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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 107 out of 6,867

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VAERS ID: 1659038 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Burning sensation, Diarrhoea, Dizziness, Flushing, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (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: Vitamin C, Vitamin D, B-Complex, Vitamin E, Magnesium
Current Illness: none
Preexisting Conditions: urticaria
Allergies: Dairy, eggs, sesame
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15 minutes following vaccine I began having tingling in my outer three fingers on left hand followed by numbness in hand, wrist and forearm. That evening I also had tingling in mouth, lips, tongue and teeth numbness. I also had lightheadedness (last about 5 days), head flushing (5 days), diarrhea (1 day), and elevated blood pressure. It has been almost two weeks, and I still have numbness and tingling on and off in both hands, fingers, wrists, forearms, numbness in teeth, and a burning sensation in both calves and ankles.


VAERS ID: 1659231 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-08-19
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: posi
CDC Split Type:

Write-up: patient tested positive for covid


VAERS ID: 1659490 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-14
Onset:2021-08-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW183 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Neuropathy peripheral
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none, just trying Motrin which always works for any previous headaches but not working with this one.
CDC Split Type:

Write-up: daily severe headache with right sided neuropathy and extreme fatigue lasting over one week starting within 5 days of vaccine. It is still occurring and not letting up. No prior issues with these symptoms before vaccine


VAERS ID: 1659933 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast inflammation, Breast mass, Breast pain, Breast swelling, Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lipodystrophy (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: Aviane 0.10 mg/0.02 mg (birth control)
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Breast Ultrasound results TBD this Friday 8/31/21
CDC Split Type:

Write-up: In the morning of 8/19/21, the left breast was very sore. A lump was discovered under the nipple. In the evening of 8/20/21, the lump had grown in size, the breast was extremely sore and swollen, and a large area of skin under the nipple was red, enflamed and hot. On Monday 8/23/21, NP-C with the Practice, did an examination. The left breast was still swollen and sore, but the redness was gone. The lump had grown to the size of a ping pong ball. He could not determine the cause or provide a diagnosis. He suggested that a gynecological specialist be seen. On Thursday 8/26/21, PA-C with Obstetric and Gynecology did her examination. The lump had reduced slightly to the size of a grape, and the swelling was mostly gone. The soreness had lessened, but occasional pinching type pains remained. PA-C did not provide a cause or diagnosis, but provided a script for a breast ultrasound to examine the lump. The ultrasound is scheduled for this Friday 9/3/21. As of today 8/31/21, the lump is still the same size and is sore to the touch.


VAERS ID: 1659934 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-23
Onset:2021-08-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Neuralgia, Pain
SMQs:, Peripheral neuropathy (narrow), Arthritis (broad)

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

Write-up: Post second dose, patient reports hip joint ache and what seems like a neurological sensation in her left hip. It hurts to stand straight, it hurts to sit. Putting pressure in the site helps the pain. It has been a daily occirabce without real relief.


VAERS ID: 1659947 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-09
Onset:2021-08-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Hives. Started on hands and feet.. prescribed and steroid that helped until doses were gone. Hives returned on my head hands and waist line So unbearable I get a steroid shot seems to help for notes hopefully for good will not get second shot!!!!


VAERS ID: 1660300 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Back pain, Confusional state, Decreased appetite, Dizziness, Dysphagia, Dysstasia, Ear haemorrhage, Electric shock sensation, Gait inability, Insomnia, Migraine, Nausea, Pain in jaw, Renal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Osteonecrosis (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: Zoloft. Nexium. Ventolin.
Current Illness: NA
Preexisting Conditions: Asthma.
Allergies: NA
Diagnostic Lab Data: 082621: Prescribed steroids, muscle relaxers, received Tordol shot. Requested MRI. (Insurance denied.) 083021: Prescribed pain meds and muscle relaxers.
CDC Split Type:

Write-up: Since 081921: Kidney pain. Lasted 8 days. Jaw pain. Lasted 3 days. Trouble swallowing. Lasted 4 days. Bleeding ears. Lasted 1 day. Nausea. Lasted 4 days. No appetite. Lasted 7 days. Vomiting. Lasted 2 days. Migraines. Still occurring. Dizziness. Still occurring. Confusion. Lasted 8 days. Memory loss. Lasted 8 days. Brain zaps. Still occurring. Acute lower back pain. Unable to stand/walk without assistance. Still occurring but getting better with medication use. Unable to sleep due to pain. Lasted 4 days.


VAERS ID: 1660958 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-08-19
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Cigarette smoker (The patient reported that she was a smoker for 25 years, quit at the beginning of the year.); Food allergy
Preexisting Conditions: Comments: The patient had no history of drug abuse or illicit drug use
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210849794

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; COVID-19 INFECTION; This spontaneous report received from a consumer concerned a female of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: allergic to mushrooms, non-alcohol user, and cigarette smoker, and other pre-existing medical conditions included: The patient had no history of drug abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of administration not reported, batch number: unknown and expiry: unknown) dose was not reported, administered 1 total on 19-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 19-AUG-2021, patient experienced symptoms of fever and fatigue (suspected clinical vaccination failure and covid-19 infection). On 23-AUG-2021, Laboratory data included: COVID-19 virus test (NR: not provided) positive.(covid-19 infection). The action taken with covid-19 vaccine was not applicable. The outcome of the covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210846633.; Sender''s Comments: V0:20210849794 - covid-19 vaccine -Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1660960 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Nebraska  
Vaccinated:0000-00-00
Onset:2021-08-19
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Autoscopy, Breast pain, Breast swelling, COVID-19, Dizziness, Euphoric mood, Fatigue, Feeling abnormal, Headache, Malaise, Nausea, Pain in extremity, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Lipodystrophy (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Rash trunk; Stomach cramps
Preexisting Conditions: Medical History/Concurrent Conditions: Flu symptoms (patient had flu symptoms right after flu vaccine for a few days.); Comments: The patient had no illicit drug use, No Illness at time of vaccination. Patient had history of similar event after Flu vaccine which got with pregnancy. The patient had no history of allergy to vaccine or food, had no pre-existing acute illness 30 days prior to vaccination. Patient not pregnant at time of vaccination, not currently breastfeeding and not had breast fed in 3 year. No pre-existing conditions and not have any other suspected causes including co-administered vaccine(s) or risk factors. Patient had normal lymph nodes.
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: SARS-CoV-2 PCR test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210851909

Write-up: BREASTS SWOLLEN AND SORE; FEELING VERY UNWELL; PAIN IN BREASTS; PAIN IN HANDS; CONFIRMED COVID-19 INFECTION; TIRED; NAUSEOUS; OUT OF BODY EXPERIENCE; EXTREMELY LIGHTHEADED; FELT EUPHORIC; FELT WEIRD; MILD, SPLITTING, SLIGHT HEADACHE OVER HER RIGHT EYE, HEAD WAS POUNDING, PERIODIC HEADACHES; This spontaneous report received from a patient concerned a 38 year old female. The patient''s weight was 185 pounds, and height was 175 centimeters. The patient''s past medical history included: flu symptoms, and concurrent conditions included: non alcohol use, non-smoker, extreme stomach cramping, and severe rash on torso, and other pre-existing medical conditions included: The patient had no illicit drug use, No Illness at time of vaccination. Patient had history of similar event after Flu vaccine which got with pregnancy. Patient Not that know of History of allergy to vaccine or food. Patient had not Pre-existing acute illness 30 days prior to vaccination. Patient not pregnant at time of vaccination, no Currently breastfeeding and not had breast fed in 3 year. No pre-existing conditions and not have any other suspected causes including co-administered vaccine(s) or risk factors. Patient had normal lymph nodes. The patient experienced extreme stomach cramping when treated with codeine for extreme stomach cramping, severe rash on torso when treated with hydrocodone, and benzylpenicillin for severe rash on torso. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 1808982 expiry: UNKNOWN) dose was not reported, administered on 19-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-AUG-2021, the patient experienced extremely lightheaded. On 19-AUG-2021, the patient experienced felt euphoric. On 19-AUG-2021, the patient experienced felt weird. On 19-AUG-2021, the patient experienced mild, splitting, slight headache over her right eye, head was pounding, periodic headaches. On 20-AUG-2021, the patient experienced out of body experience. On 20-AUG-2021, the patient experienced tired. On 20-AUG-2021, the patient experienced nauseous. On 23-AUG-2021, the patient experienced confirmed covid-19 infection. Laboratory data included: SARS-CoV-2 PCR test (NR: not provided) Positive. On 25-AUG-2021, the patient experienced pain in breasts. On 25-AUG-2021, the patient experienced pain in hands. On an unspecified date, the patient experienced breasts swollen and sore, and feeling very unwell. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from extremely lightheaded on 19-AUG-2021, felt euphoric, felt weird, out of body experience, tired, and nauseous on 24-AUG-2021, and pain in breasts, and pain in hands, had not recovered from mild, splitting, slight headache over her right eye, head was pounding, periodic headaches, and feeling very unwell, and the outcome of confirmed covid-19 infection and breasts swollen and sore was not reported. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment is not required as per standard procedure as case assessed as non-serious.


