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

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 108 out of 10,493

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VAERS ID: 1995640 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1995641 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3197 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Syncope, Unresponsive to stimuli
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), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe


VAERS ID: 1995642 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 4 UN / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1995769 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: no
Allergies: nka
Diagnostic Lab Data: ekg 12/30/2021
CDC Split Type:

Write-up: syncope


VAERS ID: 1995771 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angioedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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: Ferrous Sulfate
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Angioedema of lower lip


VAERS ID: 1995773 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ear pain, Injection site erythema, Injection site swelling, Musculoskeletal stiffness, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ovasitol Magnesium supplement D3 supplement Multivitamin Fish oil
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to omnicef
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, aches, stiff muscles, sore throat, earaches, raised red bump at injection site


VAERS ID: 1995779 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-12-30
   Days after vaccination:307
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 2/5, 2/26, and 10/2. Positive on 12/30


VAERS ID: 1995782 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-12-30
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 3/17, 4/7, and 12/15. Positive on 12/3


VAERS ID: 1995783 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-27
Onset:2021-12-30
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 4/6, 4/27, and 12/22. Positive on 12/30


VAERS ID: 1995790 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue
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: Totally wiped out for 24 hours


VAERS ID: 1995804 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K2LFR / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Neck pain
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 8000 units Vitamin D3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight chills started after 17 hours. Neckache and headache started roughly about the same time. At 24 hours, general weakness, chills, and headache were serious. Over the counter medications did not help. All reactions subsided substantially after a total of 34 hours.


VAERS ID: 1995816 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Patient reported a racing heart later that evening. She stated she went to the emergency room where they hooked her up to iv fluids and monitored her. She was discharged later that evening. Reports feeling fine today.


VAERS ID: 1995827 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-22
Onset:2021-12-30
   Days after vaccination:311
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Computerised tomogram thorax abnormal, Dyspnoea, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), 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: Denies
Current Illness:
Preexisting Conditions: Hip replacement
Allergies: NKDA
Diagnostic Lab Data: 12/28/2021 - SARS-COV-2 Antigen (++)
CDC Split Type:

Write-up: Ninety-five years female with no significant past medical history presented to the ED for evaluation of difficulty breathing refer patient she was exposed to go with past week. Denied any fever, vomiting, chest pain. Denied any nausea vomiting. Tested positive for COVID-19. CT scan of the chest revealed bibasilar atelectasis and possible pneumonitis. Troponins were noted to be elevated. Oxygen saturation was 88% on room air at presentation. Was placed on 4 L oxygen by nasal cannula.


VAERS ID: 1995833 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

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

Write-up: Patient inadvertently given expired vaccine from previous day.


VAERS ID: 1995834 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-12-30
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR + 12/30/21
CDC Split Type:

Write-up: Admitted to hospital with breakthrough COVID infection.


VAERS ID: 1995839 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-01
Onset:2021-12-30
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Breast Cancer, HTN; Other Dx:Deep venous thrombosis (disorder), Addt''l Med History History of tuberculosis as teenager. Significant Surg Hx As Listed Common R Lumpectomy.
Allergies: AAA-MISC. NON-DRUG ALLERGY Flexeril
Diagnostic Lab Data: 12/29/2021 - SARS-CoV-2 Antigen (-), PCR (++)
CDC Split Type:

Write-up: This is 86-year-old female patient Came into the ER with a complaint of edema of legs going on for last few days Worsened over in 24 hours Patient has a history of DVT when she was diagnosed with breast cancer 11 years ago


VAERS ID: 1995840 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Hypoaesthesia, Oropharyngeal pain, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (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: Moderna, 4/2.0/2021, low grade fever and chills
Other Medications: Birth control
Current Illness:
Preexisting Conditions:
Allergies: Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe lower back pain, causing dull achy numbness and pain in legs. Severe headache in left temple every time I stood up. Throat pain. Body aches. Chills.


VAERS ID: 1995847 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-08
Onset:2021-12-30
   Days after vaccination:325
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient hospitalized


VAERS ID: 1995850 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-30
Onset:2021-12-30
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient hospitalized


VAERS ID: 1995856 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F2117 / 1 LA / IM

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

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

Write-up: Sore arm at injection site, red & swollen about 3" in diameter


VAERS ID: 1995857 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-11
Onset:2021-12-30
   Days after vaccination:322
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient hospitalized


VAERS ID: 1995860 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-12-30
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

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

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

Write-up: Patient vaccinated against and then tested positive for COVID19


VAERS ID: 1995869 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: At the time of vaccination no medications taken. Post-vaccination patient has taken Benadryl and Zyrtec.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient has generalized urticarial patches on her back, legs, arm, and face.


