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

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



Case Details (Reverse Sorted by Onset Date)

This is page 109 out of 3,524

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VAERS ID: 1355803 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood ketone body, Blood lactate dehydrogenase, Blood uric acid, Brain natriuretic peptide, C-reactive protein, Chest discomfort, Dyspnoea, Electrocardiogram normal, Epstein-Barr virus infection, Fatigue, Fibrin D dimer, Full blood count, Full blood count abnormal, Lymphocyte count, Metabolic function test, Nausea, Neutrophil count, Pregnancy test negative, SARS-CoV-2 test negative, Troponin I, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Urgent care 5/25: COVID neg, CBC showed lymphocytosis Primary care visit 5/27/21: ECG normal, Urine preg neg, UA trace ketones, rapid COVID neg, serum pending: BNP, Troponin 1, CRP, Sed Rate, CBC, CMP, LDH, Uric acid, D-dimer, EBV panel PENDING
CDC Split Type:

Write-up: Patient awoke from a nap with chest tightness, difficulty breathing, and nausea, symptoms have continued interimittently, and are associated w/fatigue.


VAERS ID: 1355819 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-13
Onset:2021-05-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Muscle spasms, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (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: Rx: atorvastatin 10mg (1 tablet daily), atenolol 25 mg (1 tablet daily), and vitamin D3 2000 IU (1 tablet daily) OTC: fish oil and vitamin C
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia
Allergies: no known allergy per patient
Diagnostic Lab Data: Not yet (but I recommended the patient see her doctor when she complained about adverse effects on 5/27/2021)
CDC Split Type:

Write-up: Swelling, chill, and muscle spasm on her right leg and foot about 9-10 days after receiving her 1st dose Moderna vaccine on 5/13/2021


VAERS ID: 1356101 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-05-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 10mg Prenatal vitamin Iron 28 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: First pregnancy Weeks of brown bleeding prior to miscarriage Due 12/17/21 Miscarriage 05/22/21 at 1pm


VAERS ID: 1356311 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: None
Preexisting Conditions: Marfan''s Syndrome
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was extremely lightheaded right afterwards. Passed out during the 15-minute observation. Was lightheaded the next couple of days, passed out twice more that day. Was really sick to my stomach for 3 days after, with on and off dizzy spells and lightheadedness.


VAERS ID: 1356550 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood test, Cardiac monitoring, Palpitations, Tremor, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (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: prednisone 5 mg
Current Illness: RA ASTHMA
Preexisting Conditions: RA
Allergies: no
Diagnostic Lab Data: blood test Heart monitor
CDC Split Type:

Write-up: After 3 minutes,,I felt palpitations-weak-shaking. I went to the ER right away. for the first dose..I felt the same and I went to urgent care right away.


VAERS ID: 1356556 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-22
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Cardiac valve disease, Chest discomfort, Computerised tomogram coronary artery normal, Echocardiogram, Electrocardiogram normal, Palpitations, Scan with contrast normal, Troponin increased, X-ray
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: It was in I believe 2017. I had the mumps vaccine and my body reacted with my back, and legs sore the next day.
Other Medications: None. Only 2-4 cups of coffee a day, which I''ve been doing for at least a year.
Current Illness: None.
Preexisting Conditions:
Allergies: Albuterol, wheat, and dairy
Diagnostic Lab Data: I had several blood tests done on the 22nd, which found a small increase of troponin. I also had an X ray, and several EKGs done that day. On the 23rd I had an ultrasound of my heart, and a CAT scan using an iodine solution pumped directly into my blood stream. They both found it was operating regularly.
CDC Split Type:

Write-up: There was a thumping and tightness in my chest centered around my heart, as well as pain in my left arm that traveled, fulfilling the textbook definition of a heart attack. I went to the ER, got an EKG and it looked normal. The tightness lasted for the next few days, and occasionally persists to today (March 27th). After two blood tests, X ray, and blood pressure they determined my troponin levels were not only measurable, they were increasing, so I was admitted to the hospital. I was given aspirin for 30 days, and told to leave caffeine alone for that time, but I was cleared of the daily aspirin doses and allowed to consume caffeine again after approximately two weeks. Furthermore, I was prescribed nitroglycerin pills incase it should happen again. Doctors concluded that one of my heart valves had a spasm, triggering the event.


VAERS ID: 1357042 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: West Virginia  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no relevant medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210547707

Write-up: 13 YO MALE PATIENT GOT THE VACCINE; OFF LABEL USE; This spontaneous report received from a health care professional concerned a 13 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no relevant medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, and expiry: 25/MAY/2021) dose was not reported, administered on 22-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 22-MAY-2021, the subject experienced 13 yo male subject got the vaccine. On 22-MAY-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the 13 yo male patient got the vaccine and off label use was not reported. This report was non-serious.


VAERS ID: 1357378 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Iritis, Nausea, Uveitis
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Biktarvy 50-200-25 mg Tab
Current Illness:
Preexisting Conditions: Asymptomatic human immunodeficiency virus (HIV) infection Collagen Vascular Disease
Allergies:
Diagnostic Lab Data: Seen at the ER by doctor 5/23/2021 Seen by doctor 5/26/2021 and referred to see a specialist on 5/26/2021 Seen by doctor 5/27/2021
CDC Split Type:

Write-up: 8 hours after vaccine patient had a severe headache and nausea. Gradually over the course of the next 24 hours the headache became unbearable and the patient went to the ER where he was diagnosed with iritis/uveitis , given prescription drops and told to follow up with primary care physician.


VAERS ID: 1357448 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Mobility decreased, Pruritus
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Less than 24 hours after 2nd shot extreme itching. From then to now left elbow very hard to bend without extreme pain. Have a hard time holding items now.


VAERS ID: 1357603 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Limb discomfort, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: 5/22/21 around 3am- right leg pain, heaviness, mininal strength. I felt numbness, I could not lift leg by myself. Within 30 minutes it subsided- I could walk 5/23/21 to now. I have been feeling sensation of numbness at the sole my feet. I can walk- it just doesn''t feel right. 5/27/21- some swelling in both legs but subsided


VAERS ID: 1357655 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, 10mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Body Aches Lasted about 12 Hours


VAERS ID: 1357673 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: woman vitamin, metformin; glipzide, atorvastatin, levetiracetam, omeprazole, oxybutyun, lisinopril, pioglitazone, ocuvite eye vitiman, complete vitamin for over 50, leg cramp pills when needed.
Current Illness: no
Preexisting Conditions: allergies, diabetic,
Allergies: strawberries, pepto bismal.
Diagnostic Lab Data:
CDC Split Type:

Write-up: ran fever, sick to stomach, diaria, started 4 hrs after shot and lasted 2 1/2 days.


