadryl wears off


VAERS ID: 1592313 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Ear pain, Erythema, Eye pruritus, Pain, Paraesthesia, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: gastrointestinal: nausea, emesis, diarrhea
Preexisting Conditions: PVC''s, asthma, high cholesterol
Allergies: Terbutaline
Diagnostic Lab Data: none
CDC Split Type:

Write-up: left facial tingling, burning, throbbing, tugging feeling with itchy eye, pain in left ear and redness without blisters


VAERS ID: 1592326 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

Write-up: Swelling and redness left arm.


VAERS ID: 1592343 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Erythema, Facial pain, Gingival pruritus, Hypoaesthesia, Hypoaesthesia oral, Pain in extremity, Paraesthesia, Pruritus, Swelling face, Tenderness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no current meds, has mirena IUD, last used albuterol inhaler last week
Current Illness: Had a cold week before, last felt symptoms 8/13/21
Preexisting Conditions: anxiety w depression, OCD, PTSD, insomnia, eating disorder, HSV, chronic MSK pain
Allergies: Latex, tioconazole, penicillin, sulfa, zithromax, amoxil, iodine, and misoprostol.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: She got Pfizer covid-19 immz at noon yesterday and about 3 min after she noted a sensation of face tingling and at first she thought it might be related to her anxiety. She was already drivinig, was not told to stay. She experienced coughing, numb tongue, numb and itchy red arm. Face numbness. She called office, they told her to call 911, she did, EMTs checked her out, she was cleared and told to go home and take a benadryl. She took benadryl at 2PM, and the tingling improved but numbness continued and she had itchy gums, facial and arm numbness finally resolved around 8PM. Took a nap and when she woke itchy had improved. She did have facial swelling and redness, no facial droop, no dysarthria. She is feeling much improved, still has a lot of arm pain, tenderness, and facial soreness.


VAERS ID: 1592354 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Dyspnoea, Fatigue, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 20mg/day, Metoprolol, Tamsulosin , Lisinopril, Atorvastatin,
Current Illness: None
Preexisting Conditions: Asthma, Heart Disease/arrhythmia, BPH, Hx Recurrent Ventricular Tachycardia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe side effects compared to Moderna 2nd Shot including high fever, teeth rattling chills, joint and muscle pain, sob, severe fatigue and malaise. These sxs were for the Moderna Booster Shot(3rd Shot) Sx resolved after 36 hrs.


VAERS ID: 1592551 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitlopram 10mg, sunflower lecithin, post partum vitamin
Current Illness: Mild allergy congestion
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: *SPORADIC* Light headedness, difficulty breathing, racing heart. Sporadically throughout the day/ night. Not related to physical activity. Lasts from 10-30 minutes.


VAERS ID: 1592579 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain
SMQs:, 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:
Current Illness:
Preexisting Conditions: Fibroma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 51 year old female patient received first dose Moderna at 5:28pm is waiting 15 minutes in the observation area and when she was in pharmacy she felt chest pain and went back to the vaccination Center so the EMT checked her vitals. When the patient was waiting in the observations area she reports her last meal was a protein bar and 4oz of juice at 10am. Vitals at 6pm 160/100 B/P, 98% of SPO2 and 70-80 pulse. At 6:48pm her vital signs were checked again: 180/98 B/P of 100-70, 90-60 pulse. Patient is transported to medical center.


VAERS ID: 1592766 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Pt given Pfizer as second dose. She received Moderna as first dose on 6-28-21


VAERS ID: 1592770 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-08-19
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid positive after vaccination


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