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From the 6/11/2021 release of VAERS data:

Found 352,386 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 108 out of 3,524

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VAERS ID: 1350486 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture positive, Pyrexia, Staphylococcal infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (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? No
Previous Vaccinations:
Other Medications: ciprofloxacin, ferrous sulfate, melatonin, omeprazole, rifaximin, sertraline,
Current Illness: At the time of vaccination, hospitalized for decompensated cryptogenic cirrhosis.
Preexisting Conditions: Cryptogenic cirrhosis Obesity
Allergies: TMP-SMX
Diagnostic Lab Data: 5/22/2021 two sets of blood cultures: one out of four bottles has grown Staphylococcus aureus, oxacillin-susceptible
CDC Split Type:

Write-up: On 5/22/2021, the patient, who was (and is) and inpatient at a healthcare facility, developed a fever to 101.4 F, had blood cultures drawn, and one bottle has grown Staphylococcus aureus (oxacillin-susceptible). No source for the bacteremia has been found.


VAERS ID: 1350524 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Agitation, Blood methanol, Blood test, Computerised tomogram head, Confusional state, Full blood count, Hallucination, Metabolic function test, Restlessness, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: olanzapine, losartan, citalopram, atorvastatin
Current Illness:
Preexisting Conditions: vascular dementia, DM2, osteoporosis, breast cancer in situ
Allergies: septra, carbamazepine, ciprofloxacin, lisinopril, simvastatin
Diagnostic Lab Data: CBC, CMP, UA, tylenol level, salicylate level, ethanol level, CT head
CDC Split Type:

Write-up: Patient with a history of neurocognitive disorder brought in by paramedics from home with concern for increased agitation, restlessness, confusion, hallucinations. Temporal relationship to 2nd dose of Moderna vaccine approx 24 hrs prior to onset.


VAERS ID: 1350596 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8136 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Immediate post-injection reaction, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad), Hypersensitivity (narrow)

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

Write-up: Changes with monthly Menstrual . Dose 1 (04/30/2021) after pzifer vaccine, heavy period came the same day after I was injected and it came 1 week early. And now dose 2 (05/21/2021) of Pzifer vaccine heavy cramping period came immediately after vaccine as well 1 week early. menstrual is always on time never early nor painful. seeing immediate changes after these 2 doses.


VAERS ID: 1350606 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure decreased, Chest discomfort, Dizziness, Dyspnoea, Lacrimation increased, Pharyngeal swelling, Vaccination complication
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VIT. D 3 50,000 IU Q WK. MESALAMINE 800 MG Q DAY.
Current Illness:
Preexisting Conditions: CHRONE''S DISEASE, ASTHMA
Allergies: ALLERGIC TO NITRO AND IVP DYE.
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: APPROXIMATELY 22 MIN. AFTER RECEIVING VACCINE, CLIENT BECAME LIGHT HEADED, DIZZY, SHORT OF BREATH, THROAT SWELLING, EYES WATERING, BLOOD PRESSURE DROPPED, TIGHTNESS IN CHEST. 911 CALLED. PARAMEDICS GAVE IV EPI. AND TRANSPORTED CLIENT TO HOSPITAL ER. MD DIAGNOSED ANAPHYLAXIS DUE TO COVID VACCINE. IN ER, CLIENT WAS GIVEN PREDNISOLONE AND ALBUTEROL TREATMENT. CLIENT RESTED IN ER WHILE BEING MONITORED. CLIENT THEN RELEASED TO GO HOME.


VAERS ID: 1350633 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Deep vein thrombosis, Dyspnoea, Pancreatic mass, Pulmonary embolism, Right ventricular dysfunction
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, atorvastatin, fenofibrate, gemfibrozil, topiramate
Current Illness: none
Preexisting Conditions: Familial hypertriglyceridemia, DM, CKD
Allergies: none
Diagnostic Lab Data: CTA Pulmonary 5/24/21: 1. Multiple bilateral acute pulmonary emboli. 2. Right Heart strain is present. 3. Pulmonary Infarction: Not present. 4. 1.7 cm hypodense pancreatic tail mass unchanged.
CDC Split Type:

Write-up: She developed shortness of breath the day after receiving the vaccine. Three days later she presented to ED and was found to have extensive right DVT and bilateral PEs. She has no prior history of DVT/PE. She had taken a flight 6 days before getting the vaccine. She has responed to treatment and was discharged the next day.


VAERS ID: 1350667 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02202119 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Palpitations, Pyrexia, Toothache, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Zetia; Crestor; Calcium; Flaxseed oil; ASA
Current Illness: N/A
Preexisting Conditions: Hypercholesterolemia
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: At approx 2:30am I woke up experience severe chills. I began taking Tylenol at this time, and continued to take it every 4 hours throughout the day. I ran a temp of 100.9, experienced severe fatigue, tooth/jaw pain, terrible HA, and palpitations, approx every 30seconds - 2 minutes throughout the day. Symptoms resolved the following day. I did have almost all of these symptoms following dose 1 as well.


VAERS ID: 1350674 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

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

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

Write-up: Slight headache and body aches the night that I got the second dose but my first period after, which has always been very regular and predictable, was four days late.


VAERS ID: 1350690 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

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

Write-up: No adverse affects have been reported. This report is to notify of a 16 year old patient receiving a covid immunization only certified to be given for 18 year old and older.


VAERS ID: 1350773 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Vital Signs: BP - 86/42 with repeat 105/72 Pulse - 108 with repeat 82 RR: 14/min with repeat 17/min O2 Sat: 97% throughout exam
CDC Split Type:

Write-up: Patient turned pale after vaccination; fainted without injury. Completely recovered within minutes with hydration and support.


VAERS ID: 1350803 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: She developed 3 isolated episodes of 30-90 minutes where she has tingling and burning in bilateral hands, worse in right, and worst in the thumb. No symptoms in feet.