VAERS ID: 1357677 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysstasia, Fatigue, Feeling abnormal, Gait disturbance, Joint swelling, Mobility decreased, Movement disorder, Muscular weakness, Myalgia, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 1st night after vaccine: chills, fever, extreme weakness in limbs (arms and legs) and could not lift myself out of bed, 2nd day after vaccine: fever, extreme muscle pain and soreness in legs, fatigue, and head fog 3rd-7th day: Difficult time walking and supporting my weight (120 lbs), legs tingle below waist, extreme pain in muscles, knees swollen, right quad had a difficult time "activating"


VAERS ID: 1357796 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: broke out in hives and small bumps on arms, legs, & stomach


VAERS ID: 1357806 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetalol- 800 mg/day Jaimiess- 0.15mg/day Valacyclovir- 1gram/day Addyi- 100mg/day
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: None. I have an at-home blood pressure cuff to track my blood pressure do to how high it is.
CDC Split Type:

Write-up: During the two days following receiving the second dose of Modera, I had a massive drop in blood pressure which caused extreme dizziness and some faintness when standing up. My normal blood pressure sits around 123/86 on average and was 130/88 the day of the shot (5/21/21). The day after the shot (5/22/21) my blood pressure dropped to 102/68 where it stayed for two days before slowly climbing back to normal.


VAERS ID: 1357876 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-16
Onset:2021-05-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Lymphadenopathy, Palpitations, Pharyngeal swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s mother called us on 5/28 to inform us that her daughter received the Pfizer vaccine on 5/16 and started having symptoms on 5/22: Swelling of lymph nodes, breasts, and what felt like her throat, a fever of 102F and felt like her heart was pounding. Patient''s mother states that her heart is no longer pounding but is still having swelling and fever.


VAERS ID: 1358000 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea exertional, Electrocardiogram, Fatigue, Malaise, Rash
SMQs:, Anaphylactic reaction (broad), Pulmonary hypertension (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C
Current Illness: no known illnesses
Preexisting Conditions: vitiligo
Allergies: Poison oak
Diagnostic Lab Data: ECG and exam 5/26/2021
CDC Split Type:

Write-up: Patient experienced fatigue, malaise and rash within 24 hours of second COVID vaccine. Then reported feeling short of breath with exertion while at wrestling practice on 5th day following COVID vaccine.


VAERS ID: 1358035 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-07
Onset:2021-05-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Immunology test, Lymphocyte count increased, Protein total increased
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: possible Lyme
Preexisting Conditions: anxiety
Allergies: pollen
Diagnostic Lab Data: LP 5/27. Patient had elevated protein with very mild lymphocytic pleocytosis in CSF. There was a presumptive positive Lyme test prior, which has not been confirmed. A repeat Lyme screen in the hospital was negative. The causality to the vaccine is not clear, but is plausible.
CDC Split Type:

Write-up: Guillain Barre syndrome.


VAERS ID: 1358040 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: None
Current Illness: Seasonal Allergy (Pollen)
Preexisting Conditions: Seasonal Allergy (Pollen)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Staff notices patient was breathing deeply and slowly. Asked patient if he is feeling unwell. Patient states he feels lightheaded. Patient then became diaphoretic. Took patient to medical tent via wheelchair. Vital signs stable. Gave patient orange juice and water and applied a cold damp towel. Patient stopped sweating and states he no longer feels dizzy. Too BP sitting and standing. Stable both ways. Symptoms noted: paleness, sweating, fainting, lightheadedness,; Orientation x 3. Vital Signs: 12:47pm - bp 116/62, p 71, r 15, pulse ox 98; Vital signs: 12:53pm - bp 120/76, p 74, r 16, pulse ox 98; patient treated at vaccine location, stabilized and discharged to home, alert and oriented with no further complaints.


VAERS ID: 1358073 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Dyskinesia, Electric shock sensation, Electrocardiogram, Heart rate increased, Hypertension, Insomnia, Paraesthesia, Sleep disorder, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations: 1st Covid Vax-3/26/2021 pt had tachycardia, anxiety, HBP, suicidal thoughts, depression, heart palpitations.
Other Medications: multivitamin, Fish Oil, hydroxyzine 50mg,
Current Illness: generalized anxiety
Preexisting Conditions: NASH, prediabetic, generalized anxiety,
Allergies: nka
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: pt had insomnia the night after taking the vax and experiences insomnia everyday since then. She feels like she has electricity in her brain and is also in her neck and going down her spine. Then she experiences tachycardia with HBP. These symptoms are worse at night and keep her from sleeping because her body starts jerking. On 5/25/2021 she felt like her heart was pumping very fast and she was dizzy so she went to Urgent Care. She had an EKG- normal w/ tachycardia, BP was high, and heart rate was high about 100. She was given an injection and prescribed clonazepam to go along with the HBP medicine she was prescribed after taking the 1st dose of the covid vax. She was told to FU w/ Cardiologist. She went to Cardiologist on 5/27/2021 and was told to continue the medication she was on and to FU in one month. She went to her Psychiatrist because she was still having trouble sleeping and was told to double up on the medication she was currently taking.


VAERS ID: 1358106 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paget-Schroetter syndrome, Peripheral swelling, Skin discolouration, Subclavian vein occlusion, Subclavian vein thrombosis, Thrombolysis, Ultrasound Doppler abnormal, Venogram abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: strattera, lexapro
Current Illness: none
Preexisting Conditions: She has a known prothrombin gene mutation (G20210A) that was previously identified because of a family history of thrombosis.
Allergies: azithromycin, prednisone
Diagnostic Lab Data: see above.
CDC Split Type:

Write-up: Vaccine 5/18. On 5/22 4 days after vaccine, she developed right arm swelling and skin discoloration. On 5/23 she went to the ED. Ultrasound revealed acute, occlusive thrombosis of right subclavian vein. She was admitted to the hospital, started on enoxaparin, achieved therapeutic levels. On 5/25 she underwent thrombolysis and venogram and was confirmed to have findings consistent with Paget-Schroetter syndrome. She was discharged home on 5/25 in good condition. Note: she also has known prothrombin gene mutation G20210A that confers an increased risk of thrombosis. She does have repetitive use of the right arm (lacrosse player).


VAERS ID: 1358119 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Muscular weakness, Pharyngeal swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: extreme muscle weakness, difficulty breathing, swelling in chest/throat with a slow progression over a period of 5 days starting the day following immunization, did not seek medical attention


VAERS ID: 1358147 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-24
Onset:2021-05-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Platelets 35 on 5/23/21
CDC Split Type:

Write-up: Thrombocytopenia: also possibility of tick exposure.


VAERS ID: 1358210 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Facial pain, Fatigue, Hyperhidrosis, Hypoaesthesia, Oral herpes, Pain, Paraesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 50mcg daily Lexapro 20Mg daily Levemir FlexPen 10 Units daily
Current Illness: Miscarriage
Preexisting Conditions: Pre-diabetic Hypothyroidism Anxiety
Allergies: Sulfa Bee Strings Capsasin Codeine
Diagnostic Lab Data: 5/24- LVHN ER Visit
CDC Split Type:

Write-up: Saturday at 1200 I got body aches, and chills, and sweats, and went to sleep Sunday 0700 woke up, still tired but managable with ibuprofen Monday 0600 wake up with blisters/cold sores on the L top lip, applied abreva Monday 1200 noticed swelling on the L side of face Monday 1400 started tingling and numbness in the face Was taken into ER at 1530 and discharged around 1645, sent home to pick up antibiotics Been taking them since Monday evening at 1800, every 4 hours awake No relief in the amount of pain in the sores on the face and still have tingling sensation.


