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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 110 out of 10,493

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VAERS ID: 2000049 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 10-2019
Other Medications: Zoloft, klonopin, vitamin D, vitamin b12, zinc
Current Illness: None
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 13 hours after vaccine had uncontrollable shaking of all limbs, hands and feet for about 4 hours. For 42 hours I could not be upright due to feeling like I would pass out. Was flat out in bed for 42 hours starting 13 hours after vaccination. Other symptoms:fever, body aches, headache, exhausted.


VAERS ID: 2000058 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Heart rate decreased, Injection site pain, Lymph node pain, Lymphadenopathy, Lymphoma
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Malignant lymphomas (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (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: Mild injection site pain after Pfizer dose 1
Other Medications:
Current Illness: Ulcerative colitis
Preexisting Conditions: Ulcerative colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild injection site pain within a couple hours, moderate injection site pain and swollen lymph node next day - swollen lymph node was moderately to very painful, radiating from left armpit (injection was in left arm). Fatigue and lower than normal heart rate variability since vaccine. Lymphoma has 80% resolved.


VAERS ID: 2000201 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Cough; He had no energy; Low grade fever; was