VAERS ID: 1661177 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-15
Onset:2021-08-19
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210818; Test Name: Nasal Swab/PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101075231

Write-up: Breakthrough CV19 + on 19Aug2021; Breakthrough CV19 + on 19Aug2021; This is a spontaneous report from a contactable other hcp. A 57-year-old male patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number: EL3247), via intramuscular route of administration, administered in Arm Right on 27Jan2021(at the age of 57-years-old) DOSE 1, SINGLE, patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number: EL3247), via intramuscular route of administration, administered in Arm Right on 15Feb2021 (at the age of 57-years-old) as DOSE 2, SINGLE for covid-19 clinic. The patient medical history was not reported. The patient''s concomitant medications were not reported. It was unknown if patient received any other vaccines within 4 weeks prior to the COVID vaccine. It was reported that Prior to vaccination, it was unknown was the patient diagnosed with COVID-19. Since the vaccination, the patient was tested for COVID-19. The patient experienced breakthrough COVID-19 positive on 19Aug2021. Therapeutic measure were taken as no as a result of event. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 18Aug2021 (Nasal Swab). Outcome of event was Not recovered. No routine follow-up attempts are foreseen for reports received from WEB. Information about lot number has already obtained. No further info is expected.; Sender''s Comments: Based on the available information in the case, the causal association between the events vaccination failure, COVID-19 and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.


VAERS ID: 1661218 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEK; FLONASE ALLERGY RELIEF
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Hypersensitivity
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: Fever; Result Unstructured Data: Test Result:High fever; Comments: High fever started 10 hours after shot lasted for 24 hours. 102-104.7 fever above 104 for 4 hours
CDC Split Type: USPFIZER INC202101090052

Write-up: High fever started 10 hours after shot lasted for 24 hours. 102-104.7 fever above 104 for 4 hours; This is a spontaneous report from a contactable consumer (patient). A 12-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EW0173), via an unspecified route of administration, administered in left arm on 19Aug2021 12:00 (at the age of 12-year-old) as dose 2, single for COVID-19 immunisation. Medical history included allergies and asthma from an unknown date. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EW0164), via an unspecified route of administration in left arm, on 29Jul2021 17: 30 (at the age of 12-year-old), as single dose for COVID-19 immunization. Patient had no known allergies. Concomitant medications included cetirizine hydrochloride (ZYRTEK) and fluticasone propionate (FLONASE ALLERGY RELIEF) both taken for an unspecified indication. Prior vaccination, patient was not diagnosed with COVID and did not receive other vaccine in four weeks. On 19Aug2021 22:00, the patient experienced high fever which started 10 hours after the shot, temperature was 102-104.7, where temperature was above 104 for 4 hours. The fever lasted for 24 hours. The event resulted in doctor''s office visit/urgent care.. The patient was not tested COVID since vaccination. Therapeutic measures in response to the event included, alternate use of Ibuprofen 800 mg and Aspirin 600 mg. The outcome of the event was recovered on 20Aug2021 22: 00. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1662131 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-12
Onset:2021-08-19
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, Prolia
Current Illness:
Preexisting Conditions: Polymyalgia rheumatica
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization due to COVID-19 Reporting per Pfizer COVID-19 Vaccine EUA


VAERS ID: 1662143 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-10
Onset:2021-08-19
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive with cycle threshold of 19.1 on 8/19/21
CDC Split Type:

Write-up: Hospitalization due to COVID 19 Reported per Pfizer COVID-19 Vaccine EUA


VAERS ID: 1662158 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-04
Onset:2021-08-19
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR positive with cycle threshold of 19 on 8/19/21
CDC Split Type:

Write-up: Hospitalization due to COVID-19 Reported per Moderna COVID-19 Vaccine EUA


VAERS ID: 1662195 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH OW0170 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Rabbis
Other Medications: Tylenol 500 mg, omeprazole 20 mg twice daily, montelukast 10 mg, methylcobalamim 2500 mg, gabapentin 400 mg 4 times daily, calcium, losartan 25 mg twice daily, fluticasonepropionate
Current Illness: None
Preexisting Conditions: arthritis, fibromyalgia, budging disc, cracked vertebra,
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I had pain shooting up and down my arm and my hand is numb, and my arm and shoulder is in constant pain.


VAERS ID: 1662264 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin C, D and E
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: next day after being vaccinated, I had pain all over my body with joint pain. 2 days after getting the vaccine, i had to go to urgent care as i developped a rash on my right shoulder in the front and back. I was told it is Shingles and prescribed Valtrex. I still feel the shingles today and rashes are almost all gone.


VAERS ID: 1662285 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Chest pain, Cold sweat, Decreased appetite, Feeling hot, Gait disturbance, Headache, Injection site pain, Musculoskeletal stiffness, Neuromyopathy, Pain, Pain in extremity, Pruritus, Pyrexia, Rash erythematous, Rash papular, Sinus disorder, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 80mg four times daily Estradiol10mcg insert 2x week Pantoprazole 40mg daily AM Famotidine 40mg daily PM Calcium Carbonate 500mg, twice a day Vitamin D3 1000iu daily Zinc 10mg daily Krill oil 1000mg daily B-Complex time releas
Current Illness: autoimmune related neuromuscular disease - CIDP , osteopenia and tachycardia
Preexisting Conditions: autoimmune related neuromuscular disease - CIDP
Allergies: Tinidazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neuromuscular symptoms (poor balance, difficulty walking, tremors) increased within hour after shot. Took Tylenol and vitamin C per pharmacist instruction. Rested. By 4 hours later, took another Tylenol for stiff neck, headache, closed sinuses, injection site pain. By next morning (8/20/2021), symptoms remained with addition of fever, body aches, cold sweats, slight chest pain, inappetence. Fever broke on 8/21/2021, but took the whole day to recoup. Noticed on 8/22/2021 arm still hurts, raised red rash, itchy, hot. Took a couple of days to go away, but neuromuscular problems remain heightened.


VAERS ID: 1662395 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-08-19
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Infection, 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prilosec, sucralfate
Current Illness: none
Preexisting Conditions: gastritis, b12 deficiency
Allergies: codeine, dilaudid, paxil, penicillin, imitrex
Diagnostic Lab Data: + covid 19 test on 8/19/2021
CDC Split Type:

Write-up: Patient had a breakthrough case of Covid 19. Positive covid test was 8/19/2021. She received regencov the same day. She had previously received her moderna covid vaccines on 2/25/21 & 3/26/21


VAERS ID: 1662399 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-08-19
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Myalgia, Nasal congestion, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: yes
Allergies:
Diagnostic Lab Data: Rapid test resulted positive on 8-26-2021
CDC Split Type:

Write-up: fever, muscle aches, sore throat, cough, headache, fatigue, nasal congestion


VAERS ID: 1662524 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-02-24
Onset:2021-08-19
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Chills, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Headache, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Covid-19 Positive
CDC Split Type: vsafe

Write-up: I woke up with a headache and I was a little dizzy. I did not have a fever until a few hours later. I tested positive on 08/19/2021. I had a fever, chills, and congestion at the top of my lungs. I had little appetite and those symptoms lasted about three days. I had diarrhea for about two days. I started to improve after five days, and I was pretty fatigued after that. I improved slowly and returned to work after three days.


VAERS ID: 1662663 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-06
Onset:2021-08-19
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, Claritin, Mobic, zantac, calan, Cymbalta
Current Illness: none
Preexisting Conditions: seizure disorder, fibromyalgia, seasonal allergies
Allergies: cinnamon, codeine, ketchup
Diagnostic Lab Data: covid swab
CDC Split Type:

Write-up: Developed Covid infection in august 2021


VAERS ID: 1662734 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-05
Onset:2021-08-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Two weeks later he woke up midnight and went to the bathroom and he had chills and according to him his whole body was shaking and was very cold and was really tired the next day. So we went to the doctor and she just asked question and just listened to his heart but couldn''t figure out what it was.


VAERS ID: 1662921 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-06
Onset:2021-08-19
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Condition aggravated, SARS-CoV-2 test positive, Single functional kidney
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Norvasc, Lipitor, Coreg, Calcitriol, Hydrodiuril, Actemra
Current Illness:
Preexisting Conditions: Rheumatoid arthritis, osteoporosis, solitary kidney, h/o stroke, hyperlipidemia, CAD, HTN, CKD stage 3, obesity,
Allergies: Augmentin, Cefzil, Ciproflozacin
Diagnostic Lab Data: COVID positive test on 08/19/2021.
CDC Split Type:

Write-up: Fully vaccinated patient admitted through ED for mild COVID and management of acute kidney injury due to solitary kidney. Discharged without O2.


