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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 11 out of 8,010

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VAERS ID: 1786372 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-11
Onset:2021-10-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Headache, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness:
Preexisting Conditions:
Allergies: Not Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient collapsed within minutes if receiving vaccine. She stated started feeling dizzy, was unconscious for a few minutes. She hit her head during the fall and had pain and a headache. Rescue was called and she was taken to ER for further evaluation.


VAERS ID: 1786680 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Nevada  
Vaccinated:2020-12-30
Onset:2021-10-11
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Injection site induration, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain and hardness at injection site


VAERS ID: 1786685 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-18
Onset:2021-10-11
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Catheterisation cardiac normal, Chest pain, Echocardiogram, Electrocardiogram, Myocardial infarction, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Protonix, Vyvanse
Current Illness: N/A
Preexisting Conditions: Gastroparesis, GERD
Allergies: Latex
Diagnostic Lab Data: Multiple blood tests, heart cath, EKG, echo 10/11-10/12/2021
CDC Split Type:

Write-up: Potential heart attack, troponin level .75 and admitted to hospital for severe chest pain. Heart cath showed no damage however multiple blood tests showed heart attack happened.


VAERS ID: 1776576 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-03
Onset:2021-10-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016E21A / 1 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Muscle tightness, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: -Horny goat weed pill -mild iron pill -zince citrate pill -kelp pill -vatamine D3 pill
Current Illness: None
Preexisting Conditions: Allergies. Congestion, clogged nose
Allergies: No allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My right arm is now really tight all of a sudden. After the tightness went away after a few days of first fires. Pain down my left leg. Muscles feel very sore and tired. Random spikes of head pain. Dizzy in morning.


VAERS ID: 1780518 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-26
Onset:2021-10-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK0112 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood creatinine normal, Blood test, Chest pain, Glomerular filtration rate normal, Troponin I increased
SMQs:, Myocardial infarction (narrow), 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: HS Troponin I: 0.27; Creatinine: 99.78; eGFR: 79.38 Tested On 11 Oct., 2021
CDC Split Type:

Write-up: Chestpain on the left, from date 11 Oct., 2021 so far. Went to hospital for testing blood and resulted HS Troponin I: 0.27; Creatinine: 99.78; eGFR: 79.38


VAERS ID: 1775385 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-15
Onset:2021-10-10
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Pain, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa 40mg daily, Birth control, Flagyl 2 BID
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data: Covid negative
CDC Split Type:

Write-up: achiness headache and nausea


VAERS ID: 1775407 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Parosmia, Sinus pain
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Having strange phantom smells and sinus pain
Current Illness: Covid positive on August 10th 2021
Preexisting Conditions: Hypothyroidism
Allergies: Allergy to latex, and walnuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Strong phantom smell and sinus pain 2 days after second dose of Pfizer. Started 10/10/21. Shot received 10/07/21


VAERS ID: 1775422 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Extra dose administered, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 5mg once a day Calcium with vit D once a day Tylenol 1000mg three times a day for dental pain Ibuprofen 800mg three times a day for dental pain Miralax once a day Hydrocortisone and pramoxine rectal ointment once a day Nifedipi
Current Illness: Dental pain
Preexisting Conditions: Hemorrhoids
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received the shot on a Thursday. Sunday morning when I woke up I noticed my left armpit was sore. This is the same side where I received the shot. I also noticed that there was some swelling in the area of the left armpit as well.


VAERS ID: 1775448 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-10-10
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / SYR

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

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

Write-up: COVID infection


VAERS ID: 1775452 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-10-10
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / SYR

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

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

Write-up: covid infx


VAERS ID: 1775455 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-10-10
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 1775458 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-10-10
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK - / -

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

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

Write-up: covid infx


VAERS ID: 1775471 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dehydration, Dizziness, Extra dose administered, Fatigue, Hyperhidrosis, Inappropriate schedule of product administration, Insomnia, Nausea, Pain, Pyrexia, Tachycardia
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion xl Buspirone Cetirizine Multivitamin Evening Primrose oil CoQ 10 Vitamin D
Current Illness: None Did get Quadrivalent influenza vaccine on 10/5/21 (no adverse effects)
Preexisting Conditions: Exercise/cold air induced wheezing
Allergies: No
Diagnostic Lab Data: None. Did not seek medical attention.
CDC Split Type:

Write-up: About 15 hours after getting booster shot began having high fever 102, chills, sweats, mild nausea, tachycardia and body aches. Also unable to sleep even before severe symptoms started, despite feeling tired. Quite significant as I had not had anything to this level with 1st or 2nd COVID vaccines. I am a health care worker in a hospital. My second COVID vaccine was 1/11/2021. Only injection site pain, fatigue and sleep problem with second dose. It is now 24 hours later. I took acetaminophen to try to break the fever. Feeling a bit better?no more fever but do have body aches, mild dehydration (tachycardia), dizziness and fatigue.