VAERS ID: 1350813 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Confusional state, Dehydration, Depressed level of consciousness, Disorientation, Dizziness, Electrocardiogram, Erythema, Feeling hot, Headache, Loss of personal independence in daily activities, Palpitations, Pyrexia, Shock, Tremor
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Seasonique
Current Illness:
Preexisting Conditions: WPW Wolfe Parkinson?s white syndrome.
Allergies: Penicillin. (anaphylactic shock) Vancomycin Clindamycin Percocet Naproxen Nitrates MSG Artificial flavorings Decongestants
Diagnostic Lab Data: EKG on 5/22.
CDC Split Type:

Write-up: My side effects were extreme & hit fast around 1:30am. I was Dizzy & confused & Disoriented & was in like a semi coma when it first hit. When I could finally wake up around 2am I was very hot & shaking & my heart was racing. I had severe chills 102.7 fever & could feel my body was in shock. My face was red for days and fever & headache & Very dehydrated quickly extremely weak & could not drive. Went to urgent care on Saturday 5/22 & they check me over & did EKG. did not improve until late Monday 5/24 & even today 5/26 I still feeling a little dizzy randomly.


VAERS ID: 1350868 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: Cialis 10mg, Lexapro 10mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports sweating, nausea, some vomiting/diarrhea, lack of appetite starting 2 days after vaccination and continuing to 6 days post vaccination and beyond


VAERS ID: 1350898 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram abnormal, Inflammatory marker test, Laboratory test, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 5/23/2021 Echocardiogram, Cardiac MRI, basic labs, Troponin, inflammatory markers
CDC Split Type:

Write-up: Chest pain with EKG changes and elevated troponin - final diagnosis - myocarditis


VAERS ID: 1350906 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-20
Onset:2021-05-22
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 250 mg tablet aspirin tablet celecoxib (CeleBREX) 200 mg capsule cholecalciferol, vitamin D3, 10 mcg (400 unit) tablet diclofenac sodium (VOLTAREN GEL) 1 % gel hydroCHL
Current Illness:
Preexisting Conditions: Nervous Presbycusis Respiratory Difficulty breathing Allergic rhinitis Chronic pansinusitis Obstructive sleep apnea syndrome Circulatory Benign essential hypertension Aortic valve stenosis Digestive Obesity Genitourinary Overactive bladder Benign prostatic hyperplasia with urinary obstruction Musculoskeletal Primary localized osteoarthrosis of hand Onychomycosis Localized primary osteoarthritis of lower leg Lumbar spondylosis Endocrine/Metabolic Pure hypercholesterolemia Disorder of carbohydrate transport (CMS/HCC) Mixed hyperlipidemia Prediabetes Other Spinal stenosis, lumbar region, without neurogenic claudication Impotence of organic origin Generalized anxiety disorder Recurrent major depression in full remission (CMS/HCC) Unhealthy alcohol drinking behavior
Allergies: OxycodoneOther (document details in comments)
Diagnostic Lab Data: 05/23/21 1100 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/22/21 1305 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: Office Visit 5/22/2021 Urgent Care - town Med Asst Encounter for screening laboratory testing for COVID-19 virus Dx Progress Notes Med Asst (Medical Assistant) ? ? Encounter Date: 5/22/2021 ? ? Signed Patient being seen for loss of taste and smell. States that he has received both of his COVID vaccines, but recently started having symptoms. Requesting COVID test but does not wish to see provider today. Patient was swabbed for COVID and order placed in chart. Patient aware that results will be back in 24-48 hours and that he can view these on the portal. No questions or concerns at this time.


VAERS ID: 1350920 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-05-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alavert D-12, Aller-Flo nasal spray
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blistering rash around left wrist and left hand/fingers and blistering rash on right wrist and side of right hand.


VAERS ID: 1350977 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Unknown  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness, Tinnitus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hearing impairment (narrow), Hypersensitivity (broad)

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

Write-up: tinnitus, throat feeling tight


VAERS ID: 1350986 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: syncopal episode from standing, hit head


VAERS ID: 1351007 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

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

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1351026 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Eye swelling, Injection site erythema, Injection site swelling, Mouth swelling, Pruritus, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: patient recieved vaccine at 10am. Reaction did not occur until 2 pm.


VAERS ID: 1351027 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Jan 15th 2021 Moderna Covid Vaccine 85 years old
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling in throat, very similar to previous vaccination Patient received Moderna # 1 on Jan 15th had difficulty swallowing, tingling on tongue and jitters Patient was recommended by PCP who also consulted H to receive the Janssen Vaccine. Vaccine clinic spoke with ID specialist and looked at recommendation and decided to proceed with vaccinating patient


VAERS ID: 1351038 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: sore arm
Other Medications: spironolactone, doxcycline, xiidra, laxapro, vitamin B complex
Current Illness:
Preexisting Conditions: rosacea, dry eyes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore throat (five days), facial redness(three days)


VAERS ID: 1351050 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Pain, Pain of skin, Skin discomfort
SMQs:, Retroperitoneal fibrosis (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: Walnuts, Pecans, Hazelnuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: The evening of his morning shot he began to have back pain up between his shoulder blades. Describes it as burning, his "skin hurts" is uncomfortable when touched, leaning against a chair or even when his t-shirt rubs against it. Three days later and it still hurts.


VAERS ID: 1351057 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: Lamotrigine, vitamin D, biotin, multi-vitamin, vitamin B-12
Current Illness: No
Preexisting Conditions: N/A
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, weakness, fatigue


VAERS ID: 1351073 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Peripheral coldness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt started feeling dizzy and blurry vision a few minutes after vaccination. Dr observing instructed him to rest on the floor. BP low, felt cold hands. His BP increased and he stopped feeling dizzy/blurred vision a few minutes after laying on the floor w feet elevated on chair. Police detail called resucue team, but patient was feeling normal by the time paramedics arrived. Was able to stand up and sat under observation for several more minutes before leaving clinic.


VAERS ID: 1351075 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1075 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient complained of feeling dizzy after receiving vaccine. Symptoms resolved spontaneously. Observed by provider on site for 30 minutes.


VAERS ID: 1351106 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-29
Onset:2021-05-22
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Haemorrhage, Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Heavy menstrual bleeding (menorrhagia), massive clots followed by bleeding, ongoing 11 days. Abnormally high compared to any menstrual cycle in entire life.


VAERS ID: 1351108 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Rash, Wound secretion
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: PT NOTICED BLISTER & PUS UPON REMOVAL OF BAND AID, OVER 12 HOURS AFTER VACCINE ADMINISTRATION. PT COMPARED IT TO A "CHEMICAL BURN." BLISTER & PUS RESOLVED AFTER A COUPLE DAYS, BUT RASH IS STILL ONGOING. LESION IS LOCALIZED TO AREA WHERE IMMUNIZER PINCHED MUSCLE TO LOCATE OPTIMAL VACCINATION SITE & WHERE BAND AID WAS ATTACHED. AS OF TODAY, DAY #4, SYMPTOMS HAVE NOT COMPLETELY RESOLVED.