VAERS ID: 1662998 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Eye pruritus, Fatigue, Feeling abnormal, Headache, Injection site pain, Nasal congestion, Pain
SMQs:, Anaphylactic reaction (narrow), Dementia (broad), 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: Multi vitamins
Current Illness: None
Preexisting Conditions: Mild Asthma, Grover''s disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type: NA

Write-up: Days 2-4 after vaccine: body ache, tiredness, occasional headache, muscle pain where shot was administered on first day Days 6-7: light cough, stuffy nose Days 8-14: Tired, itchy eyes, foggy headed, intermittent headaches,


VAERS ID: 1663079 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-27
Onset:2021-08-19
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid 19 positive
CDC Split Type:

Write-up: tested positive for covid on reaction date


VAERS ID: 1665624 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-29
Onset:2021-08-19
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Dizziness, Epistaxis, Extra dose administered, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Joint pain; Lupus erythematosus
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Feels exhausted,Tired; Very bad joint pain; Dry blood in each nostril; High temperature of 100.9 degrees; Nausea; Feeling dizzy; Vomiting; Extra dose administered; This spontaneous case was reported by a consumer and describes the occurrence of EPISTAXIS (Dry blood in each nostril), PYREXIA (High temperature of 100.9 degrees), NAUSEA (Nausea), DIZZINESS (Feeling dizzy), VOMITING (Vomiting), FATIGUE (Feels exhausted,Tired) and ARTHRALGIA (Very bad joint pain) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 051C21A, 012L20A and 003A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Lupus erythematosus and Joint pain. Concomitant products included PARACETAMOL (TYLENOL) for an unknown indication. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced EXTRA DOSE ADMINISTERED (Extra dose administered). On 21-Aug-2021, the patient experienced EPISTAXIS (Dry blood in each nostril) (seriousness criterion hospitalization prolonged). On an unknown date, the patient experienced PYREXIA (High temperature of 100.9 degrees) (seriousness criterion hospitalization prolonged), NAUSEA (Nausea) (seriousness criterion hospitalization), DIZZINESS (Feeling dizzy) (seriousness criterion hospitalization), VOMITING (Vomiting) (seriousness criterion hospitalization), FATIGUE (Feels exhausted,Tired) (seriousness criterion hospitalization) and ARTHRALGIA (Very bad joint pain) (seriousness criterion hospitalization). The patient was hospitalized for 2 days until 21-Aug-2021 due to DIZZINESS, NAUSEA and VOMITING, and then for 2 days due to PYREXIA. On 19-Aug-2021, EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. At the time of the report, EPISTAXIS (Dry blood in each nostril), PYREXIA (High temperature of 100.9 degrees), NAUSEA (Nausea), DIZZINESS (Feeling dizzy), VOMITING (Vomiting), FATIGUE (Feels exhausted,Tired) and ARTHRALGIA (Very bad joint pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100 degree (High) High. No treatment information was provided. It was reported that patient had history of autoimmune disorder of Lupus with positive ANA that was diagnosed with prior to receiving the vaccine a few years. It was reported that patient''s was back and had something to eat. 1st dose received on: 29Jan2021, left arm, IM injection, Lot: 012L20A, Expiration: Unknown 2nd dose received on:26Feb2021, left arm, IM injection, Lot: 003A21A, Expiration: Unknown Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, medical history of Lupus with positive ANA (LLT: Lupus erythematosus) and joint pain (LLT Joint pain) could be confounding factors for the case.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, medical history of Lupus with positive ANA (LLT: Lupus erythematosus) and joint pain (LLT Joint pain) could be confounding factors for the case.


VAERS ID: 1665716 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-03
Onset:2021-08-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood magnesium normal, C-reactive protein normal, Chest X-ray normal, Chest discomfort, Chest pain, Differential white blood cell count, Electrocardiogram normal, Full blood count normal, Metabolic function test normal, Pain, Pain in extremity, Red blood cell sedimentation rate normal, Sleep disorder, Troponin normal
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins, benedryl, advil
Current Illness: none
Preexisting Conditions: insomina
Allergies: none
Diagnostic Lab Data: 22nd - ER visit - EKG, Chest X-Ray, blood test for metabolism, magnesium level, troponin levels (2x) C-reactive protein level, complete blood count with differential, sed rate, IV med outcome: all tests came back within normal range, nothing of note in EXG or chest X-rate
CDC Split Type:

Write-up: event: severe chest pain / pressure on right side that woke me up from sleep. (Thursday, 19). some radial extension to right arm for only a short period treatment: 19th - OTC advil;


VAERS ID: 1665730 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665746 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665975 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665976 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666002 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666005 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666072 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666262 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-08-19
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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? 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: Covid Positive due to contact with friends


VAERS ID: 1666263 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-08-19
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19
SMQs:, Supraventricular tachyarrhythmias (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19, Atrial Fib


VAERS ID: 1666336 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OSOCZIA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Axillary pain, Coeliac disease, Condition aggravated, Fatigue, Hypoaesthesia, Impaired work ability, Inflammation, Injection site pain, Injection site pruritus, Lymphadenopathy, Malaise, Nausea, Pain, Pain in extremity, Paraesthesia, Peripheral swelling, Rash, Rash pruritic, Swelling, Tenderness, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (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: Flu vaccine - fever, chills, nausea, vomiting, extremely sore arm at injection site
Other Medications: Tri-phasic birth controll pill, Zyrtec allergy pill, Flonase nasal spray, Vitamin C, Apple Cider Vinegar pills, Probiotic, Viactic calcium supplement.
Current Illness: None
Preexisting Conditions: Celiac disease (diagnosed about 13 years ago)
Allergies: Allergic to gluten (wheat, rye, barley, oats) and sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the first dose of the Moderna COVID vaccine on Wednesday, 8/18/21. I began to experience the extremely sore arm about 6 hours after the injection. The next evening, Thursday, 8/19, my arm was still extremely sore and it was beginning to itch at the injection site. The next evening, Friday 8/20, my arm was still extremely sore and I had developed a very small itchy rash. I used a topical steroid cream on the rash through the weekend (8/21-8/22) and it cleared up. The soreness in my arm had subsidized by the end of the weekend as well. I woke up at 2:30 am on Monday, 8/23, not feeling well. I was achy all over, had abdominal pain and felt nauseous. I stayed home from work and slept all day, I was exhausted and had no energy. My left armpit had been hurting all day so I checked it and realized the lymph node was very swollen?about the size of an egg. By that evening, I noticed the area around my left collarbone was also swollen and tender. The next morning, Tuesday, 8/24, I woke up with very sore and swollen glands in my neck. The glands in my left armpit and collarbone were still swollen and sore. I went to work and continued to be very tired. During the day, my left hand began to feel tingly and numb. The next morning, Wednesday, 8/25, I woke up still feeling tired and my lymph nodes were still swollen along with the tingly/numbness in left hand. My left arm was slightly swollen and was beginning to feel itchy at the injection site. I went to work and called my doctor and scheduled an appointment for 1:00 pm that day. When I saw my doctor, she noted the swollen lymph nodes and the slight swelling/rash on my left arm. She felt all the symptoms I had been experiencing were a result of the vaccine. I was curious about the tingling/numbness in my left arm and she thought that was inflammation as a result of the vaccine. She told me to use an ice pack and topical steroid cream on my arm, a warm compress on my lymph nodes and Tylenol for pain. I had put an ice pack on my arm that afternoon but the swelling continued to get worse. By that evening the swelling in my arm had gotten much worse and the area was extremely itchy and was breaking out in hives. I woke up at 1:30 am on Thursday, 8/26, with severe pain in my upper left arm and numbness in my hand. I got up to check it and the hives had gotten worse and I couldn?t feel my hand. I put the ice pack on my arm and took more Tylenol. I went to work that day and continued to feel worse and the swelling/itching on my arm continued to get worse. By that evening my arm was extremely swollen and I had a patch of hives that measured 5 inches tall and 4 inches wide on my upper left arm. I continued to use the ice pack, topical steroid cream, calamine lotion, Tylenol and Benadryl for my arm. The next day, Friday, 8/27, I felt exhausted again so I stayed home from work. The swelling/pain/hives on my arm were the same and I continued to treat it with ice, Tylenol, antihistamine, steroid cream and calamine lotion. The lymph nodes in my armpit and collar bone were still swollen and my left hand was still tingly/numb. I sent an online message to my doctor telling her that I had gotten worse since she saw me on Wednesday explaining my issues and provided her with pictures of my arm. She called me that evening and discussed my situation. The next day, Saturday, 8/28, I still felt tired but had more energy. It was also the first day that I didn?t wake up with new or worsening symptoms. I continued to treat my arm with ice, antihistamine and creams. The next day, Sunday, 8/29, I woke up feeling better. My hives were starting to fade out and the swelling was going down. I woke up on Monday, 8/30, feeling about 80% normal and the hives were faded out and swelling of my arm was minimal. Today is Thursday, 9/2, and my left arm is completely back to normal. I continue to have swollen lymph nodes in my left armpit and collarbone areas but appear to be a little smaller. I continue to have tingling/numbness in my left hand that comes and goes but seems to be getting better. I have celiac disease and the other side effect I experienced from 8/23 ? 8/30 was feeling like I had ingested gluten when I had not. I experienced my normal tell-tale symptoms of being ?glutened? so I wonder if in response to the vaccine my body was producing antibodies to fight gluten even though I hadn?t ingested any. That has cleared up now.