VAERS ID: 1775472 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Insomnia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Tingling/ prickly throughout body at night. Cold. Could not sleep.


VAERS ID: 1775478 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Chills, Decreased appetite, Diarrhoea, Flushing, Pyrexia, Swelling of eyelid, Tremor, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dupixent, restaysis, sublingual allergy drops, budesonide,
Current Illness: No illnesses
Preexisting Conditions: Chronic allergic rhinitis with nasal polyps Fungal sinusitis Allergy testing results from showed allergy to all trees, grasses, mold, pollens with exception of cedar and cockroach.
Allergies: NSAID''s (anaphylaxis) Ciprofloxacin Doxycycline Minocycline Latex sensitive
Diagnostic Lab Data:
CDC Split Type:

Write-up: 930am on 10/9 fever began. Spent all day with fever, no appetite, joint pain. Fever varied from 100.9 - 102.6 1130pm on 10/9: got into bed. Temp 99.1, All following events occurred on 10/10 2:45am: woken with severe abdominal cramping, flushing of skin, diarrhea. While in the bathroom dealing with diarrhea my eyelid began to swell and breathing turned wheezing. Took a tablet of benadryl and decided to monitor to see if it would progress or if I needed to administer epipen/inhaler and go to ER. 4:00am: I noticed breathing had improved, no longer wheezing, eyelid wasn''t swelling further. 4:30am: uncontrollable shaking/chills (temp 98.4) No amount of clothing or blankets helped but a hot bath for 30 min helped. 515am: no longer shaking, and comfortable enough to sleep. 830am: woke up for the day. Eyelid still swollen, still having diarrhea but infrequently need to run to toilet. Normal temp. Normal breathing. Okay as of now. We will see if anything happens today but suspect it wont. This is typically how allergic reactions start with me. Always early morning, diarrhea, one eyelid will swell. This is #3 in my life. The prior 2 resulted in ER visit.


VAERS ID: 1775484 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-28
Onset:2021-10-10
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity, hypertension
Allergies: COCONUTS, APRICOTS
Diagnostic Lab Data: NO ADVERSE EVENTS HOWEVER DIAGNOSED WITH COVID-19 PNEUMONIA 10/10/2021
CDC Split Type:

Write-up: NO ADVERSE EVENTS HOWEVER DIAGNOSED WITH COVID-19 PNEUMONIA 10/10/2021


VAERS ID: 1775514 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse, lamictal, Prozac
Current Illness: None
Preexisting Conditions: Iron deficiency anemia, anxiety, depression, add
Allergies: Penicillin
Diagnostic Lab Data: No testing, waiting to see if it goes down, if not will call primary care doctor for evaluation
CDC Split Type:

Write-up: Left Swollen arm pit, possibly lymph node


VAERS ID: 1775544 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Injection site reaction, Nausea, Sensory disturbance
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Famtodine 40mg Ensyke
Current Illness:
Preexisting Conditions:
Allergies: Sulfanomide
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient stated they felt the vaccine go into the arm. Later that day/night the patient said she experienced extreme nausea and abdominal discomfort and needed promethazine and ondansetron.


VAERS ID: 1775548 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-19
Onset:2021-10-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Patient told us that she didn''t received any COVID shot and we provide 1st dose of Pfizer shot on 09/19/2021. She came for 2nd dose on 10/10/2021. We discovered that she received J&J on 03/24/2021 due to insurance reject.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Received Pfizer dose on 09/19/21 and she came back for 2nd Pfizer dose on 10/10/21. Due to insurance reject discover that she received J&J on 03/24/21.
CDC Split Type:

Write-up: N/A


VAERS ID: 1775559 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

Write-up: Patient deleveloped rash on neck a day after getting booster dose. Pt did not have any reaction to previous dose


VAERS ID: 1775582 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe


VAERS ID: 1775619 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

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

Write-up: Tachycardia, HR up to 140 BPM upon standing, heart rate returns to normal upon sitting and laying down. Heart sounds loudest over the pulmonic area. Onset at 1:30 PM, approximately 20 hours after vaccine administration.


VAERS ID: 1775627 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and painful lymph node under right arm


VAERS ID: 1775649 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

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

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

Write-up: Rash on face: nose, both cheeks, forehead The left side of the neck is tender and has swollen glands Back on neck sore


VAERS ID: 1775679 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-02
Onset:2021-10-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 20mg 1x day; Claritin d 1 x day; Excedrin migraine; Imitrex
Current Illness:
Preexisting Conditions: Migraine and tension headaches
Allergies: Keflex, Ampicillin, Sulfa drugs
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Temple on left side of face has gone numb as well as partial numbness in left foot. Both issues started this morning


VAERS ID: 1775685 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

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

Write-up: Customer was fine while getting the vaccine but walked out into the store and 15 minutes later felt dizzy and had to lay down on the floor. Even though the paramedics were called he was ok after about 10 minutes and walked out of the store without needing any assistance.