VAERS ID: 1351113 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-07
Onset:2021-05-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin (LIPITOR) 20 mg tablet lisinopriL (ZESTRIL) 20 mg tablet
Current Illness:
Preexisting Conditions: Digestive Acute appendicitis with localized peritonitis, without perforation, abscess, or gangrene
Allergies: PenicillinsRash
Diagnostic Lab Data: 05/22/21 2143 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/22/21 1454 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1351116 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient complained of feeling dizzy after receiving vaccine. Symptoms resolved spontaneously. Observed by provider on site for 30 minutes.


VAERS ID: 1351150 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Petechiae, Platelet count normal
SMQs:, Haemorrhage terms (excl laboratory terms) (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Normal CBC including platelets
CDC Split Type:

Write-up: Petichiae dorsum left hand 8 days after vaccination. no swelling


VAERS ID: 1351196 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351211 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Constipation, Decreased appetite, Goitre, Nausea, Pleural effusion, Pyuria, SARS-CoV-2 test positive, Sepsis, Urinary tract infection, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler apixaban (ELIQUIS) 5 mg tablet aspirin 81 mg tablet digoxin (LANOXIN) 125 mcg (0.125 mg) tablet dilTIAZem (CARDIZEM) 60 mg tablet famotidine (PEPCID) 20 mg tablet ferrous sulfate 325 mg
Current Illness:
Preexisting Conditions: Nervous Type 2 diabetes mellitus with neurologic complication (CMS/HCC) Glaucoma Nonproliferative diabetic retinopathy (CMS/HCC) Type 2 diabetes mellitus with ophthalmic complication (CMS/HCC) Respiratory Lung mass Circulatory Benign essential hypertension Atrial fibrillation with RVR (CMS/HCC) Digestive Obesity Genitourinary Ureteral calculus Gross hematuria Complicated UTI (urinary tract infection) Renal insufficiency Musculoskeletal Onychomycosis Endocrine/Metabolic Hyperlipidemia Hematologic Acute anemia Iron deficiency anemia Other Weakness generalized
Allergies: Sulfamethoxazole-trimethoprim
Diagnostic Lab Data: 05/22/21 1502 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/22/21 1348 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical Chest X-ray, 1 view Portable Resulted: 05/22/21 1059 Order Status: Completed Updated: 05/22/21 1059 Narrative: XR CHEST 1 VW PORT IMPRESSION: Stable small right pleural effusion. No pneumothorax. No new or worse lung opacity. END OF IMPRESSION: INDICATION: sepsis. TECHNIQUE: AP view of the chest. COMPARISON: Multiple priors FINDINGS: Substernal goiter. Redemonstrated small right pleural effusion. Cardiomediastinal silhouette is not enlarged. No new or worse lung opacity.
CDC Split Type:

Write-up: Hospital 5/22 thru 5/24/2021 Dx: UTI/ Weakness/ Right Pleural Effusion Covid Positive (5/22/2021) ED to Hosp-Admission Discharged 5/22/2021 - 5/24/2021 (2 days) Treatment team UTI (urinary tract infection) with pyuria Hospital Problem List Generalized weakness Resolved Pleural effusion on right Resolved UTI (urinary tract infection) with pyuria Resolved Lack of appetite Resolved UTI (urinary tract infection) Resolved Constipation Resolved Intractable vomiting with nausea Resolved


VAERS ID: 1351215 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351221 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

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

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1351223 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: urticaria and itching after receiving H1N1 vaccine in 2010 at the age of 40 years old
Other Medications: - Omega 3 1000 mg 1 capsule once per day - vitamin D 2000 UI 1 pill once per day - Pantoloc 40 mg 1 pill twice per day - Synthroid 100 mcg 1 pill once per day
Current Illness: - R/O irritable bowel syndrome - vitamin D deficiency - anxiety - panic attacks - post traumatic stress disorder - severe left gonarthrosis
Preexisting Conditions: - R/O irritable bowel syndrome - severe left gonarthrosis
Allergies: Allergic to fish and seafood Lactose intolerant
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: severe generalized urticaria with swelling, redness and itching


VAERS ID: 1351230 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351239 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 millilters.


VAERS ID: 1351252 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0242C21A / 1 LA / IM

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

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

Write-up: Patient was vaccinated with a Moderna vaccine following Janssen vaccine administered on 3/26/2021. No immediate reaction was noted


VAERS ID: 1351256 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351267 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351279 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351283 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Blood test, Chest X-ray, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram, Inflammation, Pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Birth Control
Current Illness:
Preexisting Conditions: Migraines and low iron.
Allergies:
Diagnostic Lab Data: 5/22/2021: Blood work, EKG, Chest X-Ray, and CT, results reassuring.
CDC Split Type:

Write-up: Chest pain and back pain around heart area and shortness of breath started Saturday morning, 5/22/2021, at 11:00am. At 2:30, decided to go to ER as pain was not getting better. Had blood work, EKG, Chest X-Ray, and CT with contrast done. Advised all tests seemed ok. Diagnosed with Inflammation, possibly pleurisy. Prescribed Ibuprofen 600mg up to 4 times a day and rest. Follow up with primary care if symptoms don?t improve in 3-5 days with treatment. To date, symptoms come and go, but seem worse when lifting anything heavy or getting stressed out. Sometimes, symptoms such as chest pain or shortness of breath happen when lying down, or getting up, or doing normal activities, like cooking and cleaning.


VAERS ID: 1351290 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: The LPN drew up and administered 0.3 milliliters instead of 0.5 milliliters.


