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

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



Case Details (Reverse Sorted by Onset Date)

This is page 108 out of 6,867

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VAERS ID: 1677152 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-13
Onset:2021-08-19
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Inappropriate schedule of product administration, Myalgia, Peripheral swelling, Pruritus, Rash, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Itchiness; Arm Swelling (right); Tenderness (right); Arm pinkish in color; Rashes on elbow (right); Arm soreness (right); Third dose given more than 35 days from second dose; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS, PERIPHERAL SWELLING (right arm), TENDERNESS, ERYTHEMA, and RASH (right elbow) in an 87-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 044A21A and 022C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 19-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 19-Aug-2021, the patient experienced PRURITUS, PERIPHERAL SWELLING (right arm), TENDERNESS, ERYTHEMA, RASH (right elbow), MYALGIA (right arm), and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Third dose given more than 35 days from second dose). At the time of the report, PRURITUS, PERIPHERAL SWELLING (right arm), TENDERNESS, ERYTHEMA, RASH (right elbow), MYALGIA (right arm), and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Third dose given more than 35 days from second dose) had resolved. No concomitant medication were provided by the reporter. No treatment medication were provided by the reporter.


VAERS ID: 1677192 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cellulitis, Diarrhoea, Headache, Nausea, Oral herpes, Product administered at inappropriate site, Pyrexia, Vaccination site erythema, Vaccination site pruritus, Vaccination site reaction, Vaccination site swelling, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Drug abuse and dependence (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: herpes sore on my lip; Vaccination site erythema; Vaccination site swelling; Vaccination site pruritus; Vaccination site warmth; Cellulitis of arm; diarrhea; Vaccination site reaction; Headache; Nausea; Fever; Vaccine administered at inappropriate site; This spontaneous case was reported by a consumer and describes the occurrence of CELLULITIS (Cellulitis of arm) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Aug-2021, the patient experienced DIARRHOEA (diarrhea), VACCINATION SITE REACTION (Vaccination site reaction), HEADACHE (Headache), NAUSEA (Nausea), PYREXIA (Fever) and PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (Vaccine administered at inappropriate site). On 20-Aug-2021, the patient experienced CELLULITIS (Cellulitis of arm) (seriousness criterion medically significant), VACCINATION SITE ERYTHEMA (Vaccination site erythema), VACCINATION SITE SWELLING (Vaccination site swelling), VACCINATION SITE PRURITUS (Vaccination site pruritus) and VACCINATION SITE WARMTH (Vaccination site warmth). On 23-Aug-2021, the patient experienced ORAL HERPES (herpes sore on my lip). At the time of the report, CELLULITIS (Cellulitis of arm), ORAL HERPES (herpes sore on my lip), VACCINATION SITE ERYTHEMA (Vaccination site erythema), VACCINATION SITE SWELLING (Vaccination site swelling), VACCINATION SITE PRURITUS (Vaccination site pruritus), VACCINATION SITE WARMTH (Vaccination site warmth), DIARRHOEA (diarrhea), VACCINATION SITE REACTION (Vaccination site reaction), HEADACHE (Headache), NAUSEA (Nausea), PYREXIA (Fever) and PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (Vaccine administered at inappropriate site) outcome was unknown. No concomitant medication was reported. Treatment information was not provided by reporter. This case was linked to MOD-2021-265574 (Patient Link).


VAERS ID: 1677451 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Guillain Barre syndrome (History of GB syndrome in 1992.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101080733

Write-up: Rash on inner right arm, upper right arm, side of right breast and a couple of spots on abdomen; a couple spots on the right side of her stomach; This is a spontaneous report from a contactable consumer. A 53-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for Injection, Batch/Lot number: FC3180) via an unspecified route of administration, administered in Arm Left on 17Aug2021 as DOSE 1, SINGLE (at the age of 53-year-old) for covid-19 immunisation. The patient''s medical history included guillain-barre syndrome from 1992 to an unknown date History of GB syndrome in 1992. The patient''s concomitant medications were not reported. It was reported that, patient got vaccine in left arm and right side has the rash on 19Aug2021. The rash was on her inner, upper right arm and on the outer side of her right breast. Patient also has a couple spots on the right side of her stomach. Patient was currently taking Allegra twice/day for symptoms. Therapeutic measures were taken as a result of events. The outcome of the events was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1677482 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Conjunctival haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Conjunctival disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ulcerative colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101093898

Write-up: Subconjunctival hemorrhage; This is a spontaneous report from a contactable nurse (patient herself). This 50-year-old female patient (not pregnant) received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number not provided), via an unknown route, on 19Aug2021 16:00 at single dose for COVID-19 immunisation, administered at pharmacy/drug store. No other vaccine was received in four weeks. Relevant medical history included colitis ulcerative. No known allergies. The patient was taking concomitant medications (no details provided). On 19Aug2021, the patient developed subconjunctival hemorrhage. No seriousness criterion was provided by the reporter. Pre-vaccination and post-vaccination COVID tests were not performed. The patient was not treated for the event. The patient had not recovered from the event. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: Based on temporal relation, the association between the event of subconjunctival haemorrhage and the suspect product of BNT162B2 cannot be completely ruled out. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1677577 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Extra dose administered, Off label use, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: covid; Test Result: Positive.
CDC Split Type: USPFIZER INC202101133869

Write-up: This is a spontaneous report from a contactable consumer (patient). A male patient of unspecified age received third dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot Number: Unknown), via unspecified route of administration, on 19Aug2021, as dose 3, single for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot Number: Unknown), via unspecified route of administration, on an unspecified date, as dose 1 and dose 2 for COVID-19 immunization. The patient had taken third shot of Pfizer on 19Aug2021 and was tested positive for COVID on 24Aug2021. I am now past my ten days with no further symptoms from COVID, and also got the antibody treatment on 25Aug2021. My question was do I need another booster now or in 90 days. The outcome of the event (I tested positive for covid on 24Aug2021) was recovered on an unspecified date. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1678268 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dry mouth
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: USMODERNATX, INC.MOD20212

Write-up: Sudden Dry mouth; This spontaneous case was reported by a nurse and describes the occurrence of DRY MOUTH (Sudden Dry mouth) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026C21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, the patient experienced DRY MOUTH (Sudden Dry mouth). At the time of the report, DRY MOUTH (Sudden Dry mouth) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered DRY MOUTH (Sudden Dry mouth) to be possibly related. The concomitant history was not reported. The treatment history was not provided. Patient Patient experienced sudden dry mouth after first dose, another patient also experienced the same with same vial. No incidents found of improper storage refrigeration r freezing. Two remaining vials of same lot number are set aside. Clinic utilized a different lot number 047B21A no reported symptoms of dry mouth since implementation.


VAERS ID: 1678323 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-08-19
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19


VAERS ID: 1678495 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray, Chest pain, Condition aggravated, Dizziness, Headache, Laboratory test, Lymphadenopathy, Migraine, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, b complex, emgality, fluticasone nasal spray
Current Illness: None
Preexisting Conditions: Mirgaines
Allergies: Doxycycline, Keppra, Lamictal, metal, side effects from everything
Diagnostic Lab Data: Chest xray 8/20 labs
CDC Split Type:

Write-up: Chest pain. Nausea, light headedness, left hip pain, swollen lymph nodes, increase in headaches and migraines Chest x ray completed negative for myocarditis labs completed stable Given tordal and Zofran barely effective


VAERS ID: 1678505 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA 033C2IA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dysarthria, Dyspnoea, Epistaxis, Fatigue, Feeling abnormal, Headache, Nausea, Oropharyngeal pain, Pain, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tirosint, Cytomel, Vitamin D, Zinc, Testosterone, Fish Oil, Quercetin, Vitamin C, Cryptolepsis, Banderol, Samento, Addyi, Zyrtec, Topomax, and DHEA.
Current Illness: NA
Preexisting Conditions: Hashimoto''s- autoimmimmune disease Chronic Lyme Disease and Epstein Barr Virus
Allergies: NA
Diagnostic Lab Data: Have called my doctor several times to request additional tests to understand why I''m having these types of reactions and if it''s tied to my pre-existing health conditions, which is why I didn''t want to get the vaccine to begin with but my employer forced me to do it. I keep getting an voice message system and no one calls me back. It''s very concerning that no one will return my call about my health concerns.
CDC Split Type:

Write-up: Constant headaches, nausea, nose bleeds, body aches and pains, chest pains, difficulty breathing, dizziness and lightheadedness, slurred speech, blurry vision, sore throat, brain fog, and extreme fatigue. This has been non-stop since 3 days post the first vaccine. I underwent COVID testing prior to the vaccine and on 9/01/21 that both came back negative.