VAERS ID: 1358211 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-29
Onset:2021-05-22
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03913221H / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: one a day vitamin and 81 mg Aspirin
Current Illness: no illnesses
Preexisting Conditions: no
Allergies: no Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: rashes on legs and arms


VAERS ID: 1358248 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

Administered by: Other       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 under age 18 was vaccinated with Moderna, which is a vaccine error. (If the person may receive a second dose, it will be per policy off-label use for a 17-year old). Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn away. Parent validated age as 18. Unreported as error, found in data mining.


VAERS ID: 1358267 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-07
Onset:2021-05-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OU2C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthropathy, Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: I am on plenty of medications. This was just a straight horrid, flu like response that I could only compare to having food poisoning 25 years ago. Sweats, vomiting, my body temp sensor was off... I was literally pouring sweat from my pore
Current Illness: Joint issues, arthritic type with physical Cartlidge torn.
Preexisting Conditions: Joint problems, Asthma, mental illness, Joint abnormalities from birth.
Allergies: Iodine, Bactrim, Toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site code 11109; Moderna 002C21A; or OU2C2IA or 1A I am confused if i should get another shot, or it was actually food poisoning. No one else got sick.


VAERS ID: 1358291 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Latuda 80 mg Lexapro 10 mg
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I got dizzy, passed out, and threw up twice.


VAERS ID: 1358318 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About a 5 inch area around injection site has a red, splotchy rash. Radiates heat. Itchy. Occasionally feels like it''s burning. Slightly painful - more of a dull ache. Itch does relieve with application of cortisol cream. Has been present for a week.


VAERS ID: 1358361 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: famotidine, vitamin D3
Current Illness: none
Preexisting Conditions: heartburn
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: headache, joint and muscle pain


VAERS ID: 1358413 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-28
Onset:2021-05-22
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Anticoagulant therapy, Blood lactate dehydrogenase increased, Brain oedema, C-reactive protein increased, Computerised tomogram abdomen, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Deep vein thrombosis, Diabetic ketoacidosis, Dysphagia, Heparin-induced thrombocytopenia test, Hepatic failure, Immunology test, Multiple organ dysfunction syndrome, Neck pain, Platelet count decreased, Portal vein thrombosis, Renal failure, Serum ferritin increased, Sinus pain, Ultrasound Doppler abnormal, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: JUNEL FE 1MG-20(21) TABLET
Current Illness: None reported
Preexisting Conditions: Diffuse Large B Cell Lymphoma (treated 5 years ago, in remission)
Allergies: NKDA
Diagnostic Lab Data: See above: 5/26 Doppler - R femoral popliteal DVT 5/26 CTA abdomen - R femoral politeal DVT, portal vein thrombosis seen on imaging 5/26 and 5/27 CT head - cerebral edema, but no CVT
CDC Split Type:

Write-up: Patient was found unresponsive at home on 5/22, admitted to another institution, found to be in DKA, multisystem organ failure (renal failure, liver failure), new R femoral DVT, elevation of ferritin, LDH and CRP. Over the course, platelet count continues to drop while on anticoagulation, and continued progression of thrombi, and transferred to our institution for further workup, including hepatic failure, concern for HLH and Castro trophic antiphospholipid syndrome. Based on chart review, patient had non-specific symptoms for a few weeks prior to the presentation, including GI distress, dysphagia and neck/sinus pain. CTH done with cerebral edema but not intracranial venous thrombosis. CT chest and abdomen with no PE, but presence of R popliteal vein thrombus, and portal vein thrombus. Heparin Ab (PF4 -ELISA test) was negative (at both referring hospital and current hospital). Serotonin release assay is pending at the time of report. While the symptoms are not consistent VITT that were reported (Heparin ab negative, received mRNA vaccines), however this possibility cannot be ruled out. IVIG was started on 5/27 - 5/28 to treat empirically for concern for heparin induced thrombocytopenia vs VITT.


VAERS ID: 1358459 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abnormal faeces, Decreased appetite, Diarrhoea, Dysphoria, Fatigue, Flatulence, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Salmonella enterica ("typhoid" vaccination, age 12. Usual response, cleared routinely.
Other Medications: Vitamin C/ascorbic acid 500mg. daily
Current Illness: None. Good health.
Preexisting Conditions: None.
Allergies: none
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine. After the expected fatigue, dysphoria and sleepiness from 12 hours to c. 36 hours after inoculation, I recovered in timely manner, but noticed my lower bowel with some gas, which terminated and eased with one episode of diarrhia on the third day after inoculation. There was an unusual odor from the feces only then. This occurred within my usual dietary regimen. I did not experience any upper tract or gastric unpleasantness. I did not have loss of appetite except as resulting from the general dysphoria of the immune response. This response was mild and cleared quickly, but I thought it might be of interest; as it has never been mentioned publicly that I have heard.


VAERS ID: 1358470 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye irritation, Eye pain, Faeces discoloured, Headache
SMQs:, Glaucoma (broad), Corneal disorders (broad), Noninfectious diarrhoea (broad)

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

Write-up: severe headache, black stool, burning/pain on eyes


VAERS ID: 1358496 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Pt c/o slight SOB, dry mouth, dizziness after 2nd dose of Pfizer. RN & NP assessed VS (BP 147/87; HR 114, AOx4) afebrile, no SOB or trouble swallowing. Pt has history of anemia & taking iron supplements. Pt felt similar after 1st dose. RN & NP reassessed vital signs (BP 127/79; HR 99). Pt denied SOB, verbalized sx resolution. D/C to home with steady gait


VAERS ID: 1358509 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Dizziness, Fine motor skill dysfunction, Hypoaesthesia, Magnetic resonance imaging abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: positive stroke s on MRI
CDC Split Type:

Write-up: patient had 2nd dose moderna vaccine and 2 days later developed dizziness followed by numbness left upper extremity and then fine motor difficulty left hand.


VAERS ID: 1358510 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain, Skin tightness
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: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: A stabbing pain, with compression like sensations.


VAERS ID: 1358561 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Dyspepsia, Pain
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Other ischaemic heart disease (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: Over the Counter 24-hour non drowsy GENERIC allergy medication FLO daily vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal Allergies
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Heart pain woke me up at 3 am in the morning. Pain was a dull ache that did not subside with heartburn tablets (I don''t normally experience heartburn). Symptoms were like a toothache in the heart?dull, persistent. Did not subside until 3-4 days after the initial onset. Have not experienced this type of pain before.


VAERS ID: 1358676 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / -

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

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

Write-up: High heart rate even while resting. 120s-130s most of the day. It got up to 150 at least once.