VAERS ID: 1351356 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Axillary pain, Dizziness, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none. BC pills for occasional migraine; took BC upon awakening from nap at 8:00 due to headache
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none; customer will go to urgent care after work
CDC Split Type:

Write-up: 5/22/21 day of shot customer reports she came home and took nap after got home from shot appointment woke up around 8:00pm with headache. Took BC pill to relieve headache. Headache resolved 24 hours later. 5/24/21 developed lightheadness and dizziness along with right side arm tingling all way down entire into hand. Right side of arm is tingling and continues today 5/26/2021 day of report. Lightheadness and dizziness went away 5/25/21 sometime, tingling with "cannot lay down on my right side of body" reported . Also same day 5/26/2021 customer reports under armpit above right breast a dull throbbing pain "feels like a boil inside under my arm "


VAERS ID: 1351358 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: While in observation period following 1st dose Pfizer COVID vaccine, patient flagged the EMT to state she was feeling a sensation of rapid heart beat and dizziness. Client stated the symptoms began immediately after vaccine dose. EMT noted that client was alert and oriented x 4. Client was moved to a wheelchair and transported to the zero gravity chair for further evaluation. At 1426 baseline vitals taken while sitting: Blood Pressure (BP): 130/86, Respiratory Rate (RR): 14, Heart rate (HR): 84, Pupils equal, round, reacting to light (PEARL), Skins were warm, dry and normal color for ethnicity. Client stated rapid heart rate subsided, and dizziness was subsiding. Client claims symptoms lasted less than 5 minutes. Client denied history of reactions to other vaccines. Stated positive for allergy to cats, pollen, medical history of Asthma with inhaler use. Client was offered a bottle of water. At 1437 second set of vitals taken while sitting: BP 136/80, RR 12, HR 83, PEARL, skins warm, dry and normal color for ethnicity. Client stated symptom of dizziness was improving. Client advised to stay additional 30 minutes for observation. At 1453 final set of vitals obtained with client standing: BP 136/88, HR: 88, RR: 12, PEARL skins warm and dry, negative for orthostatic pressures. Client stated symptoms completely resolved and denied dizziness and rapid HR. Client waited an additional 5 minutes for husband to finish his observation time. Husband stated he would drive client home. At 1458 they both walked away from the observation site with a steady gait.


VAERS ID: 1351361 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest discomfort, Chills, Dyspnoea, Feeling cold, Headache, Hypoaesthesia, Trismus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dystonia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: DAY 1: shaking jaw and body, chills, feeling cold, numb hands all came on suddenly at 10pm. Next day, headache and somache ache all day. Next day recovered except chest feeling weak and hard to breathe deeply.


VAERS ID: 1351383 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Biopsy stomach, Colonoscopy abnormal, Computerised tomogram normal, Diarrhoea haemorrhagic, Endoscopy abnormal, Faeces discoloured, Haemoglobin decreased, Large intestinal ulcer, Loss of consciousness, Mobility decreased, Polymerase chain reaction, Transfusion
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (broad), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec 10mg daily.
Current Illness: None
Preexisting Conditions: Allergies to pollen, dust.
Allergies: None
Diagnostic Lab Data: Negative PCR and CT scan 5/24/21. Hgb 9.1 and 7.1 on 5/24/21. Colonoscopy 5/25/21 colon ulcer which was cauterized and stomach biopsies taken- still awaiting those results.
CDC Split Type:

Write-up: He had black stool on the night of 5/22/21 and on 5/23/21 starting having copious bloody diarrhea, passed out. Went to the ER on 5/23/21 was given blood transfusion and IV because hemoglobin dropped from 9.1 to 7.1 after one bowel movement. He had endoscopy and colonoscopy on 5/25/21 and was diagnosed with a colon ulcer which they cauterized and he was discharged in the afternoon due to hemoglobin being stable at 8. The next morning on 5/26/21 he woke up to use the restroom, defecated brownish-black-red stool and almost fainted and couldn?t get up from the floor. I called Dr. (gastroenterologist) who told me to take him to the ER immediately. My husband, is currently back at hospital getting evaluated.


VAERS ID: 1351406 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Immediate post-injection reaction, Polymenorrhoea, Sleep disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My menstrual cycle started immediately when I was given the shot. It was one week early. The period was extremely extremely heavy. I had severe cramping while bleeding that kept me awake into the night. I do not usually have cramping with my periods.


VAERS ID: 1351414 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiocardiogram, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Painful respiration, Troponin
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data: Troponin, EKG, Transthoracic echo, coronary angiogram.
CDC Split Type:

Write-up: 5/22 having mid central chest pain, shortness of breath, hurts when breathing in.


VAERS ID: 1351427 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Pulmonary pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Intermittent chest and lungs pains. Occasionally leg pains as well


VAERS ID: 1351468 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Lymphadenopathy, Muscular weakness, Myalgia, Pain, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Quercitin, Claritin, magnesium, vitamin C, oil of oregano
Current Illness: None
Preexisting Conditions: Lyme disease
Allergies: Penicillin, gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, aches, chills, swollen lymph nodes under left arm, muscle pain and muscle weakness, hives across abdomen, severe headache, brain fog


VAERS ID: 1351474 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-18
Onset:2021-05-22
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site induration, Injection site reaction, Rash erythematous, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg, Citalopram 20mg, Fish Oil, Daily Multivitamin, Melatonin 3mg
Current Illness: sinus infection with unrelenting coughing- tested negative for COVID-19
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Raised, Red, Itchy Circular Rash around injection site. Rash was firm to touch, very itchy. Bright pinkish red color. Circular extending around injection site Fairly evenly about 1-1.5 inches. Rash lasted approx 72 hours then itching lessened and color faded and texture returned to normal pretty quickly after this time period. Was 100% gone within a week. Treatment: at home. Did not report to physician. Used Gold bond topical anti itch lotion which relieved itch dramatically. Outcome: signs and symptoms gone within a week.


VAERS ID: 1351524 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Dyspnoea, Fatigue, Headache, Injection site pain, Malaise, Nausea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Allerclear allergy OTC
Current Illness:
Preexisting Conditions: Polyarteritis Nodosa, Fibromyalgia
Allergies: xray dye Imuran
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5/22/2021 - Day after vaccine I experienced the following: Sore arm at injection site. Extreme fatigue. Moderate body aches. Headache. Chills. Nausea. Fever. 5/23/2021 - 2nd day after vaccine I experienced the following: Moderate Fatigue. Weakness. Mild body aches. Mild breathing difficulty. 5/24/2021 - Had to take the day off from work as weakness/fatigue and overall residual malaise from the prior 2 days took its toll.


VAERS ID: 1351552 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Fatigue, Headache, Injection site pain, Malaise, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Seafood, Nuts, Pineapple, Contrast Media Dye
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer-BioNTech Covid-19 Vaccine EUA Injection Site Pain radiating down to hand -2 days - Advil first day - no relief - Tylenol tiredness - 36 hours headache -72 hours - Tylenol day 2 and 3 muscle pain and aches in legs - 72 hours chills - first 48 hours Joint pain - 48 hours Fever to 100.4 first 48 hours injection site swelling and hot to the touch 48 hours nausea - 72 hours dizzy - 72 hours feeling unwell 72 hours


VAERS ID: 1351617 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: patient fainted right after vaccine administration


VAERS ID: 1351624 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity Type II diabetes well controlled with diet.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced mild erythema, swelling, and heat to the injection site. Symptoms began several days after the injection. Area appears to resemble a localized reaction. Patient was started on antihistamine and antibiotic. Patient monitored as an outpatient.