VAERS ID: 1666344 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-08-19
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Fatigue, 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, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet; atorvastatin (LIPITOR) 10 MG tablet; bethanechol (URECHOLINE) 10 MG tablet; clopidogrel (PLAVIX) 75 MG tablet; donepezil (ARICEPT) 5 MG tablet; latanoprost (XALATAN) 0.005 % ophthalmic solution; memantine (
Current Illness: None known
Preexisting Conditions: Cerebral infarction (HCC); Glaucoma; PMR (polymyalgia rheumatica) (HCC); Gastroesophageal reflux disease with esophagitis; Essential hypertension with goal blood pressure less than 140/90; Osteopenia; Daytime hypersomnia; LVH (left ventricular hypertrophy); Anemia, unspecified type; Need for prophylactic vaccination with tetanus-diphtheria (Td); Medication refill; Overweight; Vitamin B12 deficiency; Elevated; sedimentation rate; Polymyalgia rheumatica (HCC); Depression screening; Primary osteoarthritis of knee, unspecified laterality; History of stroke; Late onset Alzheimer''s disease without behavioral disturbance (HCC); PVD (peripheral vascular disease) with claudication (HCC)
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 8/19/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 8/20/2021 with fatigue. She had tested positive for COVID-19 on 8/19/2021. She was admitted and started on dexamethasone. She was discharged on 9/1/2021 to a skilled nursing facility.


VAERS ID: 1666445 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-06
Onset:2021-08-19
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive COVID-19 test on 8/19/2021


VAERS ID: 1666480 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-24
Onset:2021-08-19
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive COVID-19 Test on 08/19/2021


VAERS ID: 1666559 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head abnormal, Computerised tomogram neck, Eyelid function disorder, Facial paralysis, Full blood count normal, Metabolic function test normal
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, losartan, amlodipine, lipitor
Current Illness: none
Preexisting Conditions: CVA, HTN
Allergies: nkda
Diagnostic Lab Data: CT brain on 9/2/21 (subsequent visit after sx persisted) showed: IMPRESSION: 1. No acute intracranial hemorrhage, significant mass effect, or midline shift. 2. Sequela of extensive chronic microvascular ischemic disease. CT soft tissue neck: unremarkable on 9/2/21 CBC and BMP unremarkable on 9/2/21
CDC Split Type:

Write-up: Bells palsy occurred 2 days after Pfizer vaccine. Left facial droop and difficulty closing left eye, no other neurologic deficits, no other recent viral illness.


VAERS ID: 1666561 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-08
Onset:2021-08-19
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acquired diaphragmatic eventration, Aortic arteriosclerosis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Diarrhoea, Dyspnoea, Fatigue, Headache, Hypoxia, Lung opacity, Malaise, Nausea, Oropharyngeal pain, Pain, Presyncope, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (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), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: unknown
Current Illness: unknown
Preexisting Conditions: PMHx of HTN, HLD, central retinal vein occlusion of L eye 10/2013 (on ASA 325mg), GERD, vertigo
Allergies: clindamycin
Diagnostic Lab Data: Diagnostic Results; (08/25/2021 10:17 CDT XR Chest Portable); Reason For Exam soa; Report EXAMINATION: XR Chest Portable; INDICATION: soa; VIEWS: 1 view; COMPARISON: None; FINDINGS: Normal cardiomediastinal silhouette with atherosclerotic calcifications in the thoracic aorta. Left lower lung zone patchy airspace opacities. No pleural effusions. No pneumothorax. No acute osseous abnormalities. Nonspecific elevation of the right hemidiaphragm. IMPRESSION: Left lower lung zone patchy airspace opacities, may be related to the patient''s known COVID-19 pneumonia.
CDC Split Type:

Write-up: Chief Complaint diagnosed with coivd 5 days ago. having malaise, fatigue, shortness of breath at times. vomitted this morning and near syncopal episode today; History of Present Illness - Patient is a 70yo man with PMHx of HTN, HLD, central retinal vein occlusion of L eye 10/2013 (on ASA 325mg), GERD, vertigo, who was admitted to internal medicine on 8/25 for further management of hypoxemia and COVID-19 pneumonia. He reports that on Wednesday 8/18 he started to have a sore throat, body aches, chills, and subjective fevers which were worse by Thursday. He was seen by his PCP on Thursday and tested positive for COVID-19 pneumonia, and started on prednisone 20mg, levofloxacin 500mg, and prescribed an albuterol inhaler. He also notes that he was prescribed apixaban 2.5mg bid for DVT ppx. He states that he was doing ok until Saturday when he developed a cough and dyspnea which has gotten significantly worse since that time. He also has been experiencing nausea, vomiting, and diarrhea, but feels like he''s been tolerating po intake well. He presented today because he had a presyncopal episode today and felt extremely fatigued. He states that his highest fever at home was 100.1 which was on Thursday. He states that he has been vaccinated with his last dose of Pfizer being in 3/21. He has not had any recent travel or known sick exposures. He states that currently his primary symptoms are a severe headache as well as a cough and dyspnea.


VAERS ID: 1666587 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Patient''s father falsified at pharmacy in order to obtain his vaccination early, giving the pharmacy a DOB of 8/9/2009 rather than his actual DOB of 11/9/2009. This falsification was caught and notice was given to Pharmacy on 9/2/21. Two phone calls to the father were attempted, but he hung up the phone once, and would not answer the second time so a voice mail was left to confirm that he has not had any adverse effects due to early vaccination. Patient''s PCP was notified of the vaccination and it was requested that her nurse attempted to contact Patient''s father to confirm that patient has not experienced any adverse effects and to confirm that he will need to consult his PCP for further vaccinations of COVID 19 after 11/9/2021.


VAERS ID: 1666676 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event, Wrong 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: The patient was supposed to get the Moderna vaccine but was given the Pfizer vaccine instead. No adverse event occurred with patient.


VAERS ID: 1666736 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-08-19
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (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), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose02/18/21 2nd dose03/12/21 Diagnosed covid positive:08/24/21 Symptom onset:08/19/21 Exposure:COMMUNITY Symptoms:fever, SOB,fatigue,muscle aches,sore throat,diarrhea,chills, runny nose,HA


VAERS ID: 1666831 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-08-19
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: Patient became ill and tested PCR positive for Covid $g 14 days after the completion of vaccine series


VAERS ID: 1666882 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-05
Onset:2021-08-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / IM

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

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

Write-up: Patient stated she lost hearing in 1 ear about 2 weeks after receiving vaccine


VAERS ID: 1666890 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-14
Onset:2021-08-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Pulmonary embolism, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: idiopathic pulmonary fibrosis, oxygen dependent
Preexisting Conditions:
Allergies: mold, dust mites
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine on 8/14/21 and on 8/16/21 had a syncopal episode that was ultimately diagnosed as a deep venous thrombosis and pulmonary embolism on 8/17/21


VAERS ID: 1667135 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-02-24
Onset:2021-08-19
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Culture urine, Dehydration, Dizziness, Fatigue, Herpes zoster, Nephrolithiasis, Pneumonia, Rash, Ultrasound scan, Urinary retention, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins - Multi Vitamin; Calcium; Biotin; B12; Amlodipine; Losartan HCL; Valacyclovir
Current Illness: No
Preexisting Conditions: Hypertension - controlled with medicine; orthopedic stuff
Allergies: Statins
Diagnostic Lab Data: UTI culture and sensitivity tests
CDC Split Type: vsafe

Write-up: No fever but chills, extreme fatigue, dizziness, and that was main thing. When I stood up the dizziness was overwhelming. I have never had chills like that before - ever. After I was back from vacation - on the 19th - I went to Urgent Care - I had a UTI - positive for that - had prednisone and antibiotic and I had it because later found out I had the kidney stones. Prior to that, on vacation, I had sun poisoning (rash) and dehydration and couldn''t urinate on vacation - they gave me fluids at some Urgent Care don''t remember the name, and gave cream for my skin and prior to vacation, I had shingles before I left. I had mild shingles at this time - because I knew to start the medicine. Was told I had a UTI and Pneumonia - they said I had a slight Pneumonia - I wasn''t short of breath. Later on, I discovered I had a kidney stone - about a week and a half after - I went to my doctor and he told me to get a sonogram which I did. It has passed now. I''m just sore now. I had another sonogram but haven''t had the results yet. Dr.


VAERS ID: 1669593 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-08-19
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Blood test, Glycosylated haemoglobin, Groin pain, White blood cell count
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN; ELIQUIS; GLIPIZIDE; SIMVASTATIN; LISINOPRIL; ASA
Current Illness: Cigarette smoker (Patient smokes at least 1 pack per day and sometimes 1.5 packs or more per day. Lately in the past 2 weeks, the patient has been smoking more than 1.5 packs per day.); Diabetes
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210822; Test Name: Blood test; Result Unstructured Data: Not reported; Test Date: 20210823; Test Name: HbA1C; Result Unstructured Data: high; Test Date: 20210823; Test Name: WBC count; Result Unstructured Data: normal
CDC Split Type: USJNJFOC20210902721

Write-up: ABDOMINAL PAIN IS ON THE LOWER RIGHT SIDE AND IS ALSO RADIATING TO THE HIP AND AROUND THE BACK AND IS CONSISTENTLY THERE AND SOMETIMES GETS WORSE WITH MOVEMENT; GROIN PAIN WAS ONGOING BUT COMES AND GOES; This spontaneous report received from a patient concerned a 53 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: cigarette smoker, and diabetes, and other pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 21-SEP-2021) dose was not reported, administered on 19-AUG-2021 for prophylactic vaccination. Concomitant medications included glipizide for diabetes, metformin for diabetes, acetylsalicylic acid for drug used for unknown indication, apixaban for drug used for unknown indication, lisinopril for drug used for unknown indication, and simvastatin for drug used for unknown indication. On AUG-2021, treatment medications included: ibuprofen. On 19-AUG-2021, the patient experienced groin pain was ongoing but comes and goes. On 20-AUG-2021, the patient experienced abdominal pain is on the lower right side and is also radiating to the hip and around the back and is consistently there and sometimes gets worse with movement. On 22-AUG-2021, Laboratory data included: Blood test (NR: not provided) Not reported. On 23-AUG-2021, Laboratory data included: HbA1C (NR: not provided) high, and WBC count (NR: not provided) normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from abdominal pain is on the lower right side and is also radiating to the hip and around the back and is consistently there and sometimes gets worse with movement, and groin pain was ongoing but comes and goes. This report was non-serious.