VAERS ID: 1358684 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Disorientation, Palpitations, Peripheral swelling, Pyrexia, Tachycardia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? acetaminophen (TYLENOL) 500 MG tablet Take 1,000 mg by mouth every 8 (eight) hours ? amLODIPine (NORVASC) 10 mg tablet take 1 tablet by mouth once daily ? azithromycin (ZITHROMAX) 250 mg tablet take 2 tablets by mouth today then take 1 ta
Current Illness: Anemia, Arthritis (8/17/2012), Brain aneurysm (8/17/2012), Constipation, Headache, Hearing loss, Hypertension, Osteoporosis, Rheumatoid arthritis (HC Code), Stroke (HC Code), and Venous stasis dermatitis (1/6/2014), Joint replacement (2009); Total shoulder arthroplasty (5/10/12); Total hip arthroplasty (Left, 2010); Total shoulder replacement (Left, 2012); and cataract surgery (Bilateral)
Preexisting Conditions: Anemia, Arthritis (8/17/2012), Brain aneurysm (8/17/2012), Constipation, Headache, Hearing loss, Hypertension, Osteoporosis, Rheumatoid arthritis (HC Code), Stroke (HC Code), and Venous stasis dermatitis (1/6/2014), Joint replacement (2009); Total shoulder arthroplasty (5/10/12); Total hip arthroplasty (Left, 2010); Total shoulder replacement (Left, 2012); and cataract surgery (Bilateral)
Allergies: - Tramadol - Ciprofloxacin - Penicillins - Advil (Ibuprofen)
Diagnostic Lab Data: EKG (5/28/2021): NSR with NSSTTC
CDC Split Type:

Write-up: Daughter reports vaccination was received on 5/21. On the morning of 5/22, patient began to develop fever ($g100.0), bilateral leg swelling, and palpitations. She reports an episode of tachycardia up to HR 140''s, but states she was most likely febrile but was unsure. She reports that at baseline she is confused but reports she was more disoriented than usual. She states that the patient was experiencing more DOE. Of note, she has hx of COPD and is on 2L NC at baseline. Per daughter, leg swelling and palpitations began to resolve after fever resolved -- now improved but still has more DOE. Also reports some mild suprapubic discomfort. No N/V/D.


VAERS ID: 1358737 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-14
Onset:2021-05-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: Shingles developed 8 days after injection


VAERS ID: 1358758 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022321A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Dizziness and flushing occurred 17 minutes after injection of the vaccine. Continued to experience these side effects for 20 minutes.


VAERS ID: 1358836 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 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:
Allergies: penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and painful lymph node in armpit.


VAERS ID: 1359030 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Influenza like illness, Injection site infection, Oxygen saturation decreased, Pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Botox, gabapentin, propranolol, pyridium, Prilosec, aleve, chloroxazone, Xanax, seraquil, magnesium, vitamin d, vitamin b, singular, klonopin, aloe Vera, metformin
Current Illness: Migraines, diabetes, fibromyalgia, IC
Preexisting Conditions: Migraines, diabetes, fibromyalgia, IC
Allergies: Sulfa drugs, nuts, shell fish
Diagnostic Lab Data: 5/25/21 evaluated by PCP. Lungs sounded clear and diagnosed with skin infection at infection site. 5/28/21 recommended to seek treatment at ER due to worsening breathing symptoms.
CDC Split Type:

Write-up: I had flu like symptoms and body ache on Saturday (day after vaccine). Then I began experiencing difficulty breathing, shortness of breathe, and low pulse oxygen levels with movement/exertion. Breathing difficulties have continued to worsen Over the last week and increased palpitations . Developed a skin infection at the injection site as well.


VAERS ID: 1359297 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Miliaria
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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: What appears to be a heat rash on my right arm near elbow pit, also on my left forearm, my neck, legs.


VAERS ID: 1359527 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration, Injection site mass, Injection site pain, Injection site pruritus, Skin infection, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (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: Generic of Bactrim DS, Generic of Tylenol
Current Illness:
Preexisting Conditions:
Allergies: Codeine, Penicillins, Clindamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had 2nd dose of COVID-19 shot on 05/22/2021. She developed skin problem the same day after the 2nd shot. Her skin was hot to touch and feeling itch underneath around the injection site. She took Tylenol, put ice pack and drank a lot of water. After 2 to 3 days of the 2nd dose, her left arm around the injection site had a mass that was red/purple with sharp pain and itch. No fever was reported during this time. She contacted CDC and was told to see a doctor. Her doctor prescribed Bactrim DS and diagnosed for skin infection on 05/28/2021. Pharmacist found out when doing consultation on her Bactrim DS.


VAERS ID: 1359722 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Chills, Exposure during pregnancy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: Prenatal +DHA
Current Illness:
Preexisting Conditions: seasonal allergies
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reports being 6 weeks pregnant (estimated Due 12/27/21) at time of vaccination. She has been previously been pregnant 3 times with no prior miscarriages or complications. Patient reports finding out about miscarriage on 5/22 during office visit and completed miscarriage on 5/25. Patient experienced mild fever and chills approximately 6 hours after vaccine which was controlled by acetaminophen and resolved by the following morning 5/4.


VAERS ID: 1359855 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Movement disorder, Skin discolouration
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)

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

Write-up: Patient reports week-long, not yet resolved, numbness in fingers, pain in elbow of injected arm. Also ?hard to bend? and injected arm ?darker than other arm?


VAERS ID: 1360783 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intertrigo, Rash, Rash erythematous, Skin warm
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red rash under arms, under breast, part of chest, crotch area where legs attach to body, butt crack/Extra warm areas


VAERS ID: 1360805 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

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

Write-up: PATIENT LIED ABOUT PAST MEDICAL HISTORY SUCH AS HIS AGE AND HISTORY OF PAST VACCINATIONS AT VACCINATION CLINIC HELD AT CENTER. UPON SCREENING QUESTIONS HE CLAIMED HE IS OVER 18 AND NEVER HAD ANY COVID VACCINATIONS IN PAST BUT HE HAD PFIZER 1ST DOSE GIVEN OVER 1 MONTH AGO PER HIS AUNT. PATIENT RECEIEVED MODERNA VACCINE ON 5/22/2021. AFTER THE VACCINATION PATIENT WAS MONITORED FOR 30 MIN AND PATIENT DID NOT HAVE ANY REACTIONS TO VACCINE. PATIENT AND HIS AUNT WAS COUNSELD REGARDING VACCINE AND ITS SIDE EFFECTS.