VAERS ID: 1678563 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Hot flush, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir, aspirin, voltaren, hizentra, atrovent
Current Illness: none
Preexisting Conditions: CVID
Allergies: sulfa
Diagnostic Lab Data: 9/1/21 telemed visit, continued fatigue, achiness but no fevers
CDC Split Type:

Write-up: Per pt: I received a 3rd vaccine (Pfizer) on August 18 due to my immune deficiency. I felt mild symptoms about 24 hours after the shot and they last for 1/2 day. On the 20th I was fine. On the 21st and 22nd, I had extreme fatigue and a low grade fever (100.4). After that I was fine for 6 days. On Saturday the 28th, I was again hit with the fatigue, chills and hot flashes. The 29th was okay, but both yesterday and today have been back to the symptoms again.


VAERS ID: 1679013 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-03
Onset:2021-08-19
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, ascorbic acid, benzonatate, budesonide/formoterol, calcium citrate, vit D 3, gabapentin, omega3 FA/fish oil, pravastatin, raloxifene, tiotropium bromide, vit b complex
Current Illness:
Preexisting Conditions: COPD, neuropathy, Osteoporosis, hyperlipidemia, dyspnea, cough, former cigarette smoker, hypoxemia
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/20/2021: COVID19 pos 8/22/2021: admitted to hospital with SOB and COPD flare up pt received O2 and dexamethasone in hospital 8/24/2021: discharged to home


VAERS ID: 1679049 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-06
Onset:2021-08-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Feeling abnormal, Flushing, Memory impairment, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient not taking any medications.
Current Illness: None known.
Preexisting Conditions: None known. Patient does not see a doctor.
Allergies: None.
Diagnostic Lab Data: Patient does not see a doctor.
CDC Split Type:

Write-up: Patient states she was flushed for a couple days after receiving the vaccine. Then starting on 08/18, she experienced a lot of fatigue, had to drive her friend back from an ortho surgery, and did not remember completing the drive. The patient also complained of more than normal brain fog and no appetite that lasted till about 08/21. The patient also experienced pain in both arms that she described as similar to carpal tunnel which lasted for about 1/2 day.


VAERS ID: 1681593 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-05
Onset:2021-08-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Head banging, Mobility decreased, Musculoskeletal discomfort, Neck pain, Pyrexia, Vaccination site swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (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: MULTIVITAMINS [VITAMINS NOS]
Current Illness:
Preexisting Conditions: Comments: No Medical history provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: I had a little bit of swelling in the site of injection; Fever; I cannot make any movements because my neck make sound; I feel like my neck is going to break; I started, when turning my head back, making sound, it sounds very ugly; It hurts in my neck, where the spine begins in the head; This spontaneous case was reported by a consumer and describes the occurrence of MOBILITY DECREASED (I cannot make any movements because my neck make sound), MUSCULOSKELETAL DISCOMFORT (I feel like my neck is going to break), HEAD BANGING (I started, when turning my head back, making sound, it sounds very ugly), NECK PAIN (It hurts in my neck, where the spine begins in the head) and VACCINATION SITE SWELLING (I had a little bit of swelling in the site of injection) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 091B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical history provided. Concomitant products included MULTIVITAMINS [VITAMINS NOS] for an unknown indication. On 05-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Aug-2021, the patient experienced MOBILITY DECREASED (I cannot make any movements because my neck make sound), MUSCULOSKELETAL DISCOMFORT (I feel like my neck is going to break), HEAD BANGING (I started, when turning my head back, making sound, it sounds very ugly) and NECK PAIN (It hurts in my neck, where the spine begins in the head). On an unknown date, the patient experienced VACCINATION SITE SWELLING (I had a little bit of swelling in the site of injection) and PYREXIA (Fever). The patient was treated with IBUPROFEN ongoing since an unknown date for Product used for unknown indication, at an unspecified dose and frequency. At the time of the report, MOBILITY DECREASED (I cannot make any movements because my neck make sound), MUSCULOSKELETAL DISCOMFORT (I feel like my neck is going to break), HEAD BANGING (I started, when turning my head back, making sound, it sounds very ugly), NECK PAIN (It hurts in my neck, where the spine begins in the head), VACCINATION SITE SWELLING (I had a little bit of swelling in the site of injection) and PYREXIA (Fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.


VAERS ID: 1681835 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101084242

Write-up: Headache; Nausea; This is a spontaneous report from a contactable consumer. This consumer (patient parent) reported for 12-year-old male patient(son) that he received BNT162B2 (BioNTech Covid-19 Vaccine, formulation: Solution for injection, batch/lot number: unknown), via unknown route of administration on 19Aug2021 (at the age of 12 years old) as a DOSE 1, SINGLE for COVID-19 immunisation. The patient medical history and concomitant medication was not reported. The patient experienced headache and nausea on 19Aug2021. The outcome of the event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1681880 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anticoagulant therapy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091053

Write-up: I am experiencing pain in my shoulder where I got the shot; This is a spontaneous report from a contactable consumer (the patient). A 9-decade-old patient of an unspecified gender received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration on 19Aug2021 (Batch/Lot Number: EW0181) as single dose for covid-19 immunisation . Medical history included anticoagulant therapy. The patient''s concomitant medications were not reported. The patient experienced pain in my shoulder where i got the shot (non-serious) on 19Aug2021 with outcome of unknown. The patient still has pain in the muscle three days after the shot. Follow up information has been requested.


VAERS ID: 1681884 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091229

Write-up: Large blood clot in right leg(DVT). Currently on blood thinners; This is a spontaneous report from a contactable consumer (patient). A 58-year-old male patient received first dose of bnt162b2 (BNT162B2), via an unspecified route of administration, administered in Arm Right on 11Aug2021 13:00 (Lot Number: FC3180) as single dose (at age of 58-year-old) for covid-19 immunisation. Medical history was reported as none. He had no known allergies. Concomitant medications were not reported. Facility type vaccine: pharmacy or drug store. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. On 19Aug2021 06:00 patient experienced large blood clot in right leg, deep vein thrombosis (DVT). Currently on blood thinners. Event resulted in: Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care. Patient was admitted for the event on unknown date. Patient was treated with Coumadin and Lovenox. Patient did not have COVID prior vaccination. No COVID tested post vaccination. Patient had not recovered, at the time of the report.