VAERS ID: 1670086 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Muscle twitching
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Multi Vitamin/Probiotic
Current Illness: N/A
Preexisting Conditions: Low platelets (just below normal range)
Allergies: N/A
Diagnostic Lab Data: None yet to date. Following up with neurologist.
CDC Split Type:

Write-up: After 1st dose I experienced abdominal muscle twitches in the evening that subsided, but gradually over the next few days came back and have persisted intermittently all over body. These are now at 2 weeks post first does still being felt in my calves, fingers, thighs, stomach, and a few in my tongue. I have visited my physician who wanted me to report. I also experienced menstral like cramps on day 3 despite being in the part of my cycle post ovulation, pre-menstruation.


VAERS ID: 1670092 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Cerebral venous sinus thrombosis, Seizure, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Pfizer COVID-19 vaccine on 8/19. I do not know where he got the vaccine. The following day he was noted to have altered behavior and ultimately seizures. Additional testing discovered the presence of a venous sinus thrombosis. He also has thrombocytopenia though this is a chronic issue. The possibility of a vaccine induced immune thrombotic thrombocytopenia has been considered and thus we will need to file a VAERS report. I was told that this could be initiated through Agency. There are atypical features that suggest that this might not be vaccine related (type of vaccination, age and gender patient, near immediate onset of symptoms, and alternative potential etiology for thrombosis (cirrhosis)). That being said, there is a temporal relationship between venous and thrombosis in COVID-19 vaccine, I think we do have to file a VAERS report.


VAERS ID: 1670237 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Drainage, Erythema, Feeling hot, Hidradenitis, Injected limb mobility decreased, Injection site warmth, Nodule, Sensory disturbance, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Only thing taken at home is the occasional ibuprofen and Tumeric supplements (not consistent)
Current Illness: I suffer from HS (Hidradenitis Suppurativa) and I had a low/mild flares in both armpits as well as other areas.
Preexisting Conditions: Hidradenitis Suppurativa
Allergies: Allergy to Sudafed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started about 20 minutes after injection. It started out very similar to when you hit your funny bone.. and it went throughout my arm. Then I started to feel heat building on that side. Definitely at the injection site (expecting that) but then it started to REALLY build in my arm pit. By the time I got home (28 min drive) I had a full blown flare. At first I didn''t think anything of it. I knew my immune system was going to take a hit which was going to mess with my condition but I had no idea it would be to THIS extent. After a week and I was able to lift my arm a little and proceed to drain my flares - I have INTENSE red/purple discoloration and I am draining from about 4 different places (I did not poke/lance, they started draining on their own). I also had (and still have) localized heat at the injection site. Up until a few days ago, I had a large knot and the red/heat was growing in diameter. At it''s peak, reached about 3.5-4 inches. The red did dissipate but the heat did not. That is still present I have pictures depicting all of this.


VAERS ID: 1670257 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / -

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

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

Write-up: Had hives on my legs, back, and arms for about 7 days.


VAERS ID: 1670563 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670592 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670600 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error, Improper Storage temperature.


VAERS ID: 1670606 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670614 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670617 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670629 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670677 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670714 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670732 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1670816 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-12
Onset:2021-08-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dyspnoea, Fatigue, Lung opacity, Pain in extremity, Peripheral artery occlusion, Pulmonary embolism, Scan with contrast abnormal, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamotrigine, Metformin, Tresiba FlexTouch 200 unit/mil solution pen injector, Novolog FlexPen solution pen injector, Lisinopril, Rosuvastatin calcium, Aspirin, Fexofenadine, Fluticasone Propionate suspension spray, Armodafinil, Fluocinolone
Current Illness: None
Preexisting Conditions: Diabetes Mellitus type 2, Obesity, Obsessive-compulsive disorder, Bipolar 2 disorder, Obstructive Sleep Apnea, Carpal Tunnel Syndrome, Hypogonadism in male, PTSD, Essential Hypertension, Low back pain of multiple sites of spine with sciatica, Seasonal Allergies, Gastroesophageal Reflux Disease, Asthma, Sciatica, Environmental Allergies, Polyarthritis, Insulin long-term use
Allergies: Metoprolol succinate
Diagnostic Lab Data: Venous Duplex Lower Left Extremity- Interval recanalization of previously occluded left popliteal vein with residual nonocclusive thrombus in the distal femoral vein and popliteal vein. Persistent occlusion of the left peroneal trunk and posterior tibial vein. No sonographic evidence of deep venous thrombosis of the right lower extremity above the calf. CT/CTA Chest for PE w/wo IV CON- The pulmonary arteries are well opacified. Thre are filling defects in the proximal aspects of the primary branches of the right lower lobe pulmonary artery. There are no other visible filling defects. The lungs are clear. There is no evidence of mediastinal or hilar adenopathy. Pleural surfaces are unremarkable. The thoracic aorta is normal. RV/LV ratio is 0.8.
CDC Split Type:

Write-up: Patient had Moderna vaccine on 8/12/2021 by Pharmacy. Patient had an appointment with our facility on 8/20/2021 for left leg pain that started the night before. He states it felt like a slight twinge that was more severe by his appointment. Was sent to the Emergency Room on 8/20/2021 and was diagnosed with left popliteal DVT. He was prescribed Eliquis and told to follow up with our facility 3 days later. Patient called on 8/25/2021 stating he felt worn out after moving around for a few minutes and needed to take breaks to catch his breath. Patient''s doctor at our facility recommended him go the Emergency Room due to concern of pulmonary embolism. CTA on 8/25/2021 was positive for pulmonary emboli in the right lower lobe. The patient has no personal or family history of DVT.


VAERS ID: 1670859 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamcinolone 0.5% topical Ensure oral liquid Ketotifen 0.025% eye drops Cetirizine 10mg po Zyprexa 5mg po Prazosin 2mg capsule Omeprazole 20mg po
Current Illness: History of positive ppd
Preexisting Conditions: R63.4 Abnormal weight loss L24.89 irritant contact dermatitis due to other agents F63.81 Intermittent Explosive disorder F60.3 Borderline personality disorder Se patient record for more.
Allergies: None Known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client did not have any adverse reactions to the Moderna covid 19 vaccine. clients age is the reason for reporting this.


VAERS ID: 1671155 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chest discomfort, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Injection site pain, Myalgia, Oedema peripheral, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: After the vaccine she experienced two days of fever, fatigue, generalized myalgias, headache, sweating, leg edema, chest discomfort, SOB (felt it was difficult to take a deep breath), and b/l burning leg pain. Majority of sx have resolved by date of visit 9/3/21 although still experiencing R upper arm pain at injection site, intermittent headache, and leg swelling/pain. The sx have all improved significantly and edema is nearly resolved today. The pain has been circumferential.


VAERS ID: 1672094 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E2A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, 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:
Current Illness: Allergy to topical drugs (Estrogen cream); Drug allergy (Birth control pills); Drug allergy (Aleve)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PVIUS2021001200

Write-up: Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches; Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches; Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches; Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches; This spontaneous case was reported by a consumer and describes the occurrence of INJECTION SITE WARMTH (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE SWELLING (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE ERYTHEMA (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches) and INJECTION SITE INDURATION (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 061e2a) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Aleve), Allergy to topical drugs (Estrogen cream) and Drug allergy (Birth control pills). On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form once. On 19-Aug-2021, the patient experienced INJECTION SITE WARMTH (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE SWELLING (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE ERYTHEMA (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches) and INJECTION SITE INDURATION (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches). At the time of the report, INJECTION SITE WARMTH (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE SWELLING (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches), INJECTION SITE ERYTHEMA (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches) and INJECTION SITE INDURATION (Large swollen area where recd injection red hard and hot to touch went from two inches to 4 inches) was resolving. Relevant concomitant medications were not reported. The treatment information was not provided.


VAERS ID: 1672599 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Chills; Low fever; Vomiting; This spontaneous case was reported by a consumer and describes the occurrence of CHILLS (Chills), PYREXIA (Low fever) and VOMITING (Vomiting) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced CHILLS (Chills), PYREXIA (Low fever) and VOMITING (Vomiting). At the time of the report, CHILLS (Chills), PYREXIA (Low fever) and VOMITING (Vomiting) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication were not reported. Treatment medication were not reported.