VAERS ID: 1351662 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Dysgeusia, Hypoaesthesia, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (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: vyvanse lamictal
Current Illness:
Preexisting Conditions: anemia asthma
Allergies: bananas cucumber melons
Diagnostic Lab Data:
CDC Split Type:

Write-up: my face went numb and tingly, very sore in my joints and muscles throughout my body. It has been 4 days and now i have a metallic taste in my mouth


VAERS ID: 1351678 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Ageusia, Bell's palsy, Ear pain, Facial paralysis, Hyperacusis, Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (narrow)

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

Write-up: Bell?s palsy: numb right half of face and tongue. Started as a numb tongue with no taste and next day turned into my whole jaw and cheek being numb. Now my eye won?t close, right facial paralysis. There?s also pain behind my ear along with sensitivity to loud noises.


VAERS ID: 1351685 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Fatigue, Lymphadenopathy, Pruritus, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influezna Flu Shot - 5 years back - Age 31- Dnt remember date and brand name .
Other Medications: None
Current Illness: Had Umbical Hernia Surgery and i was perfectly fine when I was on vaccination day
Preexisting Conditions: NONE
Allergies: Medications: Influenza Flu Shot[Throat, neck, lymph node swollen, hives] , High Dosage Antibiotics Like Clefox - Not sure about the name accurately [Hives, Itchy]
Diagnostic Lab Data: NONE - I didnt go for any test.
CDC Split Type:

Write-up: 1. Mild Icthy on the Skin [Face other party of body] - Took Benadryl - Night of vaccine day 2. Face Swollen [ Lymph node] - Next day of vaccine day 3. Neck Swollen - Next day of vaccine day 4. Fatigue - After 2 days 5. Pain in the lower abodmen. 6. Feeling like increase in weight or Puffiness in the mody.


VAERS ID: 1351896 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Tachyarrhythmia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

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

Write-up: Tachycardia, persisting for 4 days, rates up to 160 bpm, abnormal ekg : sinus tach with flipped T waves in inferior leads suggesting ischemia.


VAERS ID: 1352362 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Eye pain, Flushing, Paranasal sinus discomfort, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 25 minutes after injection, pt felt flushed, developed sinus/eye pain, difficulty breathing 7 hours later, at midnight, pt woke up with above sx again. Next morning, pt had a fever, continued sinus pressure, in the forehead, and more difficulty breathing


VAERS ID: 1352528 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-05-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma - not on medications at this time
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted immediately after receiving the Pfizer vaccine. She regained consciousness immediately as soon as patient was placed on her back on the floor with feet elevated. Her blood pressure was normal and she was kept under watch for 20-25 mins after receiving the vaccine and she left the clinic after we observed her for 20-25 mins and she was doing absolutely fine. Followed up with the parent on Wednesday 5/26/21 at around 7:45pm. Mother reported patient is doing absolutely fine. I told patient''s mom, fainting can be caused due to nervousness and drop in oxygen levels to the brain. However, this adverse effect will be reported to patients doctor and also to the VAERS for Pfizer covid-19 vaccine.


VAERS ID: 1352538 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Significant chest pain, shortness of breath, and extreme fatigue after little to no activity whatsoever. I am still experiencing these symptoms five (5) days after receiving my second dose of the Pfizer vaccine. Additionally, I can assure anyone reviewing this report that I absolutely did not exhibit these symptoms (or anything similar) prior to Saturday, 22 May 2021.


VAERS ID: 1352763 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Chest discomfort, Chills, Diarrhoea, Eye pain, Fatigue, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, pain behind eyes, fever, body aches, nausea, vomiting, diarrhea, chest restriction, bloating, fatigue


VAERS ID: 1352999 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Aphasia, Body temperature, Chills, Diarrhoea, Dyspnoea, Dysuria, Fatigue, Feeding disorder, Headache, Hypokinesia, Migraine, Mobility decreased, Neck pain, Pain, Pollakiuria, Pyrexia, Tremor, Urinary tract pain, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SYMBICORT
Current Illness: Abstains from alcohol; Allergy (Makes prone to urticaria and angioedema); Asthma; Nonsmoker; Pollen allergy (Causes hives); Reaction unevaluable (Causes hives and angioedema)
Preexisting Conditions: Comments: The patient had no drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 103.5- 104.5 F
CDC Split Type: USJNJFOC20210545338