VAERS ID: 1360828 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-05-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Pain in extremity, Paraesthesia, Pruritus, Rosacea, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin Loratadine Vitamin C Zinc Multivitamin
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin Sulpha
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chronic itching and some hives (appeared five days after vaccination) Rosacea flare on face Pain and tingling in fingers and toes


VAERS ID: 1360829 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-12
Onset:2021-05-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C212 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Erythema, Fatigue, Irritability, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Ibuprofen 800mg, Mag-Oxide 400mg, Protonix 40mg, Verapamil 240 ER, Vitamin B2 (rx), Vitamin B12 (rx), Vitamin C, Vitamin D3, Topamax 50mg
Current Illness: none
Preexisting Conditions: Migraines since 8 years old, back problems since 12 years old, neck problems 30+ years
Allergies: all mold spores
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness in the arm that came out of nowhere one day more than a week later but continues to worsen now more than 2.5 weeks later, additional body aches almost all over but especially in the torso (it feels like someone has been kicking me) and fatigue and confusion and irritability and vision and chills


VAERS ID: 1360923 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-08
Onset:2021-05-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Hydrochlorothiazide Lisinopril/hits Omeprazole Fluticasone
Current Illness:
Preexisting Conditions: High blood pressure GERD High cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a tingling and slight pain on the bottom back of her right arm about two weeks after she got the vaccination (same arm she received COVID vaccine). She went to the emergency room and they concluded the COVID vaccine could have reactivated the shingles virus and she had a shingles infection. There was no rash. They prescribed her Valtrex 1 gram three times a day.


VAERS ID: 1360947 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: - Drospirenone and ethinyl estradiol tablets USP - VisionPro EPA/DHA/GLA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the night of the second dose (Saturday), I started feeling soreness on my entire back. This soreness lasted all Sunday. Taking ibuprofen, resting and laying down on a warm pad helped. The night of the Sunday to Monday was not comfortable, as the pain continued. On the Monday, the pain was gone, but I felt somewhat tired. I was able to work (on a computer), though. This is when the rash started on my face. I had what looked like an allergic reaction (at least, it manifested itself like when I get bitten by a mosquito and react badly). This first started on my forehead, above my right eye. It looked like a circle of 2cm in diameter. I also felt and saw some rash above my 2 eyebrows. What was interesting was also the rash I experienced on the back of my head. This lasted about 2 days. So, I took some Zyrtec. The rash on the front of my face then went away. The one on the back lasted a little longer. But then the rash went down the exterior of my left forearm, and to the stomach, also on the left side. This lasted a few days too. Taking Zyrtec again helped. Today, 1 week after the second dose, I still have marks from the rash on my belly, but the itchy sensation is gone.


VAERS ID: 1360970 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium carbonate Bupropion XL Olanzapine Lorazepam Norgestimate and Ethinyl Estradiol
Current Illness:
Preexisting Conditions: Bipolar Anxiety PTSD
Allergies: Aspirin Dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unbearable pain in left arm that is not relieved by Tylenol. Pain is still unbearable one week later (5/29/21) Vomiting on night of 5/22-23/21


VAERS ID: 1361018 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Lactation puerperal increased, Neuropathy peripheral, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Functional lactation disorders (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Parasthesias/ peripheral neuropathy since shortly after vaccination, joint pains email joints of left husky, increased milk supply


VAERS ID: 1361033 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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

Write-up: Patient representative, I believe his wife, called and stated he had a stroke about 1 week after his second dose. She states he is admitted to Medical center so outcome is unknown.


VAERS ID: 1361072 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO164 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Dysphagia, Fall, Headache, Hyperhidrosis, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The day following vaccination, I was doing doing light yard work, came in the house, got a drink and it got caught in my throat, I sat down in a chair and woke up on the floor( presuming I had passed out.) I was out for a few minutes. When I awoke I was disorientated and had suddenly a headache, nausea, sweaty and clammy skin.


VAERS ID: 1361188 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: N/A
Current Illness: N/A
Preexisting Conditions: Obesity Depression Anxiety
Allergies: NKDA-N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbing on tongue and lips- has continued since day after vaccination 5/22-presently


VAERS ID: 1361232 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site rash
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: A week after receiving vaccine on May 22nd, patient says rash appeared at injection site for a couple hours and disappeared by noon. On the 23rd of May, the same thing happened, rash appeared in the morning and disappeared by noon. He also says whenever he takes a deep breath or presses on his chest, the place where he had a stent inserted over 20 years ago aches. He is seeing his cardiologist on 6/11/21 and will mention the chest pain also


VAERS ID: 1361254 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-22
Onset:2021-05-22
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004A21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Full blood count normal, Rash erythematous, Rash vesicular, Viral test
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: Multiple herbal supplements. Patient unfamiliar with names
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: CBC - Normal - 5/29/21 Viral Culture - Pending - 5/29/21
CDC Split Type:

Write-up: Red, blistering rash


VAERS ID: 1361300 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, 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:
CDC Split Type:

Write-up: arm soreness, day after vaccine fatigue, two days after vaccine


VAERS ID: 1361490 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-05-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Chronic serous otitis media
Allergies: Possible very slight reaction to amoxicillin
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Heart pain. Improved after 400 mg ibuprofen + rest


VAERS ID: 1361510 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-13
Onset:2021-05-22
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Intervertebral disc space narrowing
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Mri . 5/29/2021
CDC Split Type:

Write-up: 39 days after the 2nd Pfizer shot I had numbness in my left calf and foot. One weak after that I lost most feeling in my legs ( I can move both but cannot walk unassisted with them not giving out. Went to the ER and had an MRI which said minor L3 L4 narrowing but no herniated disc.


VAERS ID: 1361520 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Rash, Rash erythematous, Rash pruritic
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I failed to report when I first filled out this form--temporary form, that in addition to a rash under my arms, breasts/chest, where my legs attach to body in crotch area and butt crack----- I had a round, red itchy patch about 3 inches under the actual injection site. It was about in the same location that I had the first dose of the vaccine.


VAERS ID: 1361547 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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 known at this time
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bell''s palsy on left side of face


VAERS ID: 1361601 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Immediate post-injection reaction, Parosmia, Taste disorder
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlopodine, xanax
Current Illness: Acute bronchitis
Preexisting Conditions:
Allergies: Hydroxyzine, hair dye, chephlexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Instant sterile taste and smell as I was being injected. End of nose had felt like slight burn. Taste lasted a short time(about 3 hours). Smell lingered for few days. I would describe the smell as to what a bandaid smells like when you open it.


VAERS ID: 1361638 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-24
Onset:2021-05-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Nausea and Dizziness


VAERS ID: 1361645 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Physical examination normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Tree nuts
Diagnostic Lab Data: Normal physical exam on 5/30/21.
CDC Split Type:

Write-up: 7 days after receiving second dose, patient developed diffuse headache, which then settled in occipital region. He had 3 episodes , the last of which was still present the day after it developed. Headache more noticeable with physical activity, and usually began after he finished lifting weights.


VAERS ID: 1361720 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Dizziness, Fatigue, Head discomfort, Headache, Nausea, Neck pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)

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

Write-up: Felt neck ache and back ache the morning after as well as headache and fatigue. That Monday had a pounding headache, nausea, vomiting, light headed, weak. Was prescribed Zofran. Nausea subsided but dizziness, pulsing headache, fatigue and light headed continued all week. That Friday I almost fainted and my head felt like there was liquid wooshing around and kept pulsating. Went to walk in and was sent to ER. Was prescribed Promethazine at ER. Here I am a week and two days after the second dose feeling constant dizziness and light headed.