VAERS ID: 1995872 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Condition aggravated, Fatigue, Impaired work ability, Nausea, Night sweats, Pain, Respiratory tract congestion, SARS-CoV-2 test, Sinus operation
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: PFIZER second shot on 03/15/2021. Same reaction as the third dose. I was too sick to work for two days. Lot number EN6208
Other Medications: Wellbutrin Flagyl
Current Illness: VB
Preexisting Conditions: Depression
Allergies: Ibuprofen
Diagnostic Lab Data: Sent home from work and Covid swab in ER
CDC Split Type:

Write-up: Body aches, cold chills, fatigue, nausea, night sweats, congestion, nasal drainage


VAERS ID: 1995889 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

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

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

Write-up: BROKE OUT IN HIVES. REACTION SUBSIDED WITH LIQUID BENADRYL


VAERS ID: 1995891 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D3, atorvastatin 40, donepezil 5 and 10 mg, propranolol 60mg, memantine 10 and 5mg, venlafaxine er 75mg, estradiol 2mg, ipratropium 0.03% nasal spray, meloxicam 7.5mg
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states she has lower back pain that started after she got her booster of Moderna, while she was still sitting in the chair outside the pharmacy waiting for 15 minutes after her vaccine. It has continued into the next day despite her taking tylenol and meloxicam.


VAERS ID: 1995898 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, 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: Pfizer COVID vaccine
Other Medications:
Current Illness:
Preexisting Conditions: HBP
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node armpit (side of injection); still significant after 36 hours Fever up to 102.3?lasted for 24 hours


VAERS ID: 1995902 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-12-30
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A - NOT VACCI / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A - NOT VACCI / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Interchange of vaccine products, SARS-CoV-2 test positive
SMQs:, Medication errors (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR on 12/30/2021
CDC Split Type:

Write-up: Per facility, patient received Moderna COVID-19 vaccine on 3/10/2021 and Pfizer COVID-19 vaccine on 9/25/2021 and was subsequently diagnosed at our hospital with COVID-19


VAERS ID: 1995903 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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: 85 MG aspirin Vit c Vit d Calcium
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy on following day. Still dizzy second following day.


VAERS ID: 1995907 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nausea, Fever, Chills, Headache, body aches, injection site tenderness


VAERS ID: 1995917 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-15
Onset:2021-12-30
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Write-up: COVID infection after vaccination


VAERS ID: 1995933 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site extravasation, Injection site hypoaesthesia, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (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: Minastrin FE 1/20; Zyrtec
Current Illness: My allergies were acting up
Preexisting Conditions:
Allergies: Lo Loestrin FE; Valium
Diagnostic Lab Data: I do not trust the standard physician to be able to help me and I do not wish to waste my money on inquiring for their advice.
CDC Split Type:

Write-up: When I was walking my dog the following day, I noticed that clear liquid was leaking out of my arm. It was coming from the bandaid that was placed over my vaccination site. I pulled it off to reveal strange blisters, some of which were leaking. They are clear and from afar just appear to be large water droplets. As they do not hurt, or itch, or I have no desire to seek medical advice. I will mention that they are numb.


VAERS ID: 1995939 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No Meds Taken
Current Illness:
Preexisting Conditions: Active Problems ? Z55.9 - Academic Problem ? F43.22 - Adjustment Disorder with Anxiety ? E88.81 - Dysmetabolic Syndrome X ? 691.8 - Eczema, Atopic Dermatitis ? E78.5 - Hyperlipidemia ? E03.9 - Hypothyroidism Subclinical - per endocrine note 11/2017, could be early autoimmune thyroiditis. Repeat TSH in 11/2018, and if $g 10 return to endocrine, repeat sooner if symptoms. ? E66.8 - Obesity Morbid ? H52.13 - Refractive Error - Myopia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13yo patient had already received dose one on 5/14/21 and dose two on 6/25/21 at clinic. Father called to make an appointment for patient to receive second dose of the vaccine. Patient was scheduled to receive second dose on 12/30/21. Mother came in with patient and vaccine was given. Patient did not have vaccine card. Upon checking vaccine record to print for parent, I realized that patient had already been given two vaccines and finished series. Patient and parent were notified of error at the clinic. Mother thought that patient was at clinic to receive a booster while father thought patient needed a second dose. Patient was monitored for 30 mins. No complaints of side effects or adverse reaction noted. Covering PCP Dr. made aware and spoke with parent over the phone.