Write-up: COULD NOT MOVE BACK OR NECK; FREQUENT URINATION; URINE WITH BURNING SENSATION; PAIN IN NECK; ACHES; FATIGUE; PAIN IN BRAIN; SEVERE CHILLS; FEELING TIRED; FEVER; LOST MOBILITY ON THE LEFT SIDE OF THE BODY; MASSIVE MIGRAINE; STABBING SHOOTING PAIN IN ALL OVER BODY; URINARY TRACT SYMPTOMS OF PAIN; BAD DIARRHEA; DIFFICULTY BREATHING/TROUBLE BREATHING; BLURRED VISION; INTENSE ABDOMINAL PAIN ON THE LEFT SIDE OF DIGESTIVE TRACT TOWARDS UTERUS AND BLADDER; ABDOMINAL SWELLING; UNABLE TO EAT; COULD NOT SPEAK; SHAKING; This spontaneous report received from a patient concerned a 38 year old female. The patient''s weight was 105 pounds, and height was not reported. The patient''s concurrent conditions included asthma, autoimmune allergy, pollen allergy, no alcohol use, nonsmoker, and heat, and other pre-existing medical conditions included the patient had no drug abuse or illicit drug usage. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1805029 and expiry: 25-MAY-2021) dose was not reported, administered on 22-MAY-2021 for prophylactic vaccination. Concomitant medications included budesonide/formoterol fumarate for asthma. On 22-MAY-2021, the subject experienced lost mobility on the left side of the body. On 22-MAY-2021, the subject experienced massive migraine. On 22-MAY-2021, the subject experienced stabbing shooting pain in all over body. On 22-MAY-2021, the subject experienced urinary tract symptoms of pain. On 22-MAY-2021, the subject experienced bad diarrhea. On 22-MAY-2021, the subject experienced difficulty breathing/trouble breathing. On 22-MAY-2021, the subject experienced blurred vision. On 22-MAY-2021, the subject experienced intense abdominal pain on the left side of digestive tract towards uterus and bladder. On 22-MAY-2021, the subject experienced abdominal swelling. On 22-MAY-2021, the subject experienced unable to eat. On 22-MAY-2021, the subject experienced could not speak. On 22-MAY-2021, the subject experienced shaking. On 22-MAY-2021, the subject experienced severe chills. On 22-MAY-2021, the subject experienced feeling tired. On 22-MAY-2021, the subject experienced fever. On an unspecified date, the subject experienced could not move back or neck, frequent urination, urine with burning sensation, pain in neck, aches, fatigue, and pain in brain. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 103.5- 104.5 F. Treatment medications (dates unspecified) included: phenazopyridine hydrochloride, and ibuprofen. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from severe chills, fever, massive migraine, stabbing shooting pain in all over body, urinary tract symptoms of pain, bad diarrhea, difficulty breathing/trouble breathing, feeling tired, blurred vision, intense abdominal pain on the left side of digestive tract towards uterus and bladder, abdominal swelling, unable to eat, could not speak, shaking, and lost mobility on the left side of the body, and the outcome of could not move back or neck, frequent urination, urine with burning sensation, pain in neck, pain in brain, fatigue and aches 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: 1353020 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A201A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Fatigue, Hypersomnia, Injection site pain, Pyrexia, Wrong technique in product usage process
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (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:
Preexisting Conditions: Comments: The patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data: Test Date: 20210522; Test Name: Body temperature; Result Unstructured Data: 99 F; Test Name: Body temperature; Result Unstructured Data: 97 F
CDC Split Type: USJNJFOC20210547561

Write-up: PAIN AT SITE OF INJECTION; SLEPT THROUGHOUT THE DAY; FATIGUE; FELT LIKE NEEDLE HIT THE BONE; CHILLS; FEVER; This spontaneous report received from a patient concerned a 67 year old female. The patient''s weight was 109 pounds, and height was 61 inches. The patient''s pre-existing medical conditions included the patient was not pregnant at the time of reporting. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205A201A, expiry: UNKNOWN) dose was not reported, administered on 22-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 22-MAY-2021, the subject experienced felt like needle hit the bone. On 22-MAY-2021, the subject experienced chills. On 22-MAY-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 99 F. On 23-MAY-2021, the subject experienced slept throughout the day. On 23-MAY-2021, the subject experienced fatigue. On 24-MAY-2021, the subject experienced pain at site of injection. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 97 F. The action taken with covid-19 vaccine was not applicable. The patient recovered from chills, and fatigue on MAY-2021, pain at site of injection on 24-MAY-2021, and fever on 23-MAY-2021, and the outcome of felt like needle hit the bone and slept throughout the day was not reported. This report was non-serious.


VAERS ID: 1353023 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (unspecified anesthesia)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210547668

Write-up: DIARRHEA; ABDOMINAL PAIN; NAUSEA; HEADACHE; This spontaneous report received from a patient concerned a 37 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included allergy to anesthesia.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 22-MAY-2021, the subject experienced headache. On 23-MAY-2021, the subject experienced diarrhea. On 23-MAY-2021, the subject experienced abdominal pain. On 23-MAY-2021, the subject experienced nausea. Treatment medications (dates unspecified) included: loperamide hydrochloride, and electrolytes nos/glucose. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from abdominal pain, headache, diarrhea, and nausea. This report was non-serious.


VAERS ID: 1353049 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Dry skin, Pruritus
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USJNJFOC20210549312

Write-up: SEVERELY DRY SKIN; ACHY BACK; ITCHINESS IN LEGS/ARMS/BUTTOCK/BACK/BELLY/UNDER ARM; This spontaneous report received from a patient concerned a 72 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown, and batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 22-MAY-2021, the subject experienced severely dry skin. On 22-MAY-2021, the subject experienced achy back. On 22-MAY-2021, the subject experienced itchiness in legs/arms/buttock/back/belly/under arm. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from severely dry skin, achy back, and itchiness in legs/arms/buttock/back/belly/under arm. This report was non-serious.


VAERS ID: 1354106 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of personal independence in daily activities, Mobility decreased, Neuropathy peripheral, Pain in extremity
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: PATEINT RECEIVED THE VACCINATION ON 5/21/2021 AT 1330 HOURS. BY 5/22/2021 HE HAS REPORTED THAT HE HAS DEVELOPED PERIPHERAL NEUROPATHY IN BOTH OF HIS HANDS THAT HAS PROGRESSIVELY GOTTEN WORSE OVER THE LAST 6 DAYS. TODAY HIS HANDS HURT SO BAD THAT HE CAN HARDLE ZIP UP HIS PANTS AND CANNOT LIFT MOST OPTIONS. ANYTHING THAT PUTS ANY PRESSURE ON HIS FINGERS OR HANDS CAUSES PAIN. AT THIS TIME, I AM GOING TO CONTACT HIS PHYSICIAN TO SEE IF INCREASING HIS GABAPENTIN WILL BE OF ANY BENEFIT AND IN THE MEANTIME WE ARE STARTING SCHEDULED APAP 1000 MG QID AND NAPROXEN 440 PO BID-TID UNTIL A PHYSICIAN CONSULT CAN BE MADE. CONDITION DOES NOT APPEAR TO BE LIFE THREATENING AT THIS TIME, HOWEVER THE PATIENT IS EXTREMELY DISABLED AT THIS POIN AS USE OF EITHER HAND FOR COMPLETION OF DAILY ACTIVITES IS EXTEREMLY LIMITED.


VAERS ID: 1354132 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-29
Onset:2021-05-22
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vertigo
SMQs:, Vestibular disorders (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? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: regular prescription meds and Sudafed
Current Illness: No
Preexisting Conditions: Crumbling spine
Allergies: None known
Diagnostic Lab Data: Covid test done at Hospital and it was positive.
CDC Split Type:

Write-up: He has had vertigo non stop shortly after first dose vaccine and he''s been on Meclizine with Sudafed to control the spins, he falls if doesn''t take the meds. After second dose, 3/29/21 he still had the spins, but he was healthy. His wife became ill a week a go and after mothers day around 12/13 she died in her sleep on the 19/20th at night. She had been sick and did not go to the hospital. Two days later my dad came through with breakthrough covid on Saturday 5/22/2021 after receiving both vaccines. He was admitted into the hospital after testing positive for Covid. on the 26th he was moved to a skilled nursing unit for covid patients.