VAERS ID: 1361739 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-05-22
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Haematocrit abnormal, Magnetic resonance imaging abnormal, Venogram abnormal
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg oral tablet amLODIPine (NORVASC) 10 mg oral tablet apixaban (ELIQUIS) 5 mg (74 tabs) oral tablet starter pack apixaban (ELIQUIS) 5 mg oral tablet atorvastatin (LIPITOR) 40 mg oral tablet cefdinir (OMNICEF) 300
Current Illness: None
Preexisting Conditions: Diabetes, Hypertension
Allergies: NKDA
Diagnostic Lab Data: MRI, MRV, HCT MRV 5-27-2021 - 1. Extensive thrombosis of the superior sagittal sinus. 2. Partially occlusive thrombus in the transverse sinuses bilaterally.
CDC Split Type:

Write-up: Development of unexplained Cerebral venous sinus thrombosis


VAERS ID: 1361763 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Singular, generic Paxil
Current Illness: None
Preexisting Conditions: Sinusitis, chronic cough
Allergies: Augmentin
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Standard reactions except I have been spotting vaginally and cramping since the day after getting the shot. I have the Mirena birth control implant and do not have a monthly period and have not had one for many years nor do I get the cramps and other symptoms of having a period. For the past 9 days since getting the vaccine, I have had spotting and cramping off and on daily. This is NOT normal for me!


VAERS ID: 1361802 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-12
Onset:2021-05-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / SC

Administered by: School       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Rash on entire upper left arm with raised edges


VAERS ID: 1361963 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor
Current Illness: Minot Thelassamia
Preexisting Conditions: None
Allergies: Soy, Grass Pollen
Diagnostic Lab Data: ER did tests, neg for covid, nothing detected
CDC Split Type:

Write-up: Covid second shot recieved on May 15th. Rash on arm started a week exactly after shot 1 on May 22nd. Rash started on left arm, to shoulder, to side of belly, then to other arm, right side, kept spreading all over where I ended up driving myself to the ER on May 28th. Rash is red dots, not itchy, and not affected by anti-histamine.


VAERS ID: 1361998 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Tinnitus
SMQs:, Hearing impairment (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: Milk Thistle, Rhodiola, Cordyceps, Magnesium, Vitamin b12, Vitamin b6, Borage Oil, Spirulina, Zinc, Lipo-Flavonoids.
Current Illness: None
Preexisting Conditions: Raynaud''s Syndrome, Arthritis, Diagnosed hearing loss in left ear, and tinnitus ringing and occasional clicking in left ear.
Allergies: N/A
Diagnostic Lab Data: Not available yet.
CDC Split Type:

Write-up: Increase in volume of the already existing high pitched tinnitus ringing in my left ear. The noise has definitely gotten much louder, which I noticed approximately 48 hours after receiving the shot.


VAERS ID: 1362243 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

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

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

Write-up: no adverse events reported. vaccine was administered 2 weeks after the first instead of recommended 3 week interval


VAERS ID: 1362247 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-24
Onset:2021-05-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Brain oedema, Cerebral infarction, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram abdomen normal, Computerised tomogram head abnormal, Computerised tomogram neck, Computerised tomogram pelvis, Computerised tomogram thorax normal, Decompressive craniectomy, Echocardiogram abnormal, Ejection fraction decreased, Endotracheal intubation, Glycosylated haemoglobin normal, Hemiparesis, Hemiplegia, Sinus rhythm, Thrombectomy
SMQs:, Cardiac failure (narrow), Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN 81MG ERGOCALCIFEROL 1.25MG MULTIVITAMIN
Current Illness: NONE
Preexisting Conditions: DIVERTICULOSIS
Allergies: NONE KNOWN
Diagnostic Lab Data: This patient does not have a clear etiology of his stroke. CTA head/neck shows no evidence of aortic or carotid vascular disease/plaque. Echocardiogram shows EF 50%, no wall motion abnormality, no PFO, and no intracardiac thrombus. He has been in sinus rhythm with no evidence of atrial fibrillation, no history of atrial fibrillation. His hemoglobin A1C was 5.9. He does not have a history of hypertension, though has been started on amlodipine while in the hospital for improved blood pressure control. CT of the chest/abdomen/pelvis was negative for signs of malignancy or hypercoagulability. CT brain demonstrates large territory L MCA infarct with midline shift and post-operative changes related to decompressive hemicraniectomy.
CDC Split Type:

Write-up: Patient presented 5/22 with acute onset right sided weakness and aphasia, found to have left MCA stroke. He was last normal at 0200 and was found at 0600 when he was found by hi wife. He was not a candidate for tPA as he was outside of the time window once he arrived to ER. He underwent IR thrombectomy with TICI 2B, residual clot in the left A1 and left M3 vessels. He suffered a large territory stroke with malignant cerebral edema requiring emergent decompressive hemicraniectomy. He has been unable to be extubated thus far, as he is unable to protect his airway. He has severe aphasia and right hemiplegia.


VAERS ID: 1362254 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-07
Onset:2021-05-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Herpes zoster oticus
SMQs:, Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Obesity
Allergies: Penicillins, nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed locally disseminated shingles complicated by Ramsey-Hunt syndrome (prominent facial nerve palsy). History of childhood chickenpox. No prior episodes of shingles.


VAERS ID: 1362261 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Hot flush, Hyperhidrosis, Injection site pain, Joint swelling, Lethargy, Loss of personal independence in daily activities, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega, B Complex, Vit C & D, Magnesium
Current Illness: Mild knee pain from jogging
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Item 21- I have not seen a doctor, but have a call scheduled with my doctor this week to discuss
CDC Split Type:

Write-up: I felt the following beginning Saturday morning; ? Severe leg aches, in addition to pain & swelling in my knees and ankles ? Hot flashes and sweats throughout the day and night ? Extremely lethargic Notes: The arm of the injection site only hurt for 24hrs. The effects above were extreme (bed ridden) from Saturday (22nd) to Tuesday (25th). All have lessened but are still present with the addition of a constant, dull ache in my right arm (opposite the injection site). I would just like to add that the ?side effects? I have experienced seemed to have intensified my existing ?aliments?. Pre vaccination: ? Mild knee pain (from jogging). ? Occasional night sweats - premenopausal symptoms


VAERS ID: 1362286 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Choking sensation, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Other Medications: Dexmethylphenidate ER 20 mg
Current Illness: None
Preexisting Conditions: ADHD
Allergies: None
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: Significant chest pain started around 10 pm. He indicated it was sharp and intense and seemed to have some difficulty breathing at first. For the first 30 seconds the open mouth struggling look for breath had me thinking he was choking. Breathing improved but chest pain stayed intense for about 20 minutes. He went to sleep and the next morning said ?it kind of hurt but not much?. After the morning of May 23rd he hasn?t reported any other pain.