VAERS ID: 1681976 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW167 / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure measurement, Deafness unilateral, Dizziness, Erythema, Flushing, Hypoaesthesia, Pain in extremity, SARS-CoV-2 test, Taste disorder
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVAIR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; COVID-19 (If covid prior vaccination:Yes); Diabetes; Hypertension; Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: Blood pressure; Result Unstructured Data: Test Result:drop in BP; Test Date: 20210823; Test Name: Sars-Cov-2-test; Result Unstructured Data: Test Result:Unknown; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101109946

Write-up: Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; Red, flushing with pain and numbness in hands and feet, drop in BP dizziness, and bad taste in mouth and loss of hearing right ear; This is a spontaneous report from a contactable other hcp (Patient). A 44-years-old Non- Pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot Number: EW167 and Expiry date was not reported), via an intramuscular route of administration on 18Aug2021 15:30 (at the age of 44-years-old) in Arm Right as dose number unknown, single for COVID-19 immunization. The Patient Medical history included hypertension, diabetes mellitus, asthma from all an unknown date and unknown if ongoing , drug hypersensitivity (Known allergies: sulfa) and COVID-19 from an unknown date and unknown if ongoing If covid prior vaccination:Yes. Concomitant medication(s) included fluticasone propionate, salmeterol xinafoate (ADVAIR), BP medication and diabetic med all taken for an unspecified indication, start and stop date were not reported. The patient received other medications within 2 weeks of vaccination: BP medication and diabetic med and advair inhaler. The Patient was not pregnant at the time of vaccination. The patient had not received other vaccine in 4 weeks prior to COVID 19. The Patient diagnosed with COVID-19 prior to vaccination and the patient had tested for COVID-19 post vaccination. On 19Aug2021 16:00, the patient experienced red, flushing with pain and numbness in hands and feet, drop in bp dizziness, and bad taste in mouth and loss of hearing right ear. The Patient received treatment with steroids. Patient visited physician office. The patient underwent lab tests and procedures which included blood pressure measurement: drop in bp on 19Aug2021, sars-cov-2 test: unknown on 23Aug2021 Nasal Swab. The outcome for the events was recovered with sequel in 2021. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: The event of "deafness unilateral" is assessed as possibly related to the suspect drug "BNT162B2" based on strong temporal association, but consider also possible contributory effects from patient''s medical history and/or concomitant medications. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1682049 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Extra dose administered, Off label use, SARS-CoV-2 test
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: COVID-19; Test Result: Positive
CDC Split Type: USPFIZER INC202101136002

Write-up: tested positive for covid on 24Aug; I have gotten my third shot of Pfizer on 19Aug; I have gotten my third shot of Pfizer on 19Aug; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number: unknown), dose 3 via an unspecified route of administration on 19Aug2021 as dose 3, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient previously received first and second dose of BNT162B2 on an unspecified date for COVID-19 immunization. Patient reported that I had got my third shot of Pfizer on 19Aug2021 and tested positive for covid on 24Aug2021 and now past ten days with no further symptoms from covid. I also got the anticolonial antibody treatment on 25Aug2021. Patient wanted to know do I need another booster now or in 90 days. The patient underwent lab tests and procedures which included Covid-19: positive on 24Aug2021. The events were assessed as non-serious. Therapeutic measures were taken as a result of tested positive for covid on 24aug. The clinical outcome of event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1682128 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to plants (Known allergies: trees); Cockroach allergy (Known allergies: roaches); Fruit allergy (Known allergies: cherry, cantaloupe); Heartburn; Vegetable allergy (Known allergies: Spinach)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101150816

Write-up: Pain, itching and swelling on left arm; Pain all across chest; Pain, itching and swelling on left arm; Pain, itching and swelling on left arm; This is a spontaneous report from a contactable healthcare professional. A 49-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0175) via an unspecified route of administration in the left arm on 19Aug2021 at 07:15 (at the age of 49-years-old) as a single dose for COVID-19 immunisation. Medical history included heartburn. The patient had known allergies to spinach, cherry, cantaloupe, trees, and roaches. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the COVID-19 vaccine. The patient did not take any concomitant medications. On 19Aug2021 at 08:00, the patient experienced pain, itching, swelling on left arm and pain all across the chest for a week. The patient was not going to take any more dose. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events of pain, itching and swelling on left arm were not recovered at the time of this report. The clinical outcome of pain all across chest was recovered on an unknown date in Aug2021.


VAERS ID: 1682486 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Sexual dysfunction (broad)

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

Write-up: Around 30 hours post injection patient experienced left arm and left side of face total numbness and paralyses. These symptoms moved to right side of face and down the left side of body; left upper back and left chest. Patient said it felt like she was experiencing what is described as Bell''s Palsy type symptoms. These symptoms lasted until 8/30/21 then they started fading.


VAERS ID: 1682513 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-31
Onset:2021-08-19
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

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

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

Write-up: Pt seen at Allegan on 8/19 and tested positive for COVID-19 on the Liat. Pt then admitted on 8/28 for hypoxia at Hospital.


VAERS ID: 1682520 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losarton
Current Illness: None
Preexisting Conditions: HTN
Allergies: no allergies but she reports hypersensitivity to medications
Diagnostic Lab Data: Pending ECHO
CDC Split Type:

Write-up: She complained of coughing and shortness of breath. She thought it was due to mask she was wearing but it continued. She went home. She continued to cough so she brought a pulse ox. Her oxygen sat was 93%. She started having chest tightness. She called our office on Sun night 8/22 and then called on Monday 8/23. Due to symptoms it was suggested she seek medical attention. She went to hospital and they told her they coughing was due to a reaction. They referred to cardiologist. She was told by cardiologist it was related to vaccine reaction.


VAERS ID: 1682876 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Exposure during pregnancy, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: cephalosporins, fentanyl, penicillin, vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: When patient was in for 2nd shot, she stated she developed lower back pain the day after her 1st shot. Patient stated she had a hard time walking for about a week and a half after the shot. She is 7 weeks pregnant and due in April. She stated she went to the er and her pcp, both told her it was because she was pregnant. She went to her ob/gyn and told her it was not related to her pregnancy and not sure why she had the back pain. Patient stated she had to do physical therapy now.


VAERS ID: 1683227 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Previous Pfizer Covid-19 vaccines. 2/20/2021; 3/13/2021
Other Medications: Xeljanz, Apriso, aspirin
Current Illness:
Preexisting Conditions: Ulcerative colitis
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache, some tiredness, body aches


VAERS ID: 1683732 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthropod bite, Body temperature, Chills, Erythema, Fatigue, Fibrin D dimer, Headache, Illness, Lymphadenopathy, Lymphoedema, Migraine, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Medical History/Concurrent Conditions: Breast cancer (Verbatim: Breast cancer); Lymphedema (lymphedema in the right arm/ lymphedema arm from having had breast cancer)
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: temperature; Result Unstructured Data: Test Result:99.8; Test Date: 20210831; Test Name: D-dimer; Result Unstructured Data: Test Result:unknown
CDC Split Type: USPFIZER INC202101134190

Write-up: swollen lymph nodes opposite arm of the shot; Lymphedema; her other arm turned huge and red just like she had a bug bite; her other arm turned huge and red just like she had a bug bite; her other arm turned huge and red just like she had a bug bite; felt sick all over; she was so exhausted she couldn''t get up; severe migraine headache; headache/head ache; chills; fever; This is a spontaneous report from a contactable other healthcare professional (patient). A 67-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 19Aug2021 in the evening (at the age of 67-year-old) (Lot Number: FD8448) as single dose for COVID-19 immunization. Medical history included breast cancer in 1999, lymphedema in the right arm/ lymphedema arm from having had breast cancer. Family medical history relevant to AE(s) was none. There were no concomitant medications. The patient had no history of previous immunization with the Pfizer vaccine considered as suspect. The patient had no additional vaccines administered on same date of the Pfizer suspect. The patient had no Prior Vaccinations (within 4 weeks). No AE(s) following prior vaccinations. The patient experienced severe migraine headache, headache, chills, fever since 19Aug2021, swollen lymph nodes opposite arm of the shot, Lymphedema since 30Aug2021. The patient reported that immediately after the shot, she came home and she was so exhausted she couldn''t get up; then the headache from hell started and has lasted five straight days; she also had a temperature of 99.8 for five days and chills; she had no breaks. She just felt sick all over. Then last day (30Aug2021) her other arm turned huge and red just like she had a bug bite. Added this was her lymphedema arm from having had breast cancer. States you can''t find any bites or site that would have made her arm swell. When she spoke to the pharmacist he said you won''t believe how many of these we are getting. Last night she had the headache again, it was not letting up; no matter what she eats or drinks it was not getting better. She was asking how long this was supposed to last. Added she had her grandkids last night, she was so sick with the headache she couldn''t tend to them. Last night was the second time that the headache was that debilitating, she couldn''t get out of bed. The patient didn''t go to the doctor because she thought it would pass; and she won''t go to the hospital because there was just too much stuff in there. Caller mentioned she had spoken with the doctor''s secretary who was keeping the doctor informed. Mentions she went today (31Aug2021) to get a D Dimer test in case she has a blood clot in her arm. No results provided. The patient states she has had a severe reaction to it. She was against it; and was scared into it because her sister just died of COVID. Caller was upset; mentions they just laid her sister to rest on Sunday. Adds the hospital blew her lungs out; they gave her too much oxygen. Her sister was in 23 days in the hospital. Vaccination card says her next dose should be 09Sep2021. Caller mentions she spoke with the pharmacist who told her not to get the second dose. AE(s) did not require a visit to Emergency Room or Physician Office. Outcome of the event her other arm turned huge and red just like she had a bug bite was unknown; other events was not recovered.