VAERS ID: 1672626 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-04
Onset:2021-08-19
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Immunocompromised
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Got her third dose; Fever after second dose; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever after second dose) and EXTRA DOSE ADMINISTERED (Got her third dose) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026A21A, 012M20A and 017E21A) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In 2021, the patient experienced PYREXIA (Fever after second dose). On 19-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXTRA DOSE ADMINISTERED (Got her third dose). On 19-Aug-2021, EXTRA DOSE ADMINISTERED (Got her third dose) had resolved. At the time of the report, PYREXIA (Fever after second dose) outcome was unknown. No concomitant medications were provided. Treatment medication was not provided. Reporter did not allow further contact


VAERS ID: 1672631 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Oregon  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: received a Moderna vaccine from a vial that should have been discarded; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (received a Moderna vaccine from a vial that should have been discarded) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 035C21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021 at 11:17 AM, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021 at 11:17 AM, the patient experienced EXPIRED PRODUCT ADMINISTERED (received a Moderna vaccine from a vial that should have been discarded). At the time of the report, EXPIRED PRODUCT ADMINISTERED (received a Moderna vaccine from a vial that should have been discarded) had resolved. The patient received a Moderna vaccine from the vial that should have been discarded at 2:00 AM. She had received the vaccine 9 hours after the expiration date. No concomitant product information was provided. Treatment information was not provided. Reporter did not allow further contact


VAERS ID: 1672633 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: INSULIN; MULTIVITAMIN [VITAMINS NOS]
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Pain on arm of injection; Fever; Nausea; Slight headache; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Pain on arm of injection), PYREXIA (Fever), NAUSEA (Nausea) and HEADACHE (Slight headache) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. Concurrent medical conditions included Diabetes. Concomitant products included INSULIN for Diabetes, MULTIVITAMIN [VITAMINS NOS] for Vitamin supplementation. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, the patient experienced PAIN IN EXTREMITY (Pain on arm of injection), PYREXIA (Fever), NAUSEA (Nausea) and HEADACHE (Slight headache). At the time of the report, PAIN IN EXTREMITY (Pain on arm of injection), PYREXIA (Fever), NAUSEA (Nausea) and HEADACHE (Slight headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication also included Diabetes Medications. Treatment information was not reported.


VAERS ID: 1672637 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Slight chest pain she has never had on her right side; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (Slight chest pain she has never had on her right side) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced CHEST PAIN (Slight chest pain she has never had on her right side). At the time of the report, CHEST PAIN (Slight chest pain she has never had on her right side) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant product use was provided by the reporter. No treatment medications were reported.


VAERS ID: 1672677 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-11
Onset:2021-08-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site nodule, Vaccination site pruritus, Vaccination site swelling
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: A little bump at the injection site/ golf ball size; A little itchy at the injection site; Swelling at the injection site; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE NODULE (A little bump at the injection site/ golf ball size), VACCINATION SITE PRURITUS (A little itchy at the injection site) and VACCINATION SITE SWELLING (Swelling at the injection site) in a 26-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 021C21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced VACCINATION SITE NODULE (A little bump at the injection site/ golf ball size), VACCINATION SITE PRURITUS (A little itchy at the injection site) and VACCINATION SITE SWELLING (Swelling at the injection site). At the time of the report, VACCINATION SITE NODULE (A little bump at the injection site/ golf ball size), VACCINATION SITE PRURITUS (A little itchy at the injection site) and VACCINATION SITE SWELLING (Swelling at the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medication were reported. Treatment information was not provided.


VAERS ID: 1672680 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Dose administered greater than 12 hours on pre-draw syringe; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours on pre-draw syringe) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 035C21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours on pre-draw syringe). On 19-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours on pre-draw syringe) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. The pre-drawn syringe was given 1hour and 45minutes beyond the recommended 12hour period to a patient, only one dose was given. Patient was given today dose at around 11:17am and the dose in syringe expired at 09:30am. Treatment information was not provided.


VAERS ID: 1672702 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-03
Onset:2021-08-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Second dose early; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose early) in an 18-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 006D21A and 052E21A) for COVID-19 vaccination. No Medical History information was reported. On 03-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose early). At the time of the report, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose early) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were provided by the reporter No treatment medication were provided by the reporter Most recent FOLLOW-UP information incorporated above includes: On 23-Aug-2021: TCR Follow up received on 23 AUG 2021 contains Non significant information(reporter''s contact number and Fax number)


VAERS ID: 1672758 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-28
Onset:2021-08-19
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Off label use, Pain in extremity, Vaccination site pain
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: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Massaged his hands all night), FATIGUE (Fatigue), ARTHRALGIA (Severe pain in every joint of his body from the top of his head to his toes except his spinal, Ankes hurt, Hips hurt, Toes hurt), HEADACHE (Headache) and CHILLS (Chills) in a 63-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 28-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced PAIN IN EXTREMITY (Massaged his hands all night), FATIGUE (Fatigue), ARTHRALGIA (Severe pain in every joint of his body from the top of his head to his toes except his spinal, Ankes hurt, Hips hurt, Toes hurt), HEADACHE (Headache), CHILLS (Chills), MYALGIA (Muscle pain), VACCINATION SITE PAIN (Site tenderness/ injection site hurt) and OFF LABEL USE (off label use). At the time of the report, PAIN IN EXTREMITY (Massaged his hands all night), FATIGUE (Fatigue), ARTHRALGIA (Severe pain in every joint of his body from the top of his head to his toes except his spinal, Ankes hurt, Hips hurt, Toes hurt), HEADACHE (Headache), CHILLS (Chills), MYALGIA (Muscle pain), VACCINATION SITE PAIN (Site tenderness/ injection site hurt) and OFF LABEL USE (off label use) outcome was unknown. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1672764 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-14
Onset:2021-08-19
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature decreased, Off label use
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: Low temperature; Result Unstructured Data: Low
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: off label use; Low temperature 93.9 F to 94 F after booster shot; This spontaneous case was reported by a consumer and describes the occurrence of BODY TEMPERATURE DECREASED (Low temperature 93.9 F to 94 F after booster shot) and OFF LABEL USE (off label use) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 059E21A, 036B21A and 047A21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced BODY TEMPERATURE DECREASED (Low temperature 93.9 F to 94 F after booster shot). On an unknown date, the patient experienced OFF LABEL USE (off label use). At the time of the report, BODY TEMPERATURE DECREASED (Low temperature 93.9 F to 94 F after booster shot) outcome was unknown and OFF LABEL USE (off label use) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Aug-2021, Body temperature decreased: 93.9 f to 94 f (Low) Low. No Concomitant medications were reported. No Treatment information was reported. This case was linked to MOD-2021-292888 (Patient Link).


VAERS ID: 1672781 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-21
Onset:2021-08-19
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Exposure via skin contact, Underdose
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by an other health care professional and describes the occurrence of EXPOSURE VIA SKIN CONTACT (a big portion of the liquid came out of her arm), UNDERDOSE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose) and DEVICE CONNECTION ISSUE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose) in a 31-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017E21A and 091D21A) for COVID-19 vaccination. No Medical History information was reported. On 21-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced EXPOSURE VIA SKIN CONTACT (a big portion of the liquid came out of her arm) and UNDERDOSE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose). On an unknown date, the patient experienced DEVICE CONNECTION ISSUE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose). At the time of the report, EXPOSURE VIA SKIN CONTACT (a big portion of the liquid came out of her arm) outcome was unknown and UNDERDOSE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose) and DEVICE CONNECTION ISSUE (patient received less than the recommended dose of the Moderna COVID-19 vaccine: a big portion of the liquid came out of her arm if not the entire dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product was not provided by the reporter. Treatment information was not provided.


VAERS ID: 1672782 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Nasopharyngitis, Off label use, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: cold like symptoms.; Around 11a or noon, I had severe chills; Fever; Headache; severe headache woke me up Friday morning; received my 3rd injection; This spontaneous case was reported by a consumer and describes the occurrence of NASOPHARYNGITIS (cold like symptoms.), OFF LABEL USE (received my 3rd injection), HEADACHE (severe headache woke me up Friday morning), CHILLS (Around 11a or noon, I had severe chills) and PYREXIA (Fever) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced OFF LABEL USE (received my 3rd injection). On 20-Aug-2021, the patient experienced HEADACHE (severe headache woke me up Friday morning). On an unknown date, the patient experienced NASOPHARYNGITIS (cold like symptoms.), CHILLS (Around 11a or noon, I had severe chills), PYREXIA (Fever) and HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, NASOPHARYNGITIS (cold like symptoms.), HEADACHE (severe headache woke me up Friday morning), CHILLS (Around 11a or noon, I had severe chills), PYREXIA (Fever) and HEADACHE (Headache) outcome was unknown and OFF LABEL USE (received my 3rd injection) had resolved. No Concomitant medication information was reported. Reporter did not allow further contact


VAERS ID: 1672830 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-17
Onset:2021-08-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site swelling, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Heat on left arm Injection Site after second vaccine; Swelling on left arm Injection Site after second vaccine/Knot on left arm Injection Site after second vaccine; Redness on left arm Injection Site after second vaccine; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Heat on left arm Injection Site after second vaccine), VACCINATION SITE SWELLING (Swelling on left arm Injection Site after second vaccine/Knot on left arm Injection Site after second vaccine) and VACCINATION SITE ERYTHEMA (Redness on left arm Injection Site after second vaccine) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039C21A and 005C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced VACCINATION SITE WARMTH (Heat on left arm Injection Site after second vaccine), VACCINATION SITE SWELLING (Swelling on left arm Injection Site after second vaccine/Knot on left arm Injection Site after second vaccine) and VACCINATION SITE ERYTHEMA (Redness on left arm Injection Site after second vaccine). At the time of the report, VACCINATION SITE WARMTH (Heat on left arm Injection Site after second vaccine), VACCINATION SITE SWELLING (Swelling on left arm Injection Site after second vaccine/Knot on left arm Injection Site after second vaccine) and VACCINATION SITE ERYTHEMA (Redness on left arm Injection Site after second vaccine) outcome was unknown. Concomitant medication were not reported. Treatment medication were not reported.