VAERS ID: 1362317 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest X-ray, Magnetic resonance imaging head, Parosmia, Scan with contrast, Seizure
SMQs:, Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Testosterone, Losartan , Atorvastatin Calcium, Anastrozole, B
Current Illness: none
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: Chest X-ray, MRI Brain WO contrast, MRI Brain W/ Contrast.
CDC Split Type:

Write-up: Sense of Deja Vu, could smell burnt rubber, and sense of impending doom. Started on Saturday 22 and increased in frequency throughout the week. Each episode lasted about 15 seconds. Went to the Clinic on 5/28 who then sent him to the emergency room where they treated him for prefrontal cortex seizures. He was released from the hospital with a referral to a neurologist.


VAERS ID: 1362431 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ?W0161 / 2 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER0733 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Fine motor skill dysfunction, Headache, Nasal discomfort
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: I went to an ENT to eliminate positional vertigo (had that 2 yrs ago). They found no symptoms of positional vertigo on testing.
CDC Split Type:

Write-up: Neurological: dexterity in fingers/arms impaired, balance affected, sensation in nasal bone area. Feeling off, mild headache.


VAERS ID: 1363800 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Nausea, Pain, Tension headache
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210552743

Write-up: FEELS LIKE A RUBBER BAND AROUND HEAD OR TENSE FEELING AROUND HEAD; ACHES; CHILLS; NAUSEA; This spontaneous report received from a patient 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 not reported, batch number: Unk) dose was not reported, administered on 22-MAY-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 22-MAY-2021, the subject experienced aches. On 22-MAY-2021, the subject experienced chills. On 22-MAY-2021, the subject experienced nausea. On 24-MAY-2021, the subject experienced feels like a rubber band around head or tense feeling around head. Treatment medications included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from aches, chills, and nausea on MAY-2021, and had not recovered from feels like a rubber band around head or tense feeling around head. This report was non-serious.


VAERS ID: 1363897 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-05-22
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthritis, Chills, Gait inability, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (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? 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: USJNJFOC20210556302

Write-up: This spontaneous report received from a patient concerned a 29 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, expiry: UNKNOWN) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 22-MAY-2021, the subject experienced inflamed joints below legs. On 22-MAY-2021, the subject experienced can''t walk. On 22-MAY-2021, the subject experienced chills. On 22-MAY-2021, the subject experienced headache. On 22-MAY-2021, the subject experienced fever. On 22-MAY-2021, the subject experienced nausea. On 22-MAY-2021, the subject experienced severe muscle soreness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills, headache, and nausea on 24-MAY-2021, was recovering from fever, had not recovered from inflamed joints below legs, and severe muscle soreness, and the outcome of can''t walk was not reported. This report was non-serious.; Sender''s Comments: V0:MAC not required as per standard procedure as case was assessed as non- serious.


VAERS ID: 1364025 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-22
Onset:2021-05-22
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TELMIKIND
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210522; Test Name: body temperature; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: shortness of breath/breathing wasn''t easy and was not able to fill their lung; fever; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (shortness of breath/breathing wasn''t easy and was not able to fill their lung) and PYREXIA (fever) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 025C21A and 003C21A) for COVID-19 vaccination. Concomitant products included TELMISARTAN (TELMIKIND) for an unknown indication. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 22-May-2021, the patient experienced DYSPNOEA (shortness of breath/breathing wasn''t easy and was not able to fill their lung) and PYREXIA (fever). At the time of the report, DYSPNOEA (shortness of breath/breathing wasn''t easy and was not able to fill their lung) and PYREXIA (fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 22-May-2021, Body temperature: 101 (Inconclusive) Inconclusive. On 22-May-2021, the patient had a fever of 101 for which the patient took paracetamol. He started having shortness of breath on the evening of 22-May-2021. He reported that his breathing wasn''t easy and he was not able to fill his lung. The patient went to an Urgent Care on 23-May-2021 and was prescribed cetirizine and benzonatate 10 mg. At the time of the report, his symptoms are not as strong but were still present. Company Comment : Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 24-May-2021: FU Received on 24-May-2021.Expiration Date(second dose): 10/23; 10/17/2021 (first dose) were updated; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1364283 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Pfizer vaccine was given, but first dose was Moderna. Second dose should also have been Moderna. Therefore, this was a medication error.


VAERS ID: 1364305 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Haemorrhage, Haemorrhage urinary tract, Urinary bladder haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202105; Test Name: Bloodwork; Result Unstructured Data: Test Result:Unknown result; Test Date: 202105; Test Name: CT scan; Result Unstructured Data: Test Result:Unknown result
CDC Split Type: USPFIZER INC2021583789

Write-up: Heavy clotting issues in my left kidney through my bladder which is causing urinary issues; Urinating large blood clots; Hemorrhaging blood clots/ bleeding; This is spontaneous report from a contactable consumer, the patient. A 52-years-old male patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN), via an unspecified route of administration on 21May2021 10:10 (reported as 10:10 EST) (at the age of 52-years-old) as a single dose for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. On 22May2021, the patient called to report an adverse reaction to 1st dose of vaccine, and currently in the emergency room (ER) at the hospital, in a bed with heavy clotting issues in his left kidney through his bladder which was causing urinary issues, literally urinating large blood clots. He currently had a catheter in, they have done blood work and CT scan, but no results provided. The patient had no issues with anything with prostate or kidney but hemorrhaging blood clots. The patient was not yet admitted to the hospital, just in the ER somewhere around 10:00 in the morning. The patient had a follow up and still at home had a catheter and still he was bleeding and follow up tomorrow with Urology department at 10:00; had full blood work follow up tomorrow and had a CT scan. Everything came back as normal as far as his organs go. The patient added, "I would appreciate it if someone would call me with some professional advice what I should do about this whether I need to take the second dose. I need some clarification on what is going on with this and then I need to have a discussion on whether I should take the second dose or not." The outcome of the event was not recovered, at the time of this report. The seriousness of the events was unspecified by the reporter. There is a medical information request included Caller (male, age 52 years)- his question was the first and 2nd dose the same. Tomorrow he should have the full make up back and causes of this from the doctor. It has been a rather traumatic event which he thought was going to be nothing." Due date of second dose. Response included: As noted in the Fact Sheet for Recipients, the patient should not get the Pfizer-BioNTech COVID-19 Vaccine if he had a severe allergic reaction after a previous dose of the vaccine or if he had a severe allergic reaction to any ingredient of the vaccine. The decision to receive the second dose for any other reason cannot be made by Pfizer. They refer him to speak to his healthcare provider about the risks of the vaccine compared to the risks of potentially not being fully protected against COVID-19 infection. His healthcare provider knows your health situation and has access to information that can better help inform this decision. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Pfizer-BioNTech COVID-19 Vaccine." and from VR-As the Prescribing Information does not include all adverse reactions that have been reported or that may occur, please consult with doctor/healthcare provider about what he had experienced/were experiencing. Information on Lot/Batch number has been requested.