VAERS ID: 1995951 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain in extremity
SMQs:, 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: Fever for two days after second shingles vaccine
Other Medications: estrodiol 1mg daily
Current Illness:
Preexisting Conditions: long term joint pain from auto accident 1994
Allergies: Constrast MRI dye
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: painful swollen left lymph node on left side of body same side as vaccine booster injection along with sore left arm


VAERS ID: 1995953 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Breztri Aerosphere, Constulose, Diltiazem, Duloxetine, Famotidine, Isosorbide Mononitrate, Levothyroxine, Linzess, Pramipexole, Primidone, Rabeprazole, Rosuvastatin
Current Illness:
Preexisting Conditions:
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Racing Heart, Nausea


VAERS ID: 1995957 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Racing heart, feeling dizzy/light-headed


VAERS ID: 1995960 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: I received the Pfizer Booster Shot on my right arm. One of the side effects I got that is not on listed on the cdc site is a swollen lymph node by my underarm, the same side I received the shot on my arm. I''m not sure if any others have got this side effect but it is wise to add this to the list of side effects. Thank you.


VAERS ID: 1995964 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855190 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood magnesium normal, Blood test normal, Chills, Dizziness, Electrocardiogram normal, Full blood count normal, Incontinence, Loss of consciousness, Metabolic function test normal, Migraine, Muscle contractions involuntary, Muscle tightness, Pregnancy test urine negative, Seizure like phenomena, Syncope, Urine analysis normal, White blood cell count normal
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), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Tilapia, hydrocodone
Diagnostic Lab Data: Blood count w differential, comprehensive metabolic Panel, magnesium, Blood level, POCT urine Pregnancy, Urinalysis, Electrocardiogram, blood pressure, temperature, respiration M, oxygen saturation!
CDC Split Type:

Write-up: Fainting and seizure like episode, dizziness, fainted, incontinence, muscle tension and contractions, and was unconscious for 2 mins after eyes were open. Day 1 After vaccine: migraine, chills, possible fever. Day 2 after vaccine: I woke up feeling fine and then ended up fainting at work while walking out of the clinic. Was treated immediately with the Providers and wheeled down to the emergency room. Treated with sodium chloride 0.9% Bolus Diagnosis with vasovagal syncope because all other tests came back normal. The only change in routine in the last week was getting the vaccine.


VAERS ID: 1995972 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ762 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Ear swelling, Pain of skin
SMQs:, Angioedema (broad), Osteonecrosis (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: When I got the second dose of Moderna 05/01/2021 I had an itchy round sort if swollen area over the injection site. I also had f
Other Medications:
Current Illness:
Preexisting Conditions: Obesity High blood pressure
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 6 or 7 hours after receiving my booster shot I noticed pain/tenderness on the bone behind my left ear. It also feels slightly swollen in comparison to my right ear. I took some Tylenol last night for the pain. It still hurts this morning. I took some Tylenol this morning.


VAERS ID: 1995982 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Musculoskeletal chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Went to the ED with chest pain, anterior/lateral chest wall pain that was sharp in nature


VAERS ID: 1995997 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3209 / 3 LA / IM

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

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

Write-up: Error: Booster given too early.


VAERS ID: 1996014 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling abnormal, Headache, Hyperhidrosis, Nausea, Pain, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and vertigo one hour and twenty minutes after injection. Headache, body ache, fever, chills/sweats, nausea, and foggy thinking beginning twelve hours after injection.


VAERS ID: 1996019 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-12-30
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

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

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

Write-up: Started with chills , lasting 3 or more hours. Fever of 101.5


VAERS ID: 1996021 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Underdose
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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: unkown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: adult patient received pediatric dose


VAERS ID: 1996035 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm soreness, 38, 04/08/21 and 04/29/21, Pfizer COVID-19 vaccine
Other Medications: Bariatric Advantage Multi EA; calcium chewable
Current Illness: Runny nose about a week prior.
Preexisting Conditions: Post-VSG
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm soreness near injection site; fatigue; chills


VAERS ID: 1996039 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

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

Write-up: Swollen axillary lymph nodes on the site of injection


VAERS ID: 1996058 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Peripheral swelling, Vaccination complication
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Patient had no issues first couple days post administration of booster dose. But 3rd day after immunization she noticed swelling of arm just above elbow that was large enough to move. Patient decided to go to walk in clinic to have it looked at. Although it was not at the injection site, provider there told her it was still likely to have been caused by immunization and was injection site type reaction. Instructed patient to take benadryl and contact them again if symptom did not improve. Follow up with patient today and she reports swelling has gone down and doing better.


VAERS ID: 1996060 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
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: Amlodipine 2.5mg Tab*** TAKE ONE TABLET BY MOUTH EVERY DAY Donepezil 5mg Tabs*** TAKE ONE TABLET BY MOUTH TWICE DAILY Dorzolamide Hcl 2% Eye Drops Instill ONE drop in each eye EVERY TWELVE HOURS Hm Aspirin Ec 81 Mg Tablet TAKE ONE TABLET BY
Current Illness: None
Preexisting Conditions: HTN, Hypothyroidism, GERD
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient and family reported needing a booster dose of Moderna COVID-19 Vaccine. Booster dose (0.25ml) was administered and it was later discovered that the patient had already received a booster dose from another provider on 12/14/21. No reaction/adverse effects have been reported by the patient, patient''s family, or home health.