VAERS ID: 1672848 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-22
Onset:2021-08-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chills, Disorientation, Illness, Pyrexia, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMIN [VITAMINS NOS]; VITAMIN C ACID; VITAMIN D NOS; SIMVASTATIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: Body temperature; Result Unstructured Data: had fever at 103 F all night
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Saturday Morning experienced disorientation like dizziness; real bad vision as well last Saturday Morning; Yesterday patient was still sick on the couch all day until around 6-7o''clock; Fever 103F; Chills; Violently shaking; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Violently shaking), DISORIENTATION (Saturday Morning experienced disorientation like dizziness), VISION BLURRED (real bad vision as well last Saturday Morning), ILLNESS (Yesterday patient was still sick on the couch all day until around 6-7o''clock) and PYREXIA (Fever 103F) in a 33-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 091D21A and 078C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included MULTIVITAMIN [VITAMINS NOS], ASCORBIC ACID (VITAMIN C ACID), VITAMIN D NOS and SIMVASTATIN for an unknown indication. On 22-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced TREMOR (Violently shaking), PYREXIA (Fever 103F) and CHILLS (Chills). On 20-Aug-2021, the patient experienced ILLNESS (Yesterday patient was still sick on the couch all day until around 6-7o''clock). On 21-Aug-2021, the patient experienced DISORIENTATION (Saturday Morning experienced disorientation like dizziness) and VISION BLURRED (real bad vision as well last Saturday Morning). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, TREMOR (Violently shaking), DISORIENTATION (Saturday Morning experienced disorientation like dizziness), VISION BLURRED (real bad vision as well last Saturday Morning) and CHILLS (Chills) had not resolved, ILLNESS (Yesterday patient was still sick on the couch all day until around 6-7o''clock) outcome was unknown and PYREXIA (Fever 103F) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Aug-2021, Body temperature: 103 (High) had fever at 103 F all night. Patient was advised to take Tylenol and hydrate. This case was linked to MOD-2021-293388 (Patient Link).


VAERS ID: 1672851 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: headache that is still going on; lot more fatigue than before; soreness in the arm a lot more; Inadvertent administration of more than two doses; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (headache that is still going on), FATIGUE (lot more fatigue than before), MYALGIA (soreness in the arm a lot more) and EXTRA DOSE ADMINISTERED (Inadvertent administration of more than two doses) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039B21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced EXTRA DOSE ADMINISTERED (Inadvertent administration of more than two doses). On an unknown date, the patient experienced HEADACHE (headache that is still going on), FATIGUE (lot more fatigue than before) and MYALGIA (soreness in the arm a lot more). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. On 19-Aug-2021, EXTRA DOSE ADMINISTERED (Inadvertent administration of more than two doses) had resolved. At the time of the report, HEADACHE (headache that is still going on) had not resolved and FATIGUE (lot more fatigue than before) and MYALGIA (soreness in the arm a lot more) outcome was unknown. Relevant concomitant medications were not reported. The treatment information was not provided. This case was linked to MOD-2021-293631, MOD-2021-293637 (Patient Link).


VAERS ID: 1672852 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-11
Onset:2021-08-19
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Extra dose administered, Headache, Myalgia, Off label use
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Off label use; I have a mild headache; body aches; I''m feeling a slight discomfort; Extra dose administered; This spontaneous case was reported by a consumer and describes the occurrence of DISCOMFORT (I''m feeling a slight discomfort), EXTRA DOSE ADMINISTERED (Extra dose administered), OFF LABEL USE (Off label use), HEADACHE (I have a mild headache) and MYALGIA (body aches) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 005C21A, 012M20A and 013A21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced EXTRA DOSE ADMINISTERED (Extra dose administered). On 20-Aug-2021, the patient experienced DISCOMFORT (I''m feeling a slight discomfort), HEADACHE (I have a mild headache) and MYALGIA (body aches). On an unknown date, the patient experienced OFF LABEL USE (Off label use). At the time of the report, DISCOMFORT (I''m feeling a slight discomfort), HEADACHE (I have a mild headache) and MYALGIA (body aches) outcome was unknown and EXTRA DOSE ADMINISTERED (Extra dose administered) and OFF LABEL USE (Off label use) had resolved. The concomitant medication was not reported. The treatment information was not provided.


VAERS ID: 1672900 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-19
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: sore throat; chills; This spontaneous case was reported by a consumer and describes the occurrence of OROPHARYNGEAL PAIN (sore throat) and CHILLS (chills) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In March 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced OROPHARYNGEAL PAIN (sore throat) and CHILLS (chills). At the time of the report, OROPHARYNGEAL PAIN (sore throat) and CHILLS (chills) outcome was unknown. No Concomitant medications were provided. No Treatment medications were reported.


VAERS ID: 1672910 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-06
Onset:2021-08-19
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Headache, Insomnia
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: BABY ASPIRIN; METOPROLOL; VALIUM; METFORMIN; HYTRIN; LEVOTHYROXINE
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: Body temperature; Result Unstructured Data: Inconclusive
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Woke up on and off all night; Terrible headache; This spontaneous case was reported by a consumer and describes the occurrence of INSOMNIA (Woke up on and off all night) and HEADACHE (Terrible headache) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 025L20A, 032L20A and 049C21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included ACETYLSALICYLIC ACID (BABY ASPIRIN), METOPROLOL, DIAZEPAM (VALIUM), METFORMIN, TERAZOSIN HYDROCHLORIDE (HYTRIN) and LEVOTHYROXINE for an unknown indication. On 06-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced INSOMNIA (Woke up on and off all night) and HEADACHE (Terrible headache). The patient was treated with PARACETAMOL (TYLENOL) for Headache, Insomnia and Body temperature, at an unspecified dose and frequency. At the time of the report, INSOMNIA (Woke up on and off all night) and HEADACHE (Terrible headache) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Aug-2021, Body temperature: inconclusive (High) Inconclusive. Again started fever on 20-Aug-2021 morning. Concomitant medication also included Blood thinner. This case was linked to MOD-2021-005974 (Patient Link).


VAERS ID: 1672949 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-23
Onset:2021-08-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Peripheral swelling, Vaccination site erythema, Vaccination site rash, Vaccination site swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Current Illness: Blood pressure high
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: the arm is very swollen; About the area on arm where the vaccine was injected has swollen up; there is a little dot there; there is a little red rash; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (the arm is very swollen), VACCINATION SITE SWELLING (About the area on arm where the vaccine was injected has swollen up), VACCINATION SITE ERYTHEMA (there is a little dot there) and VACCINATION SITE RASH (there is a little red rash) in a 91-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 049E21A and 040C21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure high. On 23-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced PERIPHERAL SWELLING (the arm is very swollen), VACCINATION SITE SWELLING (About the area on arm where the vaccine was injected has swollen up), VACCINATION SITE ERYTHEMA (there is a little dot there) and VACCINATION SITE RASH (there is a little red rash). At the time of the report, PERIPHERAL SWELLING (the arm is very swollen), VACCINATION SITE SWELLING (About the area on arm where the vaccine was injected has swollen up), VACCINATION SITE ERYTHEMA (there is a little dot there) and VACCINATION SITE RASH (there is a little red rash) outcome was unknown. Concomitant medication includes Blood thinners and Blood pressure Medication. Treatment information was not provided.


VAERS ID: 1672953 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-08
Onset:2021-08-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: Test Date: 20210819; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Tested positive for COVID after first dose; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Tested positive for COVID after first dose) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, the patient experienced COVID-19 (Tested positive for COVID after first dose). At the time of the report, COVID-19 (Tested positive for COVID after first dose) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Aug-2021, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. Treatment information was not provided. Patient reported that the patient and the patient''s son received their first dose of the Moderna COVID-19 vaccine on 08-Aug-2021. The patient started to observe first symptoms on 16-Aug-2021, and started to feel fever on 17-Aug-2021. This case was linked to MOD-2021-294007 (Parent-Child Link). See case MOD-2021-294007 for details regarding the child case. Most recent FOLLOW-UP information incorporated above includes: On 23-Aug-2021: Non significant follow-up appended.