VAERS ID: 1354150 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt on BP med (losartan), pantoprazole, metformin, symbicort, albuterol, singulair
Current Illness: no
Preexisting Conditions: pt on remission with COL (leukemia)
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt started to develop a rash from head to toe Sat 5/22. Dr gave pt steroid shot and benadryl on mon 5/24, which helped very little. Rash continued to get worse so Dr. is referring pt to a specialist


VAERS ID: 1354245 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-11
Onset:2021-05-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tinnitus continuously since onset. Varying loudness. Both ears. Visited ENT. No treatment recommended at this time. Scheduled for hearing test.


VAERS ID: 1354325 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-21
Onset:2021-05-22
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS COV2 PCR: positive on 5/26/2021
CDC Split Type:

Write-up: On 5/22 she began exhibiting congestion and lost of taste and smell. She subsequently tested positive for Covid-19


VAERS ID: 1354364 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt recovered in less than 1/2 hr. Checked his BP and pulse- normal. Pt and his cousin said he fainted after getting the first dose on 4/24/2021. He promised he''ll see his PCP.


VAERS ID: 1354520 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN O42A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: K-DUR, magnesium oxide, finasteride, ASA, tamsulosin, rosuvastatin, bumetadine, valsartan, dofetilide, spironolactone, carvedilol
Current Illness:
Preexisting Conditions: CHF, coronary arteriosclerosis, sleep apnea, HTN
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After administration of the Janssen vaccine information was discovered that the Veteran had received 1st dose pfizer vaccine on 1/3/2021. Veteran did not have any adverse reaction.


VAERS ID: 1354545 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Hypopnoea, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Chest compression, shallow breathing, anxiety, shakiness


VAERS ID: 1354549 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Contusion, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline Spironolactone Vitamins
Current Illness:
Preexisting Conditions: Yes working with rheumatologist undiagnosed right now
Allergies: Pcn Sulfa
Diagnostic Lab Data: None Prednisone, benadryl and zyrtec but it''s not working
CDC Split Type:

Write-up: Hives some leave bruises and bone pain


VAERS ID: 1354550 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

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

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

Write-up: Red rash around injection site 3-4 inches round


VAERS ID: 1354619 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: fish oil, flax seed oil, multivitamin, vitamin C, magnesium oxide, probiotic, nasonex
Current Illness: heart condition, sleep apnea
Preexisting Conditions: heart condition, sleep apnea
Allergies: dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart beating fast and hard. More frequent get up and urinate during the night. More chest pain.


VAERS ID: 1354708 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Fainted 20 min after vaccine, after the waiting period waiting to check out. Vitals were taken and odserved for another 20 min. Has been ok since. No additional symptoms.


VAERS ID: 1354739 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: After 10 minutes of administration the patient fainted. He was lowered to the floor and awakened almost immediately. BP was 127/65, pulse was 63. He was pale. A physician was in attendance the entire time. Once he was better he was transferred to a stretcher. Mother stated he had been at an overnight sleep over, she had picked him up from there and came directly to the clinic. He stated he had nothing to eat or drink that morning. he was given water and some snacks.. MD released him when he appeared to be back to baseline. He was seen in the pediatician''s office on the 5/24/21 as a followup at the parent''s request at which time no issues were found. Patient''s father had asked the pediatrician''s office to see the patient following the innoculation that day which the office deferred as an MD was attending this patient in the clinic.


VAERS ID: 1354877 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Injection site erythema, Tenderness
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bystolic, Metformin, Cardizem, D3
Current Illness:
Preexisting Conditions: Hypertension, AFIB, Type 2 Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tenderness for 7 days and counting Redness in an area of 5 to 6 inches around the injection site Ongoing dizziness, and light headed feeling (7 days and counting)


VAERS ID: 1354911 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-03-07
Onset:2021-05-22
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anion gap, Biopsy endometrium, Blood culture, Cerebral haemorrhage, Computerised tomogram head abnormal, Diabetic ketoacidosis, Herpes zoster oticus, Pulmonary embolism, Thrombocytopenia, Vaginal haemorrhage, Venous thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 66 y.o. female with an unknown PMHx admitted with DKA and found to have thrombocytopenia, an intraparenchymal bleed on Head CT 2/2 to dural venous thrombosis. Course also complicated by saddle submassive PE w/ + biomarkers and mild RHS. Given unclear etiology of thrombocytopenia, venous thrombosis, and PE, suspect a precipitating/underlying etiology and cannot rule out possible occult malignancy, autoimmune disorder or alternative hypercoagulable state such as APLS. Possibly bacteremic given GPB and Staph on blood cx, though likely contaminant. DKA resolved, anion gap is closed, continued monitoring of glucose and insulin adjustment .OB/Gyn following for heavy vaginal bleeding and possibly gyn malignancy workup, endometrial biopsy pending. Heme also following.


VAERS ID: 1354921 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

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

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

Write-up: Vaccine inadvertently administered. Patient did no show any type of distress after 1st dose. CDC COVID-19 vaccine hotline was contacted and advised us to give 2nd dose off label use.


VAERS ID: 1354945 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-05-22
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain upper, Menstrual disorder, Menstruation delayed, Menstruation irregular, Muscle spasms, Pelvic pain
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Natures Made Stress B Complex
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, Emycin, Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I wanted to report abnormal 16 day period following the vaccine, and now my next period is already 5 days late and I am experiencing pelvic and stomach pain that feels like a constant cramp and bloated feeling. I feel like the vaccine impacted my hormones in some way and now periods are unpredictable.


VAERS ID: 1354971 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Influenza like illness, Injection site erythema, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydorcholorthiazide (in A.M.) Plavix (in A.m.)
Current Illness: Hypothyroidism Peripheral Artery Disease High Blood Pressure
Preexisting Conditions: Hypothyroidism High Blood pressure High cholesterol
Allergies: Penicillin Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 1st injection on 4/30/2021, injection site pain, slight headache for 3 days. After 2nd vaccination on 5/21/2021: arm pain, flu-like symptoms body aches, slight headache, loss of appetite, some dizziness, chills, slight rise in body temperature, injection site swelling , redness and very hot, nausea, body rash, fatigue, joint pain. Side effects gradually decreased over the following 6 days.