VAERS ID: 1775691 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3596 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Soreness in arm near injection site. Chills and muscular aches all over. Joint soreness in knees, back, wrists


VAERS ID: 1775698 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face oedema, Headache, Pain in extremity, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Zyrtec 10 mg 1x day Singulair 10 mg 1x day Flonase PRN Astelyn PRN Dulera daily for asthma albuterol PRN for asthma Had filler and botox May 2021.
Current Illness: none
Preexisting Conditions: asthma, allergic rinihtis
Allergies: pollen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Had the vaccine Friday morning. No problems except for headache & sore arm Fri & all day Sat. Woke up Sunday morning with tenderness & edema left side of my face near my left eye. It is now 4pm and the edema is still localized to the same area.


VAERS ID: 1775707 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 - / -

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

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

Write-up: Hives upper body arms chest neck back and face


VAERS ID: 1775711 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Kidney disease, CAD, diabetes, hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had a seizure


VAERS ID: 1775712 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Per mother, long time history of petite mal seizures happening many times per year since first grade.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 - 2 minutes after vaccine administration, patient appeared very faint and lethargic. Per mother, patient has a frequent history of petite mal seizures that appear in the same way. Mother moved patient to floor, elevated her legs, and we apply a cool rag to her forehead. Patient never became unresponsive or appear to have respiratory distress. After remaining on the floor for 5-10 minutes, she was able to get herself up and sit upright in a chair. She remained in the chair for approximately 10 minutes. After the initial onset of symptoms, she never worsened and only returned to normal. Before leaving, she denied any difficulty breathing, chest tightness, or itchy throat. Before leaving, she appeared in as good of health of when she initially arrived for the vaccine.


VAERS ID: 1775714 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Mouth swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bendadryl (10/10), Atenolol, Prempro, Lisinorpil, Atorvastatin
Current Illness: N/A
Preexisting Conditions: Asthma, Hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient complains of left inner mouth swelling approximately two days after receiving her booster COVID vaccine.


VAERS ID: 1775727 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram cerebral, Angiogram pulmonary, Arteriogram carotid, Carotid arterial embolus, Cerebrovascular accident, Computerised tomogram abdomen, Computerised tomogram thorax, Deep vein thrombosis, Echocardiogram, Magnetic resonance imaging head, Perfusion brain scan, Pulmonary embolism, Pulse absent, Scan with contrast, Subclavian artery embolism, Thrombectomy, Ultrasound Doppler
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 10mg qday, HCTZ 25mg qday, naproxen 500mg PRN
Current Illness: L fibular fracture about 3 weeks prior to presentation to ED
Preexisting Conditions: HTN
Allergies: shellfish
Diagnostic Lab Data: CTA head/neck. CT perfusion. CTA chest. BLE dopplers. MRI brain. Echo. CT C/A/P w/ contrast.
CDC Split Type:

Write-up: Development of DVT w/ massive saddle pulmonary emboli requiring mechanical thrombectomy. R carotid artery emboli as well as R subclavian emboli w/ pulseless arm also requiring mechanical thrombectomies. Multiple showering CVAs/strokes.


VAERS ID: 1775729 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / IM

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

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

Write-up: gave 2nd shot at day 23 not day 24. miscalculated days.


VAERS ID: 1775746 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Extra dose administered
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), 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? Yes
Hospitalized? No
Previous Vaccinations: covid-19 moderna first dose pt experienced lip swelling in January or febuary 2021
Other Medications: albuterol, hydroxyzine known for sure. others unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient came in for her 3rd dose of covid-19 moderna vaccine. pt stated that after the first dose she had a rxn where her lips swelled up. After speaking with her allerigist/immunologist, she was given a drug regimen protocol to follow when receiving vaccines. She had the second covid-19 vaccine and did not experience an allergic reaction. today, on her 3rd vaccine, she reported having difficulty breathing. She gave herself an EpiPen injection (from her own supply). after 15 minutes she did not feel relieved, and said she couldn''t swallow. she gave herself a second EpiPen injection (from her own supply) and asked me to call 911. The paramedics came and took the patient away. She was alert and oriented x 4 when leaving the pharmacy. It seemed to be more of a panic attack than an anaphylactic reaction