VAERS ID: 1672965 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Limb discomfort, Nervousness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy NOS; Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Arm feels funny; He thinks maybe it was just nervousness; the whole arm where he got the shot went numb, from the shoulder all the way down to his fingertips; His arm is not 100% back to normal; He does not feel in his arm; Arm is 90-80% back; This spontaneous case was reported by a consumer and describes the occurrence of LIMB DISCOMFORT (Arm feels funny), NERVOUSNESS (He thinks maybe it was just nervousness), HYPOAESTHESIA (the whole arm where he got the shot went numb, from the shoulder all the way down to his fingertips), HYPOAESTHESIA (His arm is not 100% back to normal) and HYPOAESTHESIA (He does not feel in his arm) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Allergy NOS and Asthma. On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced LIMB DISCOMFORT (Arm feels funny), NERVOUSNESS (He thinks maybe it was just nervousness), HYPOAESTHESIA (the whole arm where he got the shot went numb, from the shoulder all the way down to his fingertips), HYPOAESTHESIA (His arm is not 100% back to normal), HYPOAESTHESIA (He does not feel in his arm) and HYPOAESTHESIA (Arm is 90-80% back). At the time of the report, LIMB DISCOMFORT (Arm feels funny) and NERVOUSNESS (He thinks maybe it was just nervousness) outcome was unknown and HYPOAESTHESIA (the whole arm where he got the shot went numb, from the shoulder all the way down to his fingertips), HYPOAESTHESIA (His arm is not 100% back to normal), HYPOAESTHESIA (He does not feel in his arm) and HYPOAESTHESIA (Arm is 90-80% back) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported by the patient. No treatment medications were provided by the reporter.


VAERS ID: 1673360 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Tenderness
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart rate high.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091003

Write-up: headache on her left side, it is sore to the touch; headache on her left side, it is sore to the touch; This is a spontaneous report from a contactable consumer (patient). A 58-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: FD8448) via an unspecified route of administration, administered in Arm Left on 19Aug2021 (at the age of 58 years old) as dose 1, single for COVID-19 immunisation. Medical history included heart beats real fast (she has palpitations but it has not been diagnosed. sometimes she will be thinking too hard and gets anxious, and her heart beats really fast). There were no concomitant medication. The patient previously took lipitor for blood cholesterol (the only medication she takes was cholesterol and its from Pfizer. She clarifies she was taking Lipitor. She explains about 2 weeks ago, she stopped taking it because her cholesterol was under control). Patient did not received any other vaccinations within four weeks prior to the first administration date of the suspect vaccine. Adverse event following prior vaccinations was none (never had any reaction to any medication). The patient experienced headache on her left side, it is sore to the touch on 19Aug2021. Reported as, she took her first dose of the Pfizer COVID-19 vaccine on 19Aug2021 and has been having a headache on her left side, it was sore to the touch, like if someone were to hit him on the head with something. She mentions she scheduled an appointment with her doctor for the first of November. Patient confirms the headache began late in the evening on Thursday, 19Aug2021. She states sometimes there is a sharp pain, like zoop zoop. Most of the pain is on her left side, but sometimes she feels it in her forehead. Outcome of the events were not recovered.


VAERS ID: 1673430 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-08-19
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101116692

Write-up: So my friends husband that received the Pfizer vaccination in April has developed Covid/he has developed Covid over a week ago. He is pretty sick; So my friends husband that received the Pfizer vaccination in April has developed Covid/he has developed Covid over a week ago. He is pretty sick; This is a spontaneous report from a contactable consumer (patient''s wife) via Pfizer sales representative. A male patient of unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; solution for injection, lot number, expiration date was not reported), via an unspecified route of administration, on Apr2021, at dose number unknown, single for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient received the full vaccination (as reported) at the end of Apr2021 and developed Covid over a week ago from the time of report (19Aug2021). Also reported that he was very sick. The outcome of the event was unknown. The lot number for the vaccine, (BNT162B2), was not provided and will be requested during follow up.


VAERS ID: 1674528 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-12
Onset:2021-08-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: None
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin and cranberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started getting bloody noses a week after my first dose. Generally once a day. I have not gotten bloody noses from previous vaccinations nor do I get them due to environmental concerns like dry air.


VAERS ID: 1674832 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Electrocardiogram normal, Inflammation, Pain, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (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: Symbicort, albuterol inhaler
Current Illness: none
Preexisting Conditions: asthma
Allergies: seasonal allergies, grass, juniper, cedar, peanuts, dander, horses
Diagnostic Lab Data: EKG - normal - 8/20/21 blood tests for clots - normal - 8/20/21
CDC Split Type:

Write-up: At first several sharp pains, and then a sensation of swelling in left chest area. Internal sensation, not external/muscular. No injury to site. Feeling of pressure/inflammation consistently present for several days, then started to subside and come in waves over the next week. Still persisting after several weeks.


VAERS ID: 1674878 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-08-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4222 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Adnexa uteri pain, Dysmenorrhoea, Heavy menstrual bleeding, Hepatic enzyme increased, Thrombosis, Uterine pain
SMQs:, Liver related investigations, signs and symptoms (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I?ve had a blood test since and my liver enzyme levels are elevated for the first time in my life. I will be doing a follow up pelvic ultrasound but I?m continuing to experience sharp pains in my ovaries and uterus even after my period ended.
CDC Split Type:

Write-up: I started my period on August 19th, 2021, which was my first period after receiving the vaccine. My cramping was so abnormally intense and the bleeding was so excessively heavy that I almost went to the hospital. I also had accompanying large blood clots during my period which were unusual.


VAERS ID: 1674880 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pain and palpitations that are ongoing


VAERS ID: 1675039 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-08
Onset:2021-08-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Migraine, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

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

Write-up: Extreme migraine headache lasted for 3 days, nausea, joint pain, body aches, brain fog


VAERS ID: 1675242 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreamly Painfull lymph nodes swelling that lasted 3 days


VAERS ID: 1675259 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Ear discomfort, Ear pruritus, Pruritus, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received second dose COVID Pfizer vaccine (LOT#: EW0172) on 8/19/21 at 1705. Patient came in with the instructions to stop at leads desk and ask about which vaccine she should receive for second dose due to her having an allergic reaction with the first dose. Patient was given benadryl with the first dose. Nurse did a medical consult. EMT took patient vital signs AT 1440. BP: 144/99, HR: 78, O2: 99%. EMT took a second set of vital signs st 1447. BP: 133/89, HR: 79, O2: 99%. Patient left vaccination site and came back two hours later when she was called by nurse to come back because the patient had been approved to receive second dose Pfizer with a 30 minute observation. Patient received vaccine at 1705. Patient went to sit in observation area. At 1728 the patient alerted EMT and stated that she felt itchy around her face and ears. EMT took patients vital signs at 1728. BP: 112/92, HR: 92, O2: 100%. EMT alerted nurse. Nurse offerred patient Benadryl. Patient agreed to take 50 mg of Benadryl. Nurse gave patient Benadryl at 1735. EMT reassessed and retook patients vital signs. BP: 154/99, HR: 92, O2: 100%. Patient stated that her ears were burning but the itchiness in her face was "getting better." Patient did not have any additional symptoms. Patient was given a juice. Patient drank the juice. EMT reassessed and retook patients vital signs at 1745. BP: 145/91, HR: 72, 02: 99%. Patient that her ears were "getting better" and that she was "not feeling as itchy" and that she "feels sleepy." EMT reassessed and retook patient vital signs AT 1750. BP: 150/96, HR: 75, 02: 98%. Patient stated that all her symptoms were improving. Patient stated that she "feels sleepy." Patient stated that her "ears are not as bad as before." RN reassessed and retook patients vital signs at 1800. BP: 136/90, HR: 68, O2: 99%. Patient stated that her itchiness had improved and that it was "gone" and patient stated she was "okay to drive home." Nurse educated patient on signs and symptoms of adverse reactions to the COVID vaccine and when to seek emergency care. Patient verbalized understanding of education. Patient left vaccination site at 1805 unassisted and with a steady gait.


VAERS ID: 1675365 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2020-12-26
Onset:2021-08-19
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, COVID-19, Exposure during pregnancy, SARS-CoV-2 test positive, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? Yes
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: Augmentin
Diagnostic Lab Data: Covid test positive 08/14/2021; Miscarriage ultrasound 08/20/2021
CDC Split Type:

Write-up: I tested positive for Covid at 6 weeks pregnant from Ivf. I ended up having a miscarriage that same week.


VAERS ID: 1675379 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Erythema, Fatigue, Gingival bleeding, Hyperaesthesia teeth, Odynophagia, Oral herpes, Sensitive skin, Skin irritation, Tonsillar hypertrophy, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal infections (narrow), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Menegitis- hypotensive event
Other Medications: Birth control, albuterol, valtrex, multi vitamin
Current Illness: Na
Preexisting Conditions: Mild asthma. Used inhaler 1x q2-3 years
Allergies: Sulfa, bextra, carafate, codiene, cipro
Diagnostic Lab Data: None- no primary care doctor at this time
CDC Split Type:

Write-up: Had multiple asthma attacks over the course of 72 hrs post vaccine, extreme fatigue and brain fog. Didn?t report until days later because I was so out of it. I have continued to need my inhaler every few days for ongoing asthma attacks. 9/4-5 I broke out in hives along my jaw line on the left side of my face. Swollen tonsil on the left with painful swallowing. Also had a herpes outbreak on my lip. Now skin on my face is extremely sensitive, red and and irritated. Frequent asthma attacks continue. Bleeding gums and sensitive teeth. Reported at work again because I do not have a primary car doctor but no guidance given. Next shot due Friday 9/17


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