VAERS ID: 1354989 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

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

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

Write-up: Vaccine inadvertently administered. Patient did not show any distress after 1st dose. After speaking with CDC COVID-19 vaccine hotline representative advised us to give 2nd dose vaccine off label.


VAERS ID: 1355027 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Hypopnoea, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was waiting in a chair after the vaccine and bent over to pick up a phone off of the ground. He got lightheaded and passed out as he was bending over. The patient hit his head and briefly passed out. We got him to the ground slowly and provided him with an ice pack and bottle of water. He was breathing quickly and shallowly for about 30 seconds but returned to normal shortly after.


VAERS ID: 1355097 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back injury, Decreased appetite, Fall, Fatigue, Loss of consciousness, Skin injury
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Has orthopedic issues. Has metal in both legs and is scheduled for a surgery on his shoulder in near future.
Allergies: Unknown
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 1st dose of Moderna was patient reported that he had decrease in appetite, was fatigued and sat in chair for days after his vaccination. Had no allergic reactions. Second dose was 5/21/21 at 11:10 AM. The next morning 5/22/21 passed out and fell on the floor when walking to the bathroom. Back pain and injured skin on both legs. Saw his PCP on Monday 5/24/21 for evaluation.


VAERS ID: 1355160 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection site pain: intense pain/soreness for day after injection, moderate soreness for 3 days Tiredness, severe headache, fever, chills, muscle pain, nausea from 10 hours after injection until ~48 hours after Mild headache for next 5 days


VAERS ID: 1355165 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Inappropriate schedule of product administration, Influenza like illness, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: D3 Tylenol Arthritis Lisinopril Baby Aspirin Atorvastatin Jardiance Escitalopram Allegra
Current Illness: No illnesses at the time of vaccination and no illness up to one month prior.
Preexisting Conditions: Diabetes Heart disease High cholesterol Psoriatic Arthritis Rheumatoid Arthritis
Allergies: Gluten
Diagnostic Lab Data: I talked to a Pharmacist about my symptoms and he said it sounded like I have a flu. I let a couple day''s pass to see if the symptoms would subside and the vomiting stopped until this morning 5/27/21 when I began to vomit again and the diarrhea has not stopped for 6 day''s now. I was told to stay hydrated but there is nothing I can do except ride it out.
CDC Split Type:

Write-up: I woke up the day after the vaccine feeling very tired and I felt like I had the flu. I was vomiting and had diarrhea. I have been sick with these same symptoms since then and I am 6 day''s past the vaccination. My second vaccination dose was on the 21st of may. My first dose was on the 7th of May and I was extremely sore with the first dose but, I did not have any of these other symptoms. I have autoimmune diseases and have been told by a couple different doctor''s that several other people with autoimmune diseases are reporting the same things.


VAERS ID: 1355167 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bladder pain, Constipation, Diarrhoea, Headache, Hepatic pain
SMQs:, Liver related investigations, signs and symptoms (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)

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

Write-up: 18 hours after vaccine my spleen, liver and bladder were hurting along with headache, diarrhea, joint pain all of them. Spleen, liver hurt for 3 days. After 6 days I still have headache and bladder pain along with constipation for last 2 days.


VAERS ID: 1355207 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Hypertension, Paraesthesia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Hypertension-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Unable to Sleep-Medium, Additional Details: pt state went to ER twice will follow up with her dr


VAERS ID: 1355218 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-12
Onset:2021-05-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: dicyclomine 10 mg 1q6-8hprn promethazine 25 mg 1q8hprn
Current Illness: asthma abdominal pain
Preexisting Conditions: asthma
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reports tremor in right arm-went to ER and they thought it was related to the vaccine, they ruled out stroke


VAERS ID: 1355226 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / IM

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

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

Write-up: Gave 2nd Moderna shot too early, Received first 4/30/2021 and second on 5/22/2021 --should''ve gotten it on 5/28/21 (4 weeks out) or possible 5/24/21 would have been 4 days early.


VAERS ID: 1355272 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Breast mass, Headache, Hyperhidrosis, Magnetic resonance imaging, Pain, Pyrexia, Ultrasound scan
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Bloodwork, Ultrasound for breast, MRI.
CDC Split Type:

Write-up: Fever Sweats, Body Aches, Headaches. Lump in left Breast.


VAERS ID: 1355303 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Musculoskeletal stiffness
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: I started to feel a stiff neck and pain on the upper right part of my back about 4 hours after receiving the Pfizer vaccine on my right arm. I have continued to feel the problem with my neck for several days. When I called the doctor''s office I was told to take Tylenol for the pain.


VAERS ID: 1355309 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Vaccination complication, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: Trazodone 50mg, levothyroxine 125mcg
Current Illness: Patient had cataract surgery on 5/17/2021
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data: Patient had cataract surgery on 5/17/2021.
CDC Split Type:

Write-up: Patient had cataract surgery on 5/17/2021 on her left eye. She received her second COVID shot (Moderna) on 5/21/2021. Saturday night she started feeling under the weather. Sunday morning she had cloudy vision in her left eye. Monday her vision was almost completely gone. She was seen by the doctor that did her cataract surgery and he said that the vision loss was due to constricted vessels in her eye and that was caused by the COVID shot. The patient''s vision has since fully recovered.


VAERS ID: 1355396 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram, Diarrhoea, Headache, Laboratory test, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: history of ulcerative colitis
Preexisting Conditions: ulcerative colitis
Allergies: Penicillin
Diagnostic Lab Data: ER ordered labs and a CT
CDC Split Type:

Write-up: Patient arrived at the ER on 5/22/21 after receiving her 2nd Covid vaccine, "started with vomiting overnight, had 7-8vomiting, nonprojectile, nonbilious, no blood, started having diarrhea, 4 loose watery stools, no fever, headache and body aches


VAERS ID: 1355537 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Ear discomfort, Fatigue, Headache, Neck pain, Paranasal sinus discomfort, Tinnitus, Upper-airway cough syndrome
SMQs:, Hearing impairment (narrow), Arthritis (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: seasonal allergies, anxiety
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, sinus pressure, post nasal drip, clogged ears, ringing ears, neck pain - noticed these symptoms after the acute side effects (headache, fatigue, chills) of vaccine wore off and still experiencing them 6 days later


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