VAERS ID: 1775748 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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 per client and client`s caregiver report.
Current Illness: None per client and client`s caregiver report.
Preexisting Conditions: None per client and client`s caregiver report.
Allergies: None per client and client`s caregiver report.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12:10 Client c/o dizziness, skin is pale, staff helped her on the floor, elevated her legs on the chair, EMS called, skin warm/dry to touch. 12:11 EMS arrived. 12:12 V/S are taken, lying BP-179/96 mmHg, RR-20, SPO2-98, client denies nausea at this time. 12:15 Skin color back to normal, RR-19, HR- 102, SPO2-99. Staff provided emotional support. 12:17 Staff helped client on High Fowler`s position, BP 171/87mmHg, client drinks water, she reported that she hasn`t eaten anything since morning. Staff offered food/Gatorade client refused. She stated feeling better. 12:20 Client asked to sit on the chair.told it`s safe to help her on the chair. Staff helped her on the chair. 12:22 Client is on the chair drinking water. Per client and client`s caregiver (CG) report she doesn`t have allergies, medical conditions, and surgeries. She doesn`t take any medication. 12:27 sitting BP-174/85mmHg, HR-115, RR-17. 12:34 Sitting BP-164/87mmHg. 12:39 Client states she feels better. 12:49 Sitting BP-155/77, SPO2-97, RR-18. Dr. old it`s safe for the client to leave whenever she`s ready. 12:50 Client left with her CG.


VAERS ID: 1775757 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: FOOD, PENICILLIN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT EXPERIENCED DIFFICULTY BREATHING/THROAT CLOSING UP ABOUT 5 MINUTES AFTER THE VACCINE. GAVE PATIENT ONE DOSE OF 0.3MG EPINEPHRINE AND CALLED EMERGENCY


VAERS ID: 1775775 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

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

Write-up: Patient arrived to pharmacy wanting the booster vaccination. We administered the Pfizer vaccine. When patient came back with his COVID vaccine card to update his initial vaccine series was MODERNA. We failed to verify what his initial vaccine series was before giving the booster,


VAERS ID: 1775779 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vital signs: BP: 140/70 Pulse: 100 RR: 18 SP02: 99%. BP: 125/70 Pulse: 85 RR: 16 SPO2: 99%
CDC Split Type:

Write-up: The patient felt lightheaded after his first dose of Pfizer. The patient had run 14 miles and had not had much to eat or drink today. He died any pain. AAOX3 and in no apparent distress. Good ROM and neuros intact. He denied that he was going to pass out. Patient was provided water 3 bottles of water and a granola bar. He was observed for 45 mins until he finished the water and granola bar. Patient stated he felt much better and left POV.


VAERS ID: 1775783 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Pallor, Posture abnormal, Skin warm
SMQs:, Dystonia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Attendee received first dose Moderna vaccine at 11:23 in the right arm. Lot# 026C21A. 11:24 - Attendee slumped over in his chair where he was sitting to get the vaccination, the RN vaccinator assisted and he did not fall. Attendee did not have a total loss of consciousness. Attendee''s skin was warm with cold sweat. Pale. Attendee''s respirations were not tachypneic or dyspneic. Alert and oriented. 11:25 - Attendee assisted to the cot and lied down on his side. 911 was called. 11:28 ? Attendee was speaking so much that staff was unable to get accurate respiratory rate. HR: 83 BP: 126/60 RR: Unable to obtain O2Sat%: 98


VAERS ID: 1775786 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had a seizure 10 seconds after giving dose. Paramedics came and patient made full recovery.


VAERS ID: 1775792 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ondansetron, cetirizine, lamictal, celexa, miralax, fludrocortisone, metoprolol, albuterol, flovent, prevacid
Current Illness:
Preexisting Conditions: POTS, GERD, asthma, allergies, depression
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right after she received her second dose, she started to feel really dizzy and said her head was pounding. It continued to get worse after 25 minutes. Her mother said this has happened before with other vaccines that it aggravates her POTS. Her mom said when this happens, she takes her to Children Hospital. She took her to the hospital after she left the pharmacy for treatment.


VAERS ID: 1775793 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 031308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Cold sweat, Feeling hot, Malaise
SMQs:, 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: NOT KNOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NONE
Diagnostic Lab Data: NOT KNOWN
CDC Split Type:

Write-up: CUSTOMER FELT VERY HOT AFTER ADMINISTRATION OF VACCINE. IMMIDIATLY MADE HIME LIE DOWN. BLOOD PRESSURE WAS MEASURED WHICH WAS 136/93. HE CONTINUED TO FILL HOT AND UNEASY. LATER STARTED FEELING CLAMY. 911 WAS CALLED . PARAMEDICS. ASSESED HIM AND LITTLE LATER WAS RELEASED. PER CUSTOMER PARAMDICS ASSESED HIM OF ANXIETY EVENT


VAERS ID: 1775802 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 10 mg
Current Illness: N/a
Preexisting Conditions: Sarcoidosis
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aches, chills, fever 101 and fatigue . So far, has lasted 16 hours.