VAERS ID: 1996067 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003J21-2A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling cold, Migraine, Mobility decreased, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar reaction to both Phizer doses
Other Medications: none
Current Illness:
Preexisting Conditions: Multiple sclerosis
Allergies: allergic to sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Migraine all day (couldn''t open my eyes) was in bed all day horrible fatigue, achy joints, nausea, I was freezing and a fever of 101. Had to go to bed at 10:30 am...stayed in bed until 7:30 the next morning.


VAERS ID: 1996080 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oedema peripheral, Sleep disorder, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: One day after receiving the Covid-19 booster on my left are I noticed swelling in my left underarm. It is has doubled in size and is quite painful to touch. I"m not able to sleep on my left side There is no redness in the area.


VAERS ID: 1996087 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: 2 days after my covid booster shot I had a second menstrual cycle this month. The last day of my last menstrual cycle was December 19th. My menstrual cycles are always regular although I have noticed that they had gotten a lot heavier following my second Covid vaccinations in May of 2021.


VAERS ID: 1996091 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Flushing, Headache, Muscle tightness, Neck pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra Ease by plexus Vitamins (zinc vitamin c etc)
Current Illness: None
Preexisting Conditions: None
Allergies: No known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever (low grade) Chills/flush Tired Headache Soreness -neck tight & sore


VAERS ID: 1996118 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

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

Write-up: Swollen painful cervical lymph nodes both sides of neck


VAERS ID: 1996134 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Injection site cellulitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Hx of CVA, R BKA, osteoporosis, ashd, CHF, HTN, Depression, PAD
Allergies: Penicillin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Cellulitis at injection site


VAERS ID: 1996137 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-01
Onset:2021-12-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Limb mass, Nausea, Pain, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar to 2nd shot but more severe with boosr
Other Medications: Zoloft
Current Illness:
Preexisting Conditions:
Allergies: Aspirin and all salycilates
Diagnostic Lab Data:
CDC Split Type:

Write-up: Three painful lumps in arm. Sleepiness. Nausea.


VAERS ID: 1996310 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 WAS INADVERTENTLY ADMINISTERED A 3RD BOOSTER DOSE OF ADULT PFIZER BIONTECH VACCINE WHEN SHE WAS UNDER 16. FOLLOWED UP WITH PATIENT''S MOTHER ON FOLLOWING DAY AND PATIENT HAS HAD NO ADVERSE EFFECTS.


VAERS ID: 1996312 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Discomfort, Pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Uncomfortable chest pain. Intense pressure left upper body. Started feeling pain about 14-15 hours after I got the booster shot. Still have uncomfortable pain after 2 days.


VAERS ID: 1996540 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D70H21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Relaxium, a sleep aid Flecinide Atenolol Lisinopril
Current Illness: slight cold week before
Preexisting Conditions: back issues
Allergies: none
Diagnostic Lab Data: none...swelling, at site, not reported (yet) fever/chills subsided next day, totally gone the next
CDC Split Type:

Write-up: Primary: arm swelling, soreness, redness at shot site...never had this in the previous 2 doses Secondary: SEVERE fever and chills over first night after shot...never anything like it...not even close...an 11 on a 1-10 scale


VAERS ID: 1996548 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Diarrhoea, Dizziness, Dysphonia, Dyspnoea, Ear swelling, Eye pruritus, Flushing, Lip swelling, Pruritus, Rhinitis, Swelling face, Swelling of eyelid, Throat tightness, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Biphasic anaphylaxis, 33, 2/4/2021, Moderna Covid-19 dose 2. Did not seek ER treatment as pt is healthcare provider with histor
Other Medications: Spironlactone, Lexapro, ferrous sulfate
Current Illness:
Preexisting Conditions:
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticaria, Hives, Puritis, Cough, Wheezing, Rhinitis, Throat tightness, Hoarse voice, Shortness of breath within 15 of Moderna booster injection despite premedication with Prednisone 10mg, Diphenhydramine 50mg, Pepcid 20mg; and Epi 0.3IM at time of vaccination. Puritis persisted after Solumedrol 80mg IV at ER. Mild cutaneous symptoms waxed and waned over the next 15 hours. 16 hours post vaccination pt rapidly developed skin flushing, intense global puritis, hives, wheezing, dizziness, cough, facial swelling (eyelids, lips, ear), and diarrhea. Pt took Diphenhydramine 50mg, Pepcid 20mg, and Epi 0.3mg IM, symptoms resolved. At 17 hours post vaccination global puritis and skin flushing returned and continues to wax and wane, periods of coughing and rhinitis and itchy eyes keep occurring and resolving