VAERS ID: 1684685 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I am scheduled for allergy study October 4th
CDC Split Type:

Write-up: I received my first dose of the Moderna vaccine on 8/17 prior to the deadline of 8/31 as mandated by the system. On 8/19 I started itching towards the end of my shift around 5:00pm. By the time I got home I was covered on my entire abdomen, back, neck arms and legs in a rash. This soon progressed and continued over the next 3 days to hard raised swollen welts up to my face almost causing my eyes to swell shut. Upon contacting my primary physician I was instructed not to receive the second dose until an allergy study was performed. However, under the current situation these COVID vaccine allergy studies are limited and are performed once every few weeks and the next day they were offering in September was completely booked (I am on standby for a cancellation). My appointment is October 4th which is after my scheduled second dose September 14.


VAERS ID: 1685294 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-05
Onset:2021-08-19
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Biopsy prostate abnormal, Blood test, Magnetic resonance imaging abnormal, Prostate cancer, Prostatic disorder, Prostatic specific antigen increased
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Tumour markers (narrow), Prostate malignant tumours (narrow), Prostate tumours of unspecified malignancy (narrow), Non-haematological malignant tumours (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: Levothyroxine
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: MRI; Biopsy; I am going to have some pre-operative testing on Monday, 13th of September - Bloodwork and EKG.
CDC Split Type: vsafe

Write-up: My bloodwork for a my annual exam -showed an elevated PSA - May 2021; they did an MRI and found lesions. Then they did biopsy and they discovered cancer - Prostrate - August 3rd, I think. Verified it was cancer on the August 19th. Urologist - He''s the one that is going to do the operation. The operations is scheduled for the 21st of September - they will remove my prostrate. Not experiencing any symptoms.


VAERS ID: 1685439 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Influenza like illness, Mobility decreased, Nausea, Neck pain, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: RECLAST INFUSION, SUBSEQUENT ER, HIGH BP AND PULSE AGE 68 AT TIME
Other Medications: ? Tirosint gelcap 75 mcg ? 1/day ? Liothyronine (Cytomel) 5 mcg ? 1/day ? Metanx ? 1/twice a week ? Lisinopril HCTZ 20-12.5 mg ? 1/day ? Potassium Chloride ER Capsule 10MEQ ? 1/day ? Lansoprazole 30 mg ? 1/day ? Yuvafem / 10 MCG Tab Insert
Current Illness: Ongoing IBS
Preexisting Conditions: No spleen, AXONICS sacral nerve stimulator implant, 3 upper dental implants. Past history of atrial fibrillation 8/01. Currently monitored for angiomyolipoma L. kidney, neurogenic bladder & bowel / prolapse / post menopausal, (hysterectomy 1988 / R. ovary remains), diverticulosis / hiatus hernia / GERD / IBS (sister, aunt & 1st cousin colon cancer), Hashimoto?s thyroiditis, familial hypercholesterolemia, hypertension / mildly dilated ascending aorta, osteopenia, left lower lumbar arthritis / spondylosis/ sciatica, Dupuytren?s syndrome in dominant left hand, severe arthritis R. thumb & wrist
Allergies: Avelox, Meloxicam, Morphine, Nexletol, Praluent pen, Reclast infusion. sodium laurel sulphate (SLS) in toiletries; does not tolerate statins & other cholesterol meds (aching, bruising, IBS symptoms).
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 3 FULL DAYS OF VERY SORE ARM, SORE NECK, NAUSEA, ACHINESS, DIARRHEA, FLU LIKE SYMPTOMS. NO FEVER BUT IN BED WHOLE TIME.


VAERS ID: 1685480 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Back pain, Chills, Dizziness, Faeces discoloured, Headache, Injection site pain, Lymphadenopathy, Myalgia, Oropharyngeal pain, Pain, Pruritus, Pyrexia, Rash, Somnolence, Ulcer, Urticaria, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

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

Write-up: 1st day Thursday night after the shot - swollen nodes, pain in the shot area 2nd day Friday cold chills, fever, body pain, dizziness, 5th day Monday hives, itchiness, rash all over body 7th day Wednesday head throbbing in the afternoon, sleepy 12th Monday day muscle pain, weakness, stomach ache 13th & 14th day Tues & Wed vertigo, black stool, ulcer, back pain 15th day Thurs soar throat


VAERS ID: 1685641 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-13
Onset:2021-08-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: BREAKTHROUGH CASE : Covid + 08/19/2021


VAERS ID: 1685976 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Pt states he had fever of 99.5 and chills and body aches that started the day after vaccination and continued for 7 days after


VAERS ID: 1686235 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Headache, Paraesthesia, Skin tightness
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Not so much adverse but mmr vaccine does not show up in Me I have had it five times
Other Medications: None
Current Illness: None
Preexisting Conditions: None - very healthy immune system rarely sick
Allergies: None
Diagnostic Lab Data: None at this time as I can not afford just walking into an er and asking for a full work up . Very little guidance
CDC Split Type:

Write-up: Starting the night of the shot I had weird sensations that spread all over my body(not in joints or muscles) but mainly in neck, arms, legs, chest . It was a tightening that sometimes just got really tight, sometimes had slight burning or tingling feeling. This progressed and got worse for two weeks and are a little better at three weeks but still present, also never had headaches other than with normal causes . I started getting really bad headaches in the base of my head that were decently painful. All of these things come on out of nowhere and also end abruptly. Please not I contacted not only my doctor but also Heath department and got NO help or guidance other than ho to ER and get a full work up!


VAERS ID: 1623200 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-19
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Antibody test; Result Unstructured Data: Non-reagent
CDC Split Type: BRJNJFOC20210842918

Write-up: CONFIRMED IMMUNOLOGICAL VACCINATION FAILURE; This spontaneous report received from a patient concerned a female of unspecified age, unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: Unknown) dose was not reported, 1 total administered on 02-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 19-AUG-2021, the patient received the result of antibody test as non-reagent and experienced confirmed immunological vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210842918-COVID-19 VACCINE AD26.COV2.S-Confirmed immunological vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1627937 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Chest pain and shortness of breath


VAERS ID: 1660296 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-14
Onset:2021-08-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Body caught fever, chills, headache.


VAERS ID: 1660387 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3380 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, SARS-CoV-2 test
SMQs:, Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210817; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202101081395

Write-up: Painful arm; This is a spontaneous report from a contactable consumer. This is a report received from the regulatory authority. Regulatory authority report number is GB-MHRA-WEBCOVID-202108200730124120-9JHQK. Safety Report Unique Identifier GB-MHRA-ADR 25827339. A 17-years-old patient of an unspecified gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE solution for injection, Batch/Lot Number: FE3380), via an unspecified route of administration on 19Aug2021 (at the age of 17-years-old) as dose 1, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Patient had not had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. On 19Aug2021, after receiving the vaccine the patient experienced painful arm. The patient underwent lab tests and procedures which included COVID-19 virus test (sars-cov-2 test): negative covid-19 test on 17Aug2021. Patient had not tested positive for COVID-19 since having the vaccine. The event was serious (medically significant). The outcome the event was not recovered. No follow-up attempts are possible. No further information expected.


VAERS ID: 1665953 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-04
Onset:2021-08-19
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No. All the tets in relation with the pregnancy was more than good.
CDC Split Type:

Write-up: On 5th of July i have got the 1st doze Pfizer. After 2 weeks I understand that on 4th of July my pregnancy was happend already. But on 5th of July I didnt know that still. I didnt have any bad symptoms on the vaccination day, neither after the day. The baby and the vaccine started on the almost same day. 8weeks later the embrion was without heartbeat. I didnt know ehat to do about the second doze before to understand this awful new.. The doctors told me that I can take the second doze after the 5th month of the pregnancy. They gave me an unvalid sertificate and the pregnancy now is an awful memory...