VAERS ID: 1775826 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Migraine, Pain, Pain in extremity, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pain in arm since 30 minutes after shot At 11:30 AM- (15 hours post shot), feverish, on/off aches At 9:30 PM- 25 hours later- chills shakes, migraine


VAERS ID: 1775834 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Pt was fainted for 30 sec after receiving Pfizer vaccine . He regained his consciousness very quickly and said " I am ok". He was sweat a little bit. Cold compressed applied to his face, neck and wrists. His vital signs are stable: Temp 97.8 F 98.6F ; BP 148/98 HR 98: BP 138/90 HR 90; BP 126/75 HR 78. After 15 min, the patient felt good and sat on chair for 20 min then go home with his mother.


VAERS ID: 1775838 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

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

Write-up: Patient fainted after receiving COVID vaccine. Patients states feeling dizzy


VAERS ID: 1775842 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

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

Write-up: Patient fainted 10 to 15 minutes after receiving COVID vaccination.


VAERS ID: 1775849 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-03
Onset:2021-10-10
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8736 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Feeling abnormal, Headache, Mental impairment, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Head ache, nausea, weakness, hard to think, long lasting headache. I don''t feel right, and this is the second time this has happened to me in 2 months.


VAERS ID: 1775852 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue, Headache
SMQs:, Anaphylactic reaction (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: Levothyroxine 88mcg
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, cough


VAERS ID: 1775860 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperventilation, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (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), Eosinophilic pneumonia (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizure to flu shot five years ago.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hyperventilating after shot. Passed out for about a minute and came to. EMS was called BP 120/72 and hr 110. Patient refused going to hospital.


VAERS ID: 1775862 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

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

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

Write-up: Headache, body ache, sensitive muscles, low-grade fever (99.2), fatigue, chills.


VAERS ID: 1775863 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / -

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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan 50mg HYDROCHLOROTHIAZIDE 25MG LOESTRIN FE 1.5/30 1.5-30
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Possibly causing stroke 5 months after receiving Moderna Covid-19 vaccine


VAERS ID: 1775868 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-10
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Myalgia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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: Not available
Current Illness: Not available
Preexisting Conditions: Not available
Allergies: Not available
Diagnostic Lab Data:
CDC Split Type:

Write-up: Welts around injection site, headache, muscle pain, stomach ache.


VAERS ID: 1775870 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Menstruation delayed two weeks after first dose. Arm rash itchy and painful to the touch, five inches across and joint pain, headache after second vaccine dose.


VAERS ID: 1776053 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-06
Onset:2021-10-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dysmenorrhoea, Uterine haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Orlissa, Synthroid, Motrin, Celebrex, Promethazine, Allegra
Current Illness: None
Preexisting Conditions: Hashimoto''s Thyroiditis, Ehler''s Danlos Type 3, Adenomyosis
Allergies: Latex, morphine, delaudid, penicillin, sulpha, apples, nightshades
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe menstrual pain and bleeding from atrophied uterus


VAERS ID: 1776058 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Systemic: Tingling (specify: facial area, extremities)-Mild, Additional Details: Had metallic taste in mouth and lips/tongue and arm had a tingling sensation and mild numbness. Patient was given 2 Benadryl and waiting abut 30 minutes with no worsening of symptoms


VAERS ID: 1776061 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

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

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

Write-up: Chills, slight fever, achy all over, fatigue


VAERS ID: 1776062 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Additional Details: patient reported during the 15 minute waiting period extreme lightheadessness and felt the need to faint. paramedics called, bp was 133/77. patient was responsive and left after examined by paramedics. patient recovered with no residual issues,


VAERS ID: 1776063 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Swelling of lymph nodes left armpit (injection arm) I had not experienced that in previous first and second shot


VAERS ID: 1776070 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia, Dizziness, Fear of injection, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Shakiness-Mild, Systemic: Weakness-Mild, Additional Details: Patient had severe fear of needles. He was shaking before during and after vaccine. While in the waiting area, with the older brother and mom, he told her he felt like was going to faint. I told mom he was shaking from anxiety but she wanted 911 called for both her son. Paramedics came and determined he was okay and his fear contributed to the shaking and weakness. He said he felt fine before leaving store. He returned home with mom and brothers.


VAERS ID: 1776071 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chest pain, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Weakness-Mild, Additional Details: Ten minutes after 2nd dose given patient was sweating and had chest pain in waiting area. Mom wanted us to call 911. 911 operator instructed us to give him 4 baby aspirin tablets. Paramedics came and determined he was okay and not having vaccine reaction. He went home with mother and brothers.


VAERS ID: 1776078 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: parkinsons
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient came in looking to get flu vaccine for 65+. Processed for the flu shot but when technician went to the vaccine room to administer, she accidently administered a covid booster vaccine. Patient had the booster last month (09/26/21), making this the 4th covid vaccine.