VAERS ID: 1996693 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram Oxalate 20mg daily
Current Illness: None
Preexisting Conditions: Anxiety disorder
Allergies: Percocet Tablets
Diagnostic Lab Data: Urgent Care Visit at a local health care facility
CDC Split Type:

Write-up: Non-blanching small popular rash


VAERS ID: 1996760 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Headache, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (a couple of months ago)
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: Body temperature; Result Unstructured Data: 101
CDC Split Type: USJNJFOC20211265960

Write-up: BODY ACHES; STIFF NECK; FEVER OF 101; POUNDING HEADACHE; This spontaneous report received from a parent via a company representative concerned a female. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 29-DEC-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 30-DEC-2021, the patient experienced body aches, stiff neck, fever of 101, and pounding headache. Laboratory data included: Body temperature (NR: not provided) 101. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever of 101, body aches, stiff neck and pounding headache was not reported. This report was non-serious.


VAERS ID: 1996766 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-12-30
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211266272

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. 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, and batch number were not reported, expiry: unknown) dose 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series was 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 30-DEC-2021, the patient experienced suspected covid-19 infection (cough, fever, runny nose, congestion nasal and sneezing). Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On an unspecified date, the patient experienced suspected clinical vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20211265944. This case was associated with product quality complaint number.; Sender''s Comments: V0: 20211266272-covid-19 vaccine ad26.cov2.s- Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1996815 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / OT

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

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

Write-up: This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (An HCP accidentally vaccinated a 16 year old with the Moderna COVID-19 vaccination) in a 16-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037C21A) for COVID-19 vaccination. No Medical History information was reported. On 30-Dec-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Dec-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (An HCP accidentally vaccinated a 16 year old with the Moderna COVID-19 vaccination). On 30-Dec-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (An HCP accidentally vaccinated a 16 year old with the Moderna COVID-19 vaccination) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient has no concomitant medications. Treatment information not provided.


VAERS ID: 1996821 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 - / OT

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

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

Write-up: This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered with vial left in room temperature for over 24 hours) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 066H21A) for COVID-19 vaccination. No Medical History information was reported. On 30-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered with vial left in room temperature for over 24 hours). On 30-Dec-2021, EXPIRED PRODUCT ADMINISTERED (Administered with vial left in room temperature for over 24 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. The vial was first punctured on 29-Dec-2021 10:15 AM and was administered to this patient on 30-Dec-2021 11:05 AM. The vial was kept in room temperature after first puncture.


VAERS ID: 1996831 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (Shoulder Pain) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 30-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, the patient experienced ARTHRALGIA (Shoulder Pain). At the time of the report, ARTHRALGIA (Shoulder Pain) outcome was unknown. No concomitant and treatment medication details were reported.


VAERS ID: 1996834 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fall, Limb discomfort
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Had no control over her legs; It felt like she was almost going to fall; She was also feeling very dizzy; This spontaneous case was reported by a consumer and describes the occurrence of LIMB DISCOMFORT (Had no control over her legs), FALL (It felt like she was almost going to fall) and DIZZINESS (She was also feeling very dizzy) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939909) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: Pfizer vaccine in January 2021 and Pfizer vaccine in February 2021. Past adverse reactions to the above products included No adverse event with Pfizer vaccine and Pfizer vaccine. On 29-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Dec-2021, the patient experienced LIMB DISCOMFORT (Had no control over her legs), FALL (It felt like she was almost going to fall) and DIZZINESS (She was also feeling very dizzy). At the time of the report, LIMB DISCOMFORT (Had no control over her legs), FALL (It felt like she was almost going to fall) and DIZZINESS (She was also feeling very dizzy) outcome was unknown. No concomitant medication details was provided. No treatment medication details was provided.


VAERS ID: 1996835 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-02
Onset:2021-12-30
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose
SMQs:, Medication errors (narrow)

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

Write-up: may have received 0.25 ml for second dose; This spontaneous case was reported by a consumer and describes the occurrence of ACCIDENTAL UNDERDOSE (may have received 0.25 ml for second dose) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 032H21A and 058H21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Dec-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced ACCIDENTAL UNDERDOSE (may have received 0.25 ml for second dose). On 30-Dec-2021, ACCIDENTAL UNDERDOSE (may have received 0.25 ml for second dose) had resolved. No concomitant product information was provided. No treatment information was provided.