VAERS ID: 1364308 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Computerised tomogram normal, Electrocardiogram, Fatigue, Hypoaesthesia, Muscle strain, Nasopharyngitis, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hypertension (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210523; Test Name: Blood pressure increased; Result Unstructured Data: Test Result:Increased; Comments: blood pressure was elevated at the hospital at "over 200".; Test Date: 20210523; Test Name: Blood Work; Result Unstructured Data: Test Result:Normal/Near Normal; Test Date: 20210523; Test Name: CAT scan normal; Result Unstructured Data: Test Result:Normal; Comments: CAT scan of the callers brain. Everything resulted as normal or near normal per the caller.; Test Date: 20210523; Test Name: EKG; Result Unstructured Data: Test Result:Normal
CDC Split Type: USPFIZER INC2021592810

Write-up: she started to feel fatigued; like she was coming down with a cold; pain below her left shoulder bladShe also had a pain below her left shoulder blade. Stated it became so painful she couldn''t stand.e; a pulled muscle; Her blood pressure was elevated at the hospital at "over 200"; numbness; This is a spontaneous report from a contactable consumer (patient). A 61-year-old female patient received second dose of bnt162b2 (Pfizer-Biontech Covid19 vaccine, Solution for injection, Lot Number: EW0168 and expiration date not reported), via an unspecified route of administration on right arm on 21May2021 at around 16:30 (at the age of 61-year-old) as 2nd dose, single dose, for covid-19 immunization. Medical history was not reported. The patient''s concomitant medications were not reported. It was stated she was very healthy. Patient previously took First dose of bnt162b2 (Pfizer-Biontech Covid19 vaccine, Solution for injection, Lot Number: EW0176 and expiration date not reported), via an unspecified route of administration on right arm on 29Apr2021 for covid-19 immunization. Patient experienced Sore arm after first dose of vaccine which was recovered on 01May2021. On 22May2021, Saturday around 14:00, Patient felt fatigue and felt like she had a cold coming on. She also had a pain below her left shoulder blade. Stated it became so painful she couldn''t stand. Stated at night she took some Tylenol. She said that she changed positions a lot while sleeping and had difficulty doing so that night. Her daughter called to see how she was doing and made the caller go to an Urgent Care. Patient stated she went, and they checked her vital signs. The Physician''s Assistant talked with her and prescribed her a muscle relaxer and Ibuprofen. While the patient was driving to get her prescriptions, she noticed that the pain was traveling down her left arm as well as some numbness. Her daughter told her that this was a sign of a heart attack in women. She said her daughter was a nurse and was upset that the urgent care did not do an EKG or listen to her heart. The patient went back to the Urgent Care; they said her EKG was abnormal and wanted to send her to the Emergency Room. The caller signed a form refusing the ambulance and took herself to the Emergency Room. The Emergency Room did 2 EKG''s, blood work, and a CAT scan of the patient''s brain. Everything resulted as normal or near normal per the patient. Her blood pressure was elevated at the Emergency Room, the first one was over 190, the second one over 200 per the patient. She stated that was why they did the second EKG and stated they told her both those EKG''s were normal. Patient said that the Physician''s Assistant at the Emergency Room told her that her heart was okay. She got home from the Emergency Room around 01:00 on 24May2021. She slept some after taking a muscle relaxer and Ibuprofen. She did not pull a muscle or anything. Stated the only thing she could think of was the vaccine. Patient asked if anyone else had reported having this issue after the second dose. A friend of hers had flu like symptoms after the second dose; no identifying information provided by the patient. She took care of her grandkids but had not been able to do so. Her daughter has had to find someone else to care for them. Patient asked how long may this last. Her HCP had just retired, and she had a new one who works out of withheld. It was stated that the pain below her shoulder blade comes and goes. Rates it as a 7-9 on the 1-10 pain scale. The outcome of the event numbness was unknown. Patient recovered from events other on an unknown date May2021. Follow up attempt completed. Additional information has been requested.


VAERS ID: 1364613 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       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? No
Previous Vaccinations: Flu shot arm swollen
Other Medications: Dietary supplement
Current Illness: Digestive complications and IBS
Preexisting Conditions: Asthma
Allergies: allergic to eggs and peanuts , sulfer, penicillin,
Diagnostic Lab Data: no lab work
CDC Split Type: vsafe

Write-up: no treatment


VAERS ID: 1364677 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-15
Onset:2021-05-22
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Z PACK, IBUPROFEN
Current Illness: NONE
Preexisting Conditions: HTN
Allergies: NONE
Diagnostic Lab Data: RAPID ANTIGEN POSITIVE
CDC Split Type:

Write-up: PT VACCINATED ON 03/15 BECAME SYMPTOMATIC AND RAPID ANTIGEN POSITIVE.


VAERS ID: 1364752 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Fatigue, Laboratory test, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chondroitin, calcium, Flomax ,Metamucil, naproxen sodium, Men''s 1-a-day
Current Illness: None
Preexisting Conditions: Sinusitus
Allergies: Latex
Diagnostic Lab Data: Blood test was done but yet to get results
CDC Split Type: vsafe

Write-up: Soreness, weakness, fatigue, abdominal pain. No treatment or prescription.


VAERS ID: 1364811 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypoglycaemia (broad)

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

Write-up: Itchy throat, Anxiety


VAERS ID: 1364822 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client felt lightheaded and faint. Presyncopal. Had not eaten that day by mid afternoon. Given juice and a snack and felt better quickly.


VAERS ID: 1364834 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Presyncopal - laid down on stretcher. Father states that child does this after every injection. Child had played tennis in am and come without eating or drinking. Given snack and juice. Felt better and improved quickly.


VAERS ID: 1364942 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH AW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dysphagia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient reports chest as feeling tight, had difficulty swallowing and breathing about a day after receiving first dose. She reports feeling like this for a few days, and if she had not gotten better at the time of phone call she would have gone to hospital. She was advised to reach out to her doctor and to go to ER if she experiences any more difficulty breathing.


VAERS ID: 1364967 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH AW0177 / 1 LA / IM

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

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

Write-up: Patient reports abnormal chest pain, weird "poking" feeling in heart, and abnormal thigh pain after receiving vaccine. She is still feeling a bit of chest pain but the worst was Monday following the vaccine administration. She has not gone to the ER but was advised to go if she experience any severe pain or difficulty breathing, and was also advised to reach out to her doctor prior to next dose.


VAERS ID: 1365143 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Hiccups
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: Lisinopril 5mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: symptom: Hiccups time course: 36 hours


VAERS ID: 1365231 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever & Chills


VAERS ID: 1365243 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Lymphadenopathy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 24 hours fever, chills, headache, and sore arm. Two days following vaccine swollen lymph nodes.


VAERS ID: 1365264 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Nausea, Pain
SMQs:, Acute pancreatitis (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 Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, Chills, Body aches


VAERS ID: 1365297 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Pain
SMQs:

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

Write-up: Body aches & Fatigue


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