VAERS ID: 1577660 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-10
Onset:2021-08-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Hyperhidrosis, Malaise, Nausea, Night sweats, Palpitations, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Diclofenac 2-3 times daily, Testosterone injection bi-weekly, vitamin D weekly, and an herbal supplement 3 times daily for Lyme. Also have a steriod injection 3 time per year for a back injury. Last injection was 3 months ago
Current Illness: ongoing Lyme disease
Preexisting Conditions: back issues from a car accident in 1989 that resulted in numerous fractures in thoracic and sacrum areas.
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: woke up in the middle of the night with nausea, headache, fever, loose stool, heart palpitations and utterly exhausted. Lots of nigfht time sweating and enough so bed and pillow were wet in the morning. Continued until today where I am feeling better but still not feeling great.


VAERS ID: 1579762 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Pain in extremity
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: Severe pain in arm. Chest pain.


VAERS ID: 1581679 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Laboratory test normal, Pain, Painful respiration, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CRP and ESR elevated, labs and studies otherwise benign
CDC Split Type:

Write-up: patient started with chest pain prior to ER visit, substernal, worse with breathing and leaning forward. Also with fever.


VAERS ID: 1582139 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Red rash at injection site


VAERS ID: 1582299 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Malaise, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN
Diagnostic Lab Data: N/A
CDC Split Type: N/A

Write-up: A few minutes after receiving the vaccine PT sat down, stated that she didn''t feel well, and fainted falling forward from the chair to the floor. She hit her head on the floor (right eyebrow). She was conscious immediately after the fall when I responded. There were no other symptoms or injuries. She applied ice to her eyebrow, and we gave her water. We called 911 immediately and they talked with her about the incident. She did not leave with them. They recommended someone come pick her up.


VAERS ID: 1582307 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Sickle cell disease - HgSC, bilateral avascular necrosis, hx of acute chest syndrome
Allergies: pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral lower leg (knee to feet) tingling/numbness


VAERS ID: 1582329 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Zytek Sumatripton Medical Marijuana
Current Illness: Menstrual Migraine the prior week.
Preexisting Conditions: menstrual migraines.
Allergies: Z-pack antibiotics Spironolacton-e
Diagnostic Lab Data:
CDC Split Type:

Write-up: tingling in left side of body (down to feet/toes). Only on the left side where shot was administered. Tightness in chest.


VAERS ID: 1582338 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Extra dose administered, Hot flush, Hypersensitivity, Immediate post-injection reaction, Palpitations, Panic reaction
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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: Iressa, L-thyroxine, Simvastatin, Losartan, Trazodone
Current Illness:
Preexisting Conditions: The following are currently stable due to medications above: Stage 4 metastatic non-Small Cell Lung Cancer; hypo-thyroid, high blood pressure, high cholesterol, depression.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse injected the vaccine slowly. Immediately after shot I started coughing - then had trouble catching my breath & difficulty breathing (felt like I could only take very short breathes & couldn?t get anything in my lungs), felt panicked & a warm flush & then after a couple of minutes I was able to start getting my breath back, but then could feel my heart pounding & felt lightheaded. The nurse was ready to use an epi pen, but I started feeling better, asked her to wait. This all took about 5 minutes. Rested for another 15 minutes & went home. It has now been 2-1/2 hours & I feel fine. I had no adverse effectswith first 2 shots. ? This was a very scary reaction, I?m assuming it was an allergic reaction.


VAERS ID: 1582355 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: Patient is a 15 year-old male who presented for second dose of Pfizer COVID vaccination and presents with chest pain. After first dose of Pfizer vaccination, he had chest pressure and palpitation for five minutes and resolved spontaneously. Today, he received second dose of Pfizer today. He left after an uneventful 15-minute observation period. He went back to work at a deli nearby. Then, he started experiencing chest pain and palpitations again that didn?t spontaneously resolve. Since he was nearby, he returned to the vaccine clinic. I was called at around 2:45 PM. At that time, patient reported 8-9/10 chest pressure and palpitations. He felt like someone was pressing on his chest. Not worse with exertion. No obvious aggravating or alleviating factors. No arm pain. Per on-site nurse?s physical exam: Young male with athletic build, in no apparent distress. Sitting on cot. No diaphoresis. HR 81 and regular, BP 110/68, SpO2 97% in room air Impression & Plan 15 year-old male s/p Pfizer#2 p/w chest pain of unknown etiology and currently hemodynamically stable. Discussed case with Dr. We recommended that the patient should be transferred to a medical facility for further evaluation. Patient?s mother was contacted. She sent patient?s uncle to accompany patient. Patient and family agreed with recommendation. Transportation to be arranged by paramedics/fire department who are on site. VAERS report to be filed by


VAERS ID: 1582357 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient got really hot and sweaty after second dose. We gave her an ice pack and crackers and water and she recovered


VAERS ID: 1582359 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine 200mg 2 daily; lisinopril 20mg daily; omeprazole 20 mg daily; calcium, Vit D, zyrtec OTC.
Current Illness: rheumatoid arthritis, HTN
Preexisting Conditions: HTN, rheumatoid arthritis, fatty liver, elevated cholesterol
Allergies: Levaquin, Bactrim, latex, demerol, periactin, erythromycin
Diagnostic Lab Data: None. VS BP 130/80, Pulse 80, Resp 20
CDC Split Type:

Write-up: Sudden onset numbness and tingling to nose, lips, and right side of face as well as right side of neck. No SOB, no swelling, no other discomfort. Symptoms subsiding within 20 minutes


VAERS ID: 1582371 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Patient developed a nose bleed about 10 minutes into his 15 minutes monitoring phase. Mild to moderate bleeding from left nare. Clotting obtained. Monitoring continued for an extra 10-12 minutes. Left vaccination site with family members.


VAERS ID: 1582377 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot
SMQs:

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

Write-up: Patient reports feeling hot approximately 15 minutes after dose


VAERS ID: 1582378 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

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

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

Write-up: patient received dose out of range. patient received dose 4 months after first dose.


VAERS ID: 1582388 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Second dose of Moderna Covid19 vaccine was administered 6 days early


VAERS ID: 1582416 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Immediate post-injection reaction, Incoherent, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: RIGHT AFTER THE PATIENT RECIEVED HIS SHOT, HIS COLOR TURNED PALE AND WAS UNCOHERENT FOR A FEW SECONDS. ALMOST PASSED OUT AND HE WAS TOO HOT WE CHECKED HIS BLOOD PRESSURE IT WAS TOO LOW . AFTER A WHILE AND AFTER GIVING HIM SOME WATER AND COOLING HIM DOWN WITH A SMALL FAN , HE STARTED TO FEEL BETTER


VAERS ID: 1582417 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Injected limb mobility decreased, Injection site hypoaesthesia, Injection site paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Nurses were called to designated client waiting area in parking lot after vaccine given. Client c/o not being able to feel/lift hand and numbness/tingling up to shoulder where vaccine was given.