VAERS ID: 1776083 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK LA / SYR

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

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

Write-up: red swollen hives on neck started on Sunday evening, October 10 and have continued into Monday morning October 11


VAERS ID: 1776088 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, multivitamin, birth control, Xyzal, Nasocort
Current Illness: None
Preexisting Conditions: pre-diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant swelling in the armpit and along the side of the breast


VAERS ID: 1776089 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-10-10
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 RA / IM

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

Write-up: hospitalization (non-ICU) patient did not receive second dose


VAERS ID: 1776284 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, soreness near injection site, headache


VAERS ID: 1776287 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-07
Onset:2021-10-10
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1776288 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-10-10
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / IM

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

Write-up: hospitalization (non-ICU_


VAERS ID: 1776293 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Muscle strain, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Accidents and injuries (narrow), 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: Women?s One a Day Multivitamin Elderberry chews Magnesium Oxide
Current Illness: Some congestion
Preexisting Conditions: PVC?s
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I had my third covid vaccine given in my left arm on 10/9 and started with what felt like a muscle pull on 10/10 under my left axilla. I noticed in the afternoon when changing that there is swelling under my left axilla. I cannot palpate any lumps or bumps , but it is slightly uncomfortable in that area when palpated and is swollen . No color changes noted and it is not hot to the touch . My injection site has no pain. Today is 10/11 and the swelling and tenderness are still present no changes from yesterday.


VAERS ID: 1776297 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Injection site erythema, Injection site pruritus, Injection site swelling, Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC Flonase, Generic allergy pill
Current Illness: None
Preexisting Conditions: None
Allergies: Shell fish
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1. Redness, itching, swelling at the injection site. 2. Armpit swelling and pain/tenderness


VAERS ID: 1776313 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary mass, 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: Vyvanse and Serteline
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up second day after vaccine and notice lump under right arm in armpit area. Went to a quick care locally and was told most likely a Lymph Node


VAERS ID: 1776364 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-10-10
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1776376 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-10-10
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test on 10/10/21
CDC Split Type:

Write-up: vaccine breakthrough event


VAERS ID: 1776377 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Axillary pain, Chest discomfort, Chills, Cough, Fatigue, Feeling cold, Headache, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fiber pills, vitamin c, calcium supplements, vitamin d supplement
Current Illness: None
Preexisting Conditions: Sleep apnea
Allergies: Morphine, bee venom
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I have had a fever since the 10th. My left arm, left arm pit, and left side of my chest is sore. I have a dry cough. My head hurts occasionally. I feel fatigued and get cold chills occasionally. I''ve had stomach issues on and off.


VAERS ID: 1776392 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-10-10
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia
SMQs:, Anaphylactic reaction (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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalization - acute respiratory failure with hypoxia; pneumonia due to COVID-19 virus


VAERS ID: 1776409 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-13
Onset:2021-10-10
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19
SMQs:, Anaphylactic reaction (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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalization - acute respiratory failure with hypoxia; COVID-19 virus infection


VAERS ID: 1776415 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Cymbalta
Current Illness:
Preexisting Conditions: Hashimoto''s thyroiditis
Allergies: Peanut, chocolate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, nausea, dizziness and chills. Rash on chest and neck.


VAERS ID: 1776466 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid vaccination, dose number 2, received on 1/29/2021, lot# EL9262, same reaction of swelled left axillary lymph nodes,
Other Medications: Citalopram, omeprazole, fluticasone nasal spray
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tender swelling of left axillary lymph nodes. No treatment sought.


VAERS ID: 1776469 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Fatigue, 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: Albuterol Inhaler as needed Woman''s one a day vitamin 50 +
Current Illness: none
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data: 10/11/2021: Physical exam: unremarkable Orthostatic BP: Orthostatic Blood Pressures: lying: BP- 147/74 HR- 60 symptoms-asymptomatic sitting: BP- 156/88 HR- 64 symptoms-dizziness standing: BP- 162/88 HR- 69 symptoms-dizziness standing after 2 minutes: BP- 158/85 HR- 68 symptoms- asymptomatic.
CDC Split Type:

Write-up: 10/8/21 received COVID booster, reports she was very tired the day of and the day after. Reports she woke up on 10/10/21 with nausea and some dizziness. Reports dizziness comes and goes especially with walking, but resolves after a few minutes. Reports nausea comes and goes. Denies being sick.


VAERS ID: 1776491 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-18
Onset:2021-10-10
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

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

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


VAERS ID: 1776501 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-10-10
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gait disturbance, Heavy menstrual bleeding, Muscle spasms, Muscle twitching, Muscular weakness, Pain, Polymenorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Humera injection Nortrel
Current Illness:
Preexisting Conditions: Ulcerative Colitis
Allergies: NKA
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: Heavy bleeding with clots TWO MONTHS EARLY ( normally only 4 prds a yr) Weakness in legs Twitching in legs Muscle spasms in legs Severe Pain from waist dow Difficulty walking


VAERS ID: 1776514 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac discomfort, Eye irritation, Fatigue, Nasal dryness, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal 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:
Current Illness: Hypertension Major depressive disorder Bipolar disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Irritated eyes Itchy throat Dry nose Fatigue Heart felt like it was going to burst at times.