VAERS ID: 1996841 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-12-30
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Lip swelling, Lymphadenopathy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Chills after booster; The enlarged lymph node came back again; After the booster she had Headache; After the booster she had a Low grade fever; Today, 30DEC2021 she started having swollen lips; This spontaneous case was reported by a consumer and describes the occurrence of LIP SWELLING (Today, 30DEC2021 she started having swollen lips), CHILLS (Chills after booster), LYMPHADENOPATHY (The enlarged lymph node came back again), HEADACHE (After the booster she had Headache) and PYREXIA (After the booster she had a Low grade fever) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 milliliter. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced LIP SWELLING (Today, 30DEC2021 she started having swollen lips). On an unknown date, the patient experienced CHILLS (Chills after booster), LYMPHADENOPATHY (The enlarged lymph node came back again), HEADACHE (After the booster she had Headache) and PYREXIA (After the booster she had a Low grade fever). The patient was treated with ACETYLSALICYLIC ACID, CAFFEINE, PARACETAMOL, SALICYLAMIDE (EXCEDRIN [ACETYLSALICYLIC ACID;CAFFEINE;PARACETAMOL;SALICYLAMIDE]) for Headache, at an unspecified dose and frequency. At the time of the report, LIP SWELLING (Today, 30DEC2021 she started having swollen lips), CHILLS (Chills after booster), LYMPHADENOPATHY (The enlarged lymph node came back again), HEADACHE (After the booster she had Headache) and PYREXIA (After the booster she had a Low grade fever) outcome was unknown. No concomitant medications were provided. This case was linked to MOD-2021-435175 (Patient Link).


VAERS ID: 1996864 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

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

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

Write-up: 12 hours after shoot temp of 102.4. Severe body aches, chill.


VAERS ID: 1996868 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Pain, Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sore arm & sore body with extreme exhaustion for about 24 hours. He?s fine & back to normal today. Only a sore armpit continued today.


VAERS ID: 1997134 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Axillary pain, Bone pain, Musculoskeletal stiffness, Myalgia, Neck pain, Pain in extremity, Peripheral swelling, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Painful swelling and welts on arm. Extreme muscle and bone aches. Painful lumps under injected arm. Adverse neck pain/ stiffness


VAERS ID: 1997141 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, SARS-CoV-2 test negative, Taste disorder
SMQs:, Taste and smell disorders (narrow), Dystonia (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: Tylenol
Current Illness:
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data: 12/31/2021 7pm took an at home otc Covid test and it returned negative
CDC Split Type:

Write-up: Everything tastes off or bad, salt has extremely strong taste. Also had muscle spasms


VAERS ID: 1997154 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Chills, Cough, Decreased appetite, Fatigue, Headache, Hyperhidrosis, Injection site pain, Pulmonary pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Idiopathic Urticaria ( currently not active)
Allergies: Vicodin, bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site and further down arm towards elbow and also into armpit starting by 9 PM. Woke up with acute pain in sites described at 3 AM on 31st and also profuse sweating and chills. Headache started by 4 AM and persisted for 12 hours. The sweating and chills came and went until 4Pm. Lack of appetite and tiredness kept me in bed until 4PM on the 31st. Also had a minor occasional cough that was accompanied by sharp pain in right lung similar to pain from pneumonia. Appetite restored by 6 Pm, but even though I''d slept most of the day, went to bed by 10:30 and slept through night. As of 7:30 on the 1st only symptom remaining is pain at injection site and surrounding area.


VAERS ID: 1997178 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna Vaccination
Other Medications: Multivitamin B12 D3
Current Illness:
Preexisting Conditions:
Allergies: Sulfa Surgical iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated heart rate ~20bpm higher resting heart rate (~10 hrs after injection) Fever ~101F (~27 hrs after injection) Nausea (~27 hrs after injection) Headache (~18 hrs after injection) Muscle soreness (~10 hrs after injection) Injection site soreness (4-5 hrs after injection) Tiredness (~10 hrs after injection) Most symptoms dissipated roughly 34hrs after injection. If not gone severity greatly reduced.


VAERS ID: 1997185 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Inflammation, Laboratory test normal, Lymphadenitis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, singular, symbicort
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Latex
Diagnostic Lab Data: OTC rapid test, negative
CDC Split Type:

Write-up: Fast heart rate, fever for 2+ days ranging from 100-102, body aches. Right arm inflamed, lymph in right armpit inflamed


VAERS ID: 1997205 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 3 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia
SMQs:, 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: Omeprazol
Current Illness: Cold
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme weakness


VAERS ID: 1997207 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Injection site pain, Injection site pruritus, Injection site vesicles, Nausea, Pain, Pyrexia, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Junel Fe
Current Illness: none
Preexisting Conditions: Asthma, psoriasis, IBS
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever - next day for approximately 5 hours aches - next day onset for 36 hours diarrhea - next day 7 hours nausea - next day 24 hours vomiting - next day, 2 incidents blistering at injection site that hurts and itches - began approximately 48 hours after injection, came on suddenly and grew in size, is still occuring


VAERS ID: 1997209 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Injection site pain, body aches , nausea