VAERS ID: 1582419 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness:
Preexisting Conditions: JUVENILE OSTEOCHONDROSIS OF TIBIA TUBERCLE (BILAT); ASTHMA; PANCREATIC INSUFFICIENCY;
Allergies: AMOXICILLIN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: VACCINE GIVEN SUBCUTANEOUSLY INSTEAD OF INTRAMUSCULARLY BY STAFF (STAFF IS CURRENTLY IN ORIENTATION/TRAINING)


VAERS ID: 1582436 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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 stated.
Current Illness: None stated.
Preexisting Conditions: None stated.
Allergies: Ceftin antibiotic.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient verified completed consent form with pharmacist before vaccine administration. Staff Pharmacist informed him of EUA and V-safe program and about vaccine card for patient to keep, and reviewed most common side effects and common treatment options. Vaccine administered around 2:45pm August 18th, 2021. Staff Pharmacist asked patient to wait 15 minutes after vaccine before leaving and returned to pharmacy after verbal confirmation from patient. Patient later found sitting in foyer of store by store manager. Pharmacist brought chocolate bar and water offered (both cold and room temperature). Patient also called mother after he vomited. Pieced together: patient says he was stepping out to car for a moment for something and on the way (around 2:50pm) patient started feeling bad and when he ''came-to'' he was sitting on the floor in the store foyer. He then felt sick and vomited into trashcan (per store manager) and called mother. Mother arrived after pharmacist offered water and chocolate and asked for icepack to cool patient, which store manager went to get. Per patient, he ate before hand, was not tired or feeling poorly before or during vaccine. Pharmacist asked patient how he felt, and he stated he was feeling better and visually store manager said color was returning to his face. Mother stated patient has never fainted from a vaccine before, but he does have a history (similar to mother) of "fainting when he gets sick or feels bad." She asked if he waited 15 minutes before leaving pharmacy and patient stated pharmacist did ask him to stay but he wanted to go to his car briefly and planned to return to waiting area. Patient sat on chair in foyer about 20 minutes before stating he felt fine and wanted to leave. Pharmacist asked patient to "let any healthcare personnel know for the future" regarding his fainting history. Mother stated it''s likely patient worked himself up regarding getting this vaccine which then resulted in fainting episode.


VAERS ID: 1582439 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-08-18
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram abdomen, Differential white blood cell count, Full blood count, Metabolic function test, Urine analysis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT abdomen pelvis, CBC with differential, BMP, urine microscopic reflex
CDC Split Type:

Write-up: abdominal pain


VAERS ID: 1582441 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Condition aggravated, Discomfort, Dizziness, Extra dose administered, Peripheral coldness, Skin warm, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Medication errors (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: Crestor, Cymbalta
Current Illness: intermittent elevated blood pressure
Preexisting Conditions: fibromyalgia, high cholesterol, pre-diabetes
Allergies: unknown
Diagnostic Lab Data: BS-111
CDC Split Type:

Write-up: 1243- Patient?s wife approaches RN stating her husband (patient) is feeling dizzy. RN approaches patient. NP and EMT are notified. Patient states this is his 3rd dose with Pfizer. (attestation letter was signed) 1244- NP, POD Lead, 4 nurses, EMT, and patient wife are at patient?s side. Patient is laid down on a sheet on the ground with his lower extremities elevated onto a chair. EMTs are attaching monitor to patient. NP is assessing patient. He has a h/x of intermittent elevated BP, fibromyalgia, elevated cholesterol, and pre diabetes. Patient states his SBP baseline is in the 130?s. Pt takes Crestor and Cymbalta at home. Patient states he feels ?shaky? and states his last meal was at 0800 this morning. Patient?s hands are cold to touch. Patient denies headache, chest pain, blurred vision, or SOB. NP requests BS reading. 1246- RN collects blood glucose sample. BP: 151/86, P:67, O2: 99%, BS:111 Patient states he has a h/x of elevated BP. He verbalizes he is ?slightly shaky.? Patient is given cookies and Gatorade. 1250- patient states he is feeling better and he is assisted to a sitting position in the chair. He has cold hands. Denies numbness, diaphoresis is not present, denies dizziness, denies chest pain, denies SOB. 1300- denies lightheadedness, vision changes, patient is warm to touch. 1303- patient is still sitting in chair BP: 153/85, P:58, O2: 99. 1306- patient states he feels an intermittent heaviness after taking Cymbalta 30mg this morning and sitting in the same position for long periods of time triggers his fibromyalgia symptoms. 1310- Patient states he was taking metoprolol a couple months ago but his physician stopped the medication because his BP was too low. NP advises patient to follow up with primary care physician about elevated BP. 1314- Patient states he ?feels okay, ready to go home? Patient is advised to eat when he gets home. Patient is alert, and ambulates safely to car with wife and escorted by RN.


VAERS ID: 1582455 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-10
Onset:2021-08-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052EZ1A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site inflammation, Injection site swelling, Injection site warmth
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: Scoliosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Major localized swelling at injection site, right upper arm, near the shoulder, eight days after receiving the vaccine. Swelling, bruising, and red inflammation at and around injection site. Arm/Shoulder is warm to the touch.


VAERS ID: 1582465 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 RA / IM

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

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

Write-up: Message taken by other staff and passed on to this RN: "Patient called and states that she got her COVID vaccine today and is now on her way to indigo urgent care due to her lips swelling and hives under her eyes. "


VAERS ID: 1582475 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient complaint of swelling in throat and difficulty breathing after 1st dose of moderna


VAERS ID: 1582482 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy and lightheaded


VAERS ID: 1582485 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

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

Write-up: No adverse event occurred for the patient. The patient received an initial dose of Moderna COVID vaccination at a local Pharmacy in July and came to Pharmacy for their 2nd dose. The patient stated he delayed receiving the vaccination because he was out of the country. After completing the vaccination the patient approached the vaccination area again to inform me that he had already received the Janssen vaccine back in April. He purposefully did not disclose this information to either pharmacy in order to receive the Moderna vaccination series.


VAERS ID: 1582491 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-11
Onset:2021-08-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Limb discomfort, Muscle rigidity, Pain, Pyrexia, Renal pain, Skin warm, Vaccination site induration, Vaccination site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: Patient has not been to see anyone yet, but was encouraged to do so when she reported to us.
CDC Split Type:

Write-up: Patient states that something didn''t feel quite right when she received the shot, that her arm felt weird and the shot hurt a lot. She said that her arm stayed warm and she noticed over the next few days that a hard spot was forming where the vaccine was given and has progressively gotten larger and warmer. She believes she has been running a fever off and on, and she has radiating pain across her back down to her kidney area. I was able to palpate a warm hard area on her right arm that was about 1.5 inches in diameter. She states that ibuprofen or aleve help with the pain, but that her cleaning job in environmental services, chores like mopping cause worsening of her symptoms and even cause her arm/shoulder to freeze up.


VAERS ID: 1582492 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 RA / IM

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

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

Write-up: Patient presented to pharmacy for second vaccine Pfizer. Patient is a MD. Patient stated he had had first dose only greater than 4 months ago and needed second dose. Patient confirmed on vaccine consent form that he had only received 1 dose of Pfizer. After vaccine was given, pharmacy determined via system profile that patient had in fact already received second dose of Pfizer.


VAERS ID: 1582493 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient''s mother reported history of syncopy with immunizations.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s mother reported history of syncope with immunizations. Patient became unconscious for 4 minutes after vaccination. Patient was sternum rubbed and had no reaction. Patient''s vital signs were also taken by staff and an ice pack was placed on the back of their neck. I ran over to the clinic next door to consult Dr., MD. Patient was wheeled over to the clinic next door and observed. MD reported her feeling okay and was going to be sent home.


VAERS ID: 1582494 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I took my own temperature using an in ear thermometer
CDC Split Type:

Write-up: I have a fever of 102 and have been in bed all day.


VAERS ID: 1582507 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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 known
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: vasovagal response


VAERS ID: 1582508 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Write-up: Client reported dizziness in the observation area. The client ambulated and sat down in the anti-gravity chair. The anti-gravity chair was placed into a reclined position. Vitals obtained at 1:55 PM were as follows: BP 134/82, HR 69, O2 98%. The client denied any other symptoms. The client has a history of diabetes and was prescribed Metformin about 2 weeks ago. The client states she has been experiencing dizziness related to the Metformin. She states she did eat this morning, has drank water today, and drank a juice upon arrival at the vaccination site. Offered the client a snack. The client declined. Vitals obtained at 2:04PM were as follows: BP 131/74, HR 71, O2 98%. The client stated the dizziness was getting better. Repeat vitals obtained at 2:14 PM were as follows: BP 129/75, HR 63, O2 100%. The client stated the dizziness is better and rated the dizziness at a 4/10. The client stated her current state was about the same as the dizziness she has been experiencing related to the Metformin. Client was provided education regarding s/s of anaphylaxis and when to seek EMS. Recommended the client follow up with PCP regarding the baseline dizziness. The client voiced understanding of this education. Client ambulated unassisted with a steady gait out of the vaccination site at 2:18 PM.