VAERS ID: 1776519 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: 10/11/21 - #3 COVID vaccine on 10/9. started experiencing chest pain and body aches. Chest pain is gradually subsiding. Denies SOB or other cardiac symptoms


VAERS ID: 1776527 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Protonix, Ultram, Naproxen, Multivtamin, Hydrochlorothiazide, Calcium with Vit D, Mobic, Aspirin, Senokot, Crestor, Uroxatral, Cozaar
Current Illness: N/A
Preexisting Conditions: AAA, Hematochezia, Elevated Serum Creatinine, Elevated BUN, Decreased Hgb,
Allergies: Lisinopril
Diagnostic Lab Data: RT-PCR Covid-19 Test
CDC Split Type:

Write-up: Tested Positive for COVID-19 While fully vaccinated.


VAERS ID: 1776562 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Dizziness, Fatigue, Inappropriate schedule of product administration, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vaccines given going to Africa I had too many at once and had felt very weak and like I had the flu
Other Medications: No Prescriptions. Vit D. Vit B12. Vit C. DHA/EPA
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: This second dose of the vaccine has left me with fatigue, on and off low grade fever, joint and muscle soreness and very very dizzy. From My first dose of the vaccine, on April 15, 2021, I was slightly dizzy, had joint soreness, slight bleed dots under the abdomen skin and muscle pain. That was within 2 days. That was why I waited so long before getting the second dose.


VAERS ID: 1776602 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Posture abnormal, Stress, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies: Not indicated in pre-health screening
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following the Pfizer vaccination, patient experienced a vasovagal reaction with syncope lasting approximately 4 seconds. Patient appeared to be anxious prior to receiving the vaccine and exhibited stress related symptoms prior to becoming flush and "slumping." Medical personnel on staff attended to her monitoring blood pressure and pulse. Patient was laid down with legs elevated to help return blood flow. Patient was then monitored for 30 minutes and given some food and water. Upon leaving the facility, patient appeared to have regained normal function.


VAERS ID: 1776625 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-03
Onset:2021-10-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Ophthalmic herpes simplex
SMQs:, Ocular infections (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ocular herpes flare up right eye


VAERS ID: 1776638 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Lymphadenopathy, Myalgia, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (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)

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: pain in joints, muscles, fatigue, swollen lymph nodes under arm towards the side, large in size


VAERS ID: 1776661 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fall, Flushing, Head injury, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness/Lightheadedness-Severe, Systemic: Fainting/Unresponsive-Severe, Systemic: Flushed/Sweating-Medium, Additional Details: The patient received shot and was waiting in resting area. His wife received her shot. When we opened the door to exit vaccine room, he had fallen and was trying to get up. He had carpet burns on his nose and bruise above right eye. The NP form minute clinic came over took his vitals, heart rate which were normal. She advised he let us call an ambulance to have him checked out for concussion since no one say him fall but patient refused. After 30 minutes patient was able to leave on his own.


VAERS ID: 1776691 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-08
Onset:2021-10-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole Sodium Augmentin 875 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Injection site reaction - redness greater than the size of a quarter, itching, sensation of being pricked around the site, injection site pain


VAERS ID: 1776697 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Decreased appetite, Fatigue, Hypersomnia, Injection site pain, Lymphadenopathy, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 10/092021 Fatigue and moderate pain at injection site 10/10/2021 Awakened at 4am with a pinching pain in armpit, same arm as injection site (left) Applied warm heating pad to armpit. Pain subsided, but needed to reapply several times throughout the day. Severely fatigued, slept several hours throughout the day, loss of appetite, and lo-grade fever (100 degreesF) 10/11/2021 Temperature normal (97 degrees F) Pinching pain in left armpit. Swelling in armpit is visible to the eye.