VAERS ID: 1997222 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal, vit e, baby aspirin, prednisone (10mg), levothyroxine (25mcg)
Current Illness:
Preexisting Conditions: Hashimoto?s thyroiditis - asymptomatic, normal thyroid levels
Allergies:
Diagnostic Lab Data: Positive COVID19 test, 12/31/21
CDC Split Type:

Write-up: Shortness of breath began 12/29/21, chest congestion and positive COVID19 test 12/31/21. Due date: 8/18/22


VAERS ID: 1997226 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       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? 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: Chills/aches/fever


VAERS ID: 1997232 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Exposure to SARS-CoV-2, Fatigue, Headache, Influenza virus test negative, Malaise, Myalgia, Nasal congestion, Paranasal sinus discomfort, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Sinus operation
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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ergocalciferol, Hydrochlorithiazide, Losartan, Crestor, Singulair, Diovan, Zoloft, Flonase nasal spray.
Current Illness: Was exposed to COVID-19 12/2021. Was reportedly asymptomatic. Tested positive for COVID-19 on a home test at the beginning of 12/2021 but then tested negative on a f/u PCR COVID-19 test.
Preexisting Conditions: HTN, Vitamin D deficicency, elevated Cholesterol, Anxiety, Seasonal Allergies
Allergies: NKA
Diagnostic Lab Data: Rapid COVID-19 test done 1/1/2022. Results negative. Rapid Influenza test done 1/1/2022. Results negative.
CDC Split Type:

Write-up: Patient reports that she received her booster dose of the Moderna COVID-19 vaccine 12/29/2021. Per patient, she started to not feel well on 12/30/2021. Patient reports myalgias, fatigue, headaches, sinus pressure, nasal congestion, post nasal drainage and fevers. Per patient, temperature at highest was on 12/30/2021 at 103.5.


VAERS ID: 1997241 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Induration, Mass, Pain, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexilant, singular, HCTZ, Amylodipine Beselate, Zetia, Pepcid, Paxil, Viramin D, Ashwaganda
Current Illness: Joint inflammation (back and arm)
Preexisting Conditions: Migraines, GERD, HTN, High cholesterol
Allergies: Cillins, Avelox, Ceftin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started out as a small hard, warm lump that progressed to a small softball size. Today I measured and it is 3 1/2 in long, still warm and hard. It?s itching and hurts.


VAERS ID: 1997256 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED0809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Fibrin D dimer normal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: elevated troponin, elevated CRP; nml d-dimer
CDC Split Type:

Write-up: chest pain on 12/20/21 intermittently, then continued through the night into the early morning on 12/31/21. Seen in the ED with chest pain and had elevated troponin 10K, peak was 12K and elevated crp. Nml d-dimer. Admission for myocarditis overnight stay


VAERS ID: 1997259 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197JSJ / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Knot in left arm from booster shot still present after 2 days.


VAERS ID: 1997291 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Red rash on face


VAERS ID: 1997336 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-17
Onset:2021-12-30
   Days after vaccination:316
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fall, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Sleep apnea, Dyslipidemia, TIA, Post-op pulmonary embolism, depression, cataract sx
Allergies: PCN
Diagnostic Lab Data: SARS CoV 2 PCR Covid19-Detected 12/30/2021.
CDC Split Type:

Write-up: Covid19 breakthrough infection. 1st vaccine 01/27/2021. Pt presents with multiple falls and increasing generalized weakness over the past 3 days from SNF.


VAERS ID: 1997360 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H2LB / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Chills, Pain, Rash erythematous, Rash papular, Skin discolouration, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: ?Moderna?rash + limited mobility to left arm and shoulder. 64yo, 03/04/2021 Moderna 2nd dose.
Other Medications: One-a-day Vitamin
Current Illness: None
Preexisting Conditions: Never regained full range of motion in left arm/shoulder since 2nd vaccine in March 2021
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Warm to touch and sore beginning at almost immediately. Swelling of area (and body chills) by 24 hour post vaccine. At 48 hours: pink raised rash present; very warm and sensitive to touch. By 72 hours: rash has turned redder and is warmer to touch. It has also grown larger and is more swollen. Also now sensitive into the armpit; limited motion.


VAERS ID: 1997363 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 given a booster even though he is only 13 years old


VAERS ID: 1997384 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Fatigue, Headache, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna covid 2
Other Medications: Zoloft, omneprazole
Current Illness: No
Preexisting Conditions: COPD, EMPHEZMA
Allergies: Cipron
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started with aches, pain at injection site, and fatigue. 2nd day fatigue, diarrhea, stomach pain and noticeable swelling at injection site, third day fever and slight headache.