VAERS ID: 1582513 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Dizziness, Hyperhidrosis, Hypotension, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: citalopram 40 mg oral daily clonazepam 0.5mg oral BID Lorazepam 0.5mg oral once tablet for sever anxiety lamotrigine 50mg oral once daily
Current Illness: anxiety, depression, anaphylaxis
Preexisting Conditions: unknown
Allergies: sliver, wool, morphine, Zofran, milk
Diagnostic Lab Data: vital signs monitored until departure activated AMR
CDC Split Type:

Write-up: Severe Hypotension, Diaphoresis, Dizziness, Tachycardia, shaky, confusion From 1:45 to 2:30 when she left the building. o.3 mg Epinephrine injection auto injector to the right lateral thigh Activated AMR Epinephrine RX called into local pharmacy Hypotension and confusion, and dizziness and diaphoresis were resolved with epinephrine,


VAERS ID: 1582518 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Fainted


VAERS ID: 1582531 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-24
Onset:2021-08-18
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: Pt already got JandJ and got another vaccine of Moderna


VAERS ID: 1582538 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-16
Onset:2021-08-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Fall, Head injury, Loss of consciousness, Palpitations, Tearfulness
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), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Ocular motility disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: I have only called the clinic to advise. I am an RN and did not take him into urgent care at this time. I will monitor.
CDC Split Type:

Write-up: was fishing outside on the dock with his grandfather. It was about 1130 am. Was clear, sunny and warm. He was standing. Stated his heart felt fast and he felt light headed. Before grandpa could take the fishing pole became unconscious, fell, hit the back left of his head on the dock railing and his glasses fell off. Grandpa stated he was unconscious for only a few moments and then came to, was tearful and scared. While unconscious his eyes were rolled back in his head. He did not have any incontinence. Once wakeful was aware of his surroundings and wanted to come home after he had lunch with grandpa.


VAERS ID: 1582539 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / N/A RA / IM

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

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

Write-up: Patient came in for a COVID vaccine and upon completing his paper work the tech asked him which shot he was wanting and what dose it would be for him. He informed the tech that this was his FIRST dose and that he preferred Pfizer. The patient did not have his insurance card on him so we billed the shot according to the COVID. After receiving the shot, he received a copy of his insurance card electronically so we rebilled. They rejected stating this was a "different brand than his initial dose", meaning he had already had a dose. After looking into this, records show that he received J & J on 3/14/2021.


VAERS ID: 1582541 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, propesia, testosterone pellets, progesterone, vit D, multi-vit, DIM, magnesium m, vit c.
Current Illness: None at all
Preexisting Conditions: None at all
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, muscle aches, fatigue


VAERS ID: 1582545 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre 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: Flu vaccine
Other Medications: not reported
Current Illness: none
Preexisting Conditions: Chronic Astma
Allergies: pollen, dust, mold and spiders. no food or medications
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After administering vaccine the patient stated to feel sedation and a strange tingling in her legs. We watched the patient for approximately 30 minutes until she stated she felt a strange lump in her throat. We gave her 50 mg of diphenhydramine and called 911. After their assessment and consultation with the patient she was released on her own accord.


VAERS ID: 1582549 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: atorvastatin
Current Illness: none stated
Preexisting Conditions: pt stated previous heart condition
Allergies: none known
Diagnostic Lab Data: aware of none other than BP checks in the pharmacy as stated above
CDC Split Type:

Write-up: pt felt dizzy after admin , approx 5 minutes, pt was monitored and evaluated for 30 more minutes, pt BP was 119/72 HR 67 initially and when EMS arrived was 136/80. pt refused to leave with EMS and had them walk him out to his own car where his wife drove away


VAERS ID: 1582554 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT PASSED OUT FOR 15-20 SECONDS. HE WAS SITTING IN A CHAIR AND NO SECONDARY INJURIES OCCURED. HE CAME BACK AND HAD NO OTHER ISSUES OR PROBLEMS. GAVE HIM SOME WATER AND HE CONFIRMED NO OTHE SYMPTOMS AND HE WAS BREATHING REGULARLY WITHOUT ANY ISSUES. OFFERED TO CALL 911 AND GO TO HOSPITAL. PT. REFUSED AND SAID HE IS DOING FINE.


VAERS ID: 1582555 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

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

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

Write-up: Patient given an expired dose of Moderna. Dose expired 9 pm on 8/17/21, and was given on 8/18/21 around 2 PM


VAERS ID: 1582557 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Lip haemorrhage, Lip injury, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Flu??felt weird?
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient fainted and fell after 10 minutes of injection according to the observation staff. The patient became alert and oriented immediately when I got to her side. The patient was talking and said she felt fine. Vitals: 110/72, pulse 56. The patient was positioned in supine with pillow under her head. Applied cold water towel on her forehead. She was then able to sit up and stand without any problem after 5 minutes of observation on the floor. The bleeding from the superficial split lower lip stopped immediately with gauze pressure. A superficial abrasion on the left knee was not bleeding. There was no bleeding lesion on other area of the face or the head. The patient was evaluated by medics by calling 911 upon patient husbands request .


VAERS ID: 1582558 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-08-18
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Patient received a Janseen vaccine on 4/2/2021 but it was documented in system that he had received Moderna. Patient came in on 8/18/2021 to get a dose of COVID vaccine. We we got into the the System encounter for vaccination, we noted that it was documented that he had received a Janseen vaccine. We reviewed the image of the vaccine Encounter Form that pt had filled out and signed by both patient and the vaccinator--it stated which vaccine was given on the form. It was confirmed that he had received the Janseen vaccine on 4/2. Patient was notified that he does not need any more doses of COVID vaccine, correction was made in System, and he was given a vaccination card stating that he had received Janseen vaccine on 4/2/21.


VAERS ID: 1582567 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Throat irritation
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:
Other Medications: Metoprolol, ASA, Losartan, Rosuvastatin, Tylenol
Current Illness: none
Preexisting Conditions: HTN, Hyperlipidemia
Allergies: Lipitor Plavix
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight burning sensation in throat, itching over body mostly concentrated to face, scalp, neck, arms and abdomen


VAERS ID: 1582599 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Gait inability, Inflammation, Movement disorder, Polyarthritis
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Trelegy, vintolin, singulair, birth control,
Current Illness:
Preexisting Conditions: Narcolepsy Asthma - severe Stomach ulcers Sciatica
Allergies: Penicillin, oxy family of painkillers, NSAIDs, gabapentin,
Diagnostic Lab Data: The doctor cost me too much, said you guys know that.
CDC Split Type:

Write-up: Arthritis in joints. Rolling joint pain and inflammation all over the body. So bad I can?t walk or move.


VAERS ID: 1582607 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Rash on legs this morning after getting shot yesterday at 10:30 am.


VAERS ID: 1582644 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLUA3: INFLUENZA (SEASONAL) (FLUAD) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Inappropriate schedule of product administration, Interchange of vaccine products, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SynthroidLisinapril Metropol Rovistatin multivitamin coq10
Current Illness: None
Preexisting Conditions: High blood pressure and cholesterol
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever headache dizzy after being given Medurna shot instead of seasonal flu shot afteralready Pfizer shots 4.5 months ago. Also was given flu shot


VAERS ID: 1582705 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pharyngeal erythema, Pharyngeal swelling, Rash, Rash erythematous, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Pt reported feeling itchiness of the throat post vaccination. Red rash observed on chest and anterior neck. Throat appeared red and slightly swollen, however pt reported being able to swallow. Pt was able to speak clearly with no issues. PO Benadryl was given, 50 mg. Pt reported feeling better and left with a companion.


VAERS ID: 1582709 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Cardiac ablation, Condition aggravated, Feeling abnormal, Incomplete course of vaccination, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisonosipril for Blood pressure
Current Illness: none
Preexisting Conditions: none. Asthma when I was 25 years old. And Afib in 1999
Allergies: none
Diagnostic Lab Data: I was in Afib and now on Eloquis, Olmesartan, Caredilol to protect my heart since the ablation was performed.
CDC Split Type:

Write-up: My heart raced to 165 20 hours after receiving the vaccine. For the next 3 months my heart would race intermittently . I was back in Afib and I had it fixed in 2002. It came back right after the first Moderna vaccine and I had ablation done on July 2nd 2021 by a doctor. I had Covid back in January of 2021. I am still not feeling right and it was recommended by my doctor not to take the 2nd vaccine.


VAERS ID: 1582710 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: blood pressure taken twice by pharmacy 86/62 pulse 56, 89/64 pulse 59.
CDC Split Type:

Write-up: patient fainted about 2-3 minutes after receiving the vaccine, for a few seconds. Patient''s blood pressure taken after fainting was 86/62. Paramedic was called but by the time they got to the pharmacy patient''s vitals were stable and she was not taken to the hospital.


VAERS ID: 1582714 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Paraesthesia, Skin warm, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First Pfizer Covid vaccine on 4/29/2021. Same reaction
Other Medications: Ajovy 225 mg/1.5 ml injection monthly Alprazolam 0.5 mg prn Aplenzin 522 mg daily Buspirone 30 mg daily Nurtec ODT 75 mg prn Vitamin D3 1000 u daily
Current Illness: Seasonal allergies Migraine Mood disorder
Preexisting Conditions: AS above
Allergies: Gadolinium Contrast dye - chest/throat tightness Topamax - mental status changes
Diagnostic Lab Data: Pulse 93, pulse oximetry 98%, normal respirations
CDC Split Type:

Write-up: Erythema and warmth of the cheeks and upper chest. Numbness/tingling from right cheek into right shoulder (NO urticaria, itching, shortness of breath)


VAERS ID: 1582718 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Panic attack, Paraesthesia oral, Speech disorder
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu Shot
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Flu shot, penicillin, tetracycline, sulfa, codeine, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Signs and symptoms of anaphylaxis including tingling in mouth, trouble speaking, shortness of breath, and panic. Symptoms occurred 10min after injection and lasted about 5 minutes before administering emergency EpiPen and Diphenhydramine. Patient was escorted to hospital by ambulance.


VAERS ID: 1582720 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt mother reported her fainting from hpv vaccine
Other Medications: na
Current Illness:
Preexisting Conditions:
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 5 mins after receiving the vaccine-patient completely pale, eyes rolled into the back of her head. her face almost looked as it was shaking. she basically passed out. pt came too and was fine. the paramedics came and assessed pt. her mother thought she was well enough to go home.


VAERS ID: 1582722 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fall, Musculoskeletal stiffness, Speech disorder
SMQs:, Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: UNKNOWN
Preexisting Conditions: BLINDNESS AND WHEELCHAIR BOUND
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT FELL PRIOR TO COMING INTO STORE OUT OF CAR AND GOT A BLOODY ELBOW. INSIDE PATIENT HAD RECEIVED VACCINE AND WAITED HIS 15 MINUTES. HE WAS ASKED IF HE WAS DOING OK AND HE SAID IM FINE. HE WAS TALKING AND RESPONIVE WHILE IN THE STORE. HIS CARE GIVER SAID HE WAS FINE. FROM THE TIME HE LEFT THE STORE HIS CAREGIVER SAID SHE NEEDED HELP TO GET HIM IN HIS CAR HE FELL FROM HIS WHEELCHAIR AGAIN AND HE WAS STIFF AND NOT TALKING. PATIENT WAS TAKEN TO medical facility


VAERS ID: 1582726 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest discomfort
SMQs:, Anaphylactic reaction (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: Paxil
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At the end of the 15 minute observation period the client reported slight chest discomfort in the observation area at 2:46 PM. The client denied any other symptoms. Vitals obtained at 2:40 PM were as follows: BP 122/76, HR 96, O2 98%. The client stated that she felt anxious prior to receiving the COVID vaccine Janssen and drank water. Repeat vitals obtained at 2:50 PM were as follows: BP 126/79, HR 86, O2 98%. The client stated the chest discomfort was getting better. At 2:55PM the client stated she has experienced the same discomfort in the past related to her anxiety. The client was educated on s/s of anaphylaxis and when to seek EMS. The client voiced understanding of this education. The client drove herself to the vaccination site and stated that she was "good to drive myself home." The client ambulated unassisted with a steady gait out of the observation area at 2:55PM.


VAERS ID: 1582727 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-23
Onset:2021-08-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Mother brought in son for Pfizer vaccine. Told myself (the administering pharmacist) and the inputting technician that his date of birth was making him 12 years old multiple times. Insurance rejected saying that his DOB was wrong but the mother was adamant that it was . We administered the vaccine then later got a hold of insurance and they have his DOB as making him 11 years old. Cannot get a hold of mother to verify this information. Called her and left her messages but she has not returned calls and did not bring him in for his 2nd dose.


VAERS ID: 1582729 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0191 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Respond to patient in observation area at COVID Pod vaccination site for nausea. Patient came to the vaccination site to receive her first vaccination of the Pfizer vaccine. Approximately 10 minutes after receiving the vaccine she began to feel nauseous and alerted EMS at the Covid Pod for evaluation. Patient states that she doesn''t like to be around needles but denied feeling nervous about receiving the vaccine. . During patient assessment patient stated that all her symptoms had resolved and she felt normal, she adamantly denied any further treatment and denied transport to the hopital and signed


VAERS ID: 1582735 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-29
Onset:2021-08-18
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine 100 mcg QD, norgestimate-ethinyl estradiol (Ortho Tri-Cyclen LO, 28) 0.18/0.215/0.25 mg-25 mcg, Sertraline 200 mg QD
Current Illness: L knee injury
Preexisting Conditions: Hypothyroidism, Obesity, Major depression
Allergies: NKDA
Diagnostic Lab Data: CT angiogram: Bilateral acute upper, lower lobe, right middle and lingular pulmonary emboli.
CDC Split Type:

Write-up: Bilateral submassive pulmonary embolism


VAERS ID: 1582736 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Chest X-ray normal, Computerised tomogram head normal, Electrocardiogram normal, Haemoglobin decreased, Head injury, Laboratory test normal, Platelet count normal, Syncope, Troponin normal, Urine analysis normal, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81mg, losartan, lumigan, metformin, fexofenadine, diazepam prn not taken recently, escitalopram, atorvastatin, vitamin d3, omeprazole
Current Illness: no
Preexisting Conditions: dm2, htn
Allergies: penicillin
Diagnostic Lab Data: on 8/18/21, date of injury, glucose 198, chemistries otherwise ok, troponin not elelvated, wbc 10.5, hbg 13.2, plt 193, ua neg, ct head neg acute, cxr clear, ekg ok.
CDC Split Type:

Write-up: the next day, had unwitnessed syncopal episode, hitting head, no other symptoms.


VAERS ID: 1582740 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dehydration, Dyspnoea, Fatigue, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none per mom
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: was taken to hospital 8/18/21
CDC Split Type:

Write-up: Shortly after vaccine, patient complained of extreme fatigue, stomach pain, sweating and a little SOB. I called 911, his mother agreed for me to call, 911 operator advised not to give Epipen or Benadryl, which I had on hand, said wait for EMS. They transported patient to hospital where he was found to be dehydrated per his dad, who called back to inform us.


VAERS ID: 1582749 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-16
Onset:2021-08-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Headache , nausea, fatigue


VAERS ID: 1582765 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site bruising, Injection site nodule, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Geodon, Topamax, Protonix, Hydroxyzine
Current Illness: Asthma, had lumps under my skin on left arm, after vaccine they spread to other arm and both breasts
Preexisting Conditions: Depression, Anxiety, Degenerative Disc Disease, Osteoarthritis
Allergies: Penicillin, estradiol
Diagnostic Lab Data: Going to the doctor Friday August 20th to have it checked.
CDC Split Type:

Write-up: Woke up with my arm itching really bad, had red area spread all across arm and a knot and bruise where the vaccine was given, intense itching, redness warm to the touch, this came up 6 days after the vaccine.


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