VAERS ID: 1776701 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Mental status changes, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet Take 1 tablet by mouth Daily for 180 days. atorvastatin (LIPITOR) 20 MG tablet Take 1 tablet by mouth Daily. benztropine (COGENTIN) 0.5 MG tablet Take 0.5 mg by mouth Daily. carvedilol (COREG) 6.25 MG tab
Current Illness:
Preexisting Conditions: Past Medical History: Diagnosis Date ? Acute CVA (cerebrovascular accident) (HCC) ? Anxiety ? Arthritis osteoarthritis ? Basal cell carcinoma ? Bipolar disorder (HCC) ? Breast cancer (HCC) 04/28/2017 LEFT BREAST, 1:30, INVASIVE MAMMARY CARCINOMA ? Breast cancer (HCC) 2000 Right ? Chronic cough ? CKD (chronic kidney disease), stage II ? Colon polyps 2007,2014 2007 RANDOM COLON BIOPSY-BENIGN, 2014 ILEOCECAL-HYPERPLASTIC, ASCENDING-HYPERPLASTIC, DISTAL ASCENDING-TUBULAR ADENOMA, SIGMOID-HYPERPLASTIC ? Depression ? Fibroids ? GERD (gastroesophageal reflux disease) ? H/O Diverticulitis ? HISTORY OF BREAST CANCER 2000 S/P RT LUMPECTOMY, SENTINEL NODE, 2.7 CM AT THE SUBCAPSULAR SPACE, LESS THAN 1 MM FOCUS IN THE FINAL LYMPHY NODE ON FINAL PATHOLOGY, S/P CHEMOTHERAPY & RADIATION INTOLERATN OF TAMOXIFEN OR ARIMIDEX ? History of miscarriage x1 ? History of mononucleosis ? Hypothyroidism ? Invasive carcinoma of breast (HCC) LEFT ? Melanoma (HCC) 2014 Left forearm ? Osteopenia ? PAF (paroxysmal atrial fibrillation) (HCC) 9/5/2017 ? Restless leg ? Skin cancer ? Sleep apnea ? Vitamin D deficiency
Allergies: Allergies Allergen Reactions ? Imipramine Hives ? Emetrol Unknown (See Comments) ? Fenofibrate Other (See Comments) Myalgias ? Flagyl [Metronidazole] Nausea And Vomiting and GI Intolerance ? Other Nausea And Vomiting and GI Intolerance steroids ? Phenergan [Promethazine Hcl] Nausea And Vomiting and GI Intolerance ? Prednisone Unknown (See Comments) ? Pristiq [Desvenlafaxine Succinate Er] ? Prochlorperazine Nausea Only Other reaction(s): Nausea Only ? Prochlorperazine Edisylate Nausea Only ? Rosuvastatin Calcium Itching ? Serzone [Nefazodone] ? Tofranil [Imipramine Hcl] ? Tramadol ? Wellbutrin [Bupropion] ? Metoclopramide Anxiety
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presents to the ED c/o altered mental status noticed this morning by her husband. Last known normal was reportedly 2300 last night. She received her Covid booster shot yesterday. She does complain of fever today but presents to ER with 103.2. She denies headache. She denies chest pain, shortness of breath, nausea, vomiting, abdominal pain. She reports that she is having difficulty getting words out.


VAERS ID: 1776710 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-10-10
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1776714 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-10-10
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Back pain, COVID-19, Chills, Cough, Decreased appetite, Diarrhoea, Hyperhidrosis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient Covid + on 10/10/2021. Patient received Pfizer with with 1st dose on 02/08/2021 and 2nd dose 03/01/2021. Per ED Note: History of Present Illness Patient is a 76-year-old male who denies any significant past medical history that presents to the emergency department with a chief complaint of generalized weakness and diarrhea. Patient states that he got his Covid and influenza vaccine simultaneously approximately 1 week ago. This was the patient''s third Covid vaccine. The patient states that a couple days afterwards he subsequently began experiencing generalized weakness, decreased appetite, fevers, chills, sweats. Patient states he is also developed a cough and diarrhea. Patient denies any nausea vomiting or abdominal pain. Patient does endorse that he has had back pain. Patient states he tried to alleviate the back pain with Robaxin. Patient states he is generally well and does not take any significant medications except for a statin, baby aspirin, and a vitamin.


VAERS ID: 1776722 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: Experiencing pain and swelling in my left chest area near my heart


VAERS ID: 1776754 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-11
Onset:2021-10-10
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

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

Write-up: Patient admitted after contracting COVID after vaccination due to COVID Pneumonia


VAERS ID: 1776763 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-10-10
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1776827 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-10-10
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0112M0A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose abnormal, COVID-19, Decreased appetite, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol (Zyloprim) 300 Mg Oral Tablet Amlodipine (Norvasc) 10 Mg Oral Tablet Apixaban (Eliquis) 2.5 Mg Oral Tablet Aspirin 81 Mg Oral Enteric Coated Tablet Bumetanide (Bumex) 1 Mg Oral Tablet Chole
Current Illness:
Preexisting Conditions: Essential hypertension, benign Hypercholesterolemia Diabetes mellitus Acute pulmonary embolism Chronic pulmonary embolism without acute cor pulmonale Right upper quadrant abdominal pain Acute GI bleeding Acute kidney injury superimposed on chronic kidney disease Acute blood loss anemia Gastrointestinal hemorrhage with melena Hypotension due to hypovolemia Polymyalgia rheumatica Benign prostatic hyperplasia CKD stage 4 Gout Dyslipidemia Upper GI bleed
Allergies: Colchicine Simvastatin
Diagnostic Lab Data: Positive COVID test 10/10/21
CDC Split Type:

Write-up: Pt became unresponsive. Upon arrival EMS blood sugar was 29. loss of appetite.


VAERS ID: 1776936 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-10
Onset:2021-10-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: synthroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: arm pain/very sore, diarrhea, headache, aching legs


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