VAERS ID: 1997408 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Pruritus, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine ER 15mg, Hydrocodone-APAP 10-325mg, Omeprazole 20mg, Ondansetron 8mg, Tizanidine 4mg, Diclofenac 1% Gel
Current Illness: ICD-10 Codes: M54.12, M47.816, M47.22, K21.9
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A - Pharmacist did not observe any choking or difficultly breathing in patient
CDC Split Type:

Write-up: Patient''s tongue swelled up and patient had allergic reaction -- itching


VAERS ID: 1997416 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F58762 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Dizziness, Fatigue, Hypersomnia, Musculoskeletal stiffness, Myalgia, Neck pain, Retching, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (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: Same symptoms, worse and lasted 2+ days. Age 39. Date 5/10/21. Pfizer Covid 19 2nd dose.
Other Medications: Trintellex, Buspar, Lamotrigine, Lithium, Metformin, women''s multi-vitamin
Current Illness:
Preexisting Conditions: Depression, anxiety, asthma
Allergies: Keflex, Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3pm - Tired and woozy. 10 pm- stiff and sore neck and shoulders. Sometime after 1am- sore muscles and wracking chills. 5am - dry heaving. Slept all the next day with little energy to use restroom or get a drink. Day 3 - more energy and chills gone; able to eat.


VAERS ID: 1997417 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthma, Chest pain, Condition aggravated, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 (dose 2); exacerbated asthma symptoms/chest pain; aged 25
Other Medications: Albuterol Sulfate HFA (inhaler) Women''s OTC multivitamin
Current Illness: N/A
Preexisting Conditions: Asthma (activity/allergen)
Allergies: Mold/mildew (anaphylactic)
Diagnostic Lab Data: Was diagnosed with asthma following the second dosage of the Pfizer COVID-19 vaccine in February, 2020. Was prescribed the Albuterol inhaler after diagnosis.
CDC Split Type:

Write-up: Exacerbated asthma symptoms; chest pain, difficulty breathing; using inhaler on an as-needed basis (typically every 2-3 hours).


VAERS ID: 1997421 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 311308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site erythema, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red/swelling at injection site Swollen lymph in left arm put Joint pain


VAERS ID: 1997429 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Heart rate increased, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: At-home COVID tests - I used 3 of them and they came back positive the next day after my booster.
CDC Split Type:

Write-up: Got my booster on 12/29. Beginning 12/30 I developed a sore throat, congestion, coughing, runny nose and my heart rate was at 203. My HR later came down to 57 few minutes later. HR remains slightly elevated at rest around 103. All other symptoms are still ongoing as of today 1/1.


VAERS ID: 1997452 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ767AB / UNK RA / IM

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

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

Write-up: Patient received a pediatric dose of Pfizer vaccine, however, she was 15 years old at time of vaccination. She should have received an adult formulation dose of Pfizer vaccine.


VAERS ID: 1997460 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006721AB / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling of body temperature change, Induration, Nausea, Pain, Pain in extremity, Peripheral swelling, Pyrexia, Rash papular, Vaccination complication
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Arm from dose 2
Other Medications: Prevacid Solutabs Wymzya
Current Illness: None
Preexisting Conditions: Gerd
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm became achy first. Then body aches, fatigue, fever, and naseau. Fever wasn?t very high, only got up to 101.2, but I kept getting hot and cold. Then on 12/31 around 11:00 pm I noticed my arm started to get Covid Arm rash. Today on 1/1 it has gotten larger, more raised, hard, and my arm is extremely sore.


VAERS ID: 1997472 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd COVID vaccine, Pfizer
Other Medications: Vitamin D3 with K2
Current Illness: None
Preexisting Conditions: Melanoma removed 2 years and 5 years ago
Allergies: Kiwi and sensitive to dairy, wheat and corn
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 100.6F, headache, body ache and chills


VAERS ID: 1997479 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-20
Onset:2021-12-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Joint swelling, Pruritus, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid19 vaccine second dose. May 15th, 2021. Patient was 18. Same adverse reaction occurred. Patient received a steroid
Other Medications: Norgestimate abd Ethinyl, Tylenol, Loratadine
Current Illness:
Preexisting Conditions:
Allergies: Possible shellfish allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives that come and go all over my body. The hives itch and make my joints swell. There is discoloration (purple color) around some of the hives


VAERS ID: 1997482 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: J and J
Other Medications: O8 hours after Multivitamin Prilosec Percocet
Current Illness: Potential gallstones
Preexisting Conditions: Back pain
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Fatigue Nausea Vertigo


VAERS ID: 1997491 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Lymphadenopathy, Nausea, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, l-thyroxine, bentyl, ibuprofen, multivitamin
Current Illness: None
Preexisting Conditions: Osteoarthritis, anxiety, IBS
Allergies: Cephalosporins, mold, dust, cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever (101.5?F), body aches, nausea, swollen Scilla, swollen lymph nodes, pain at injection sore, redness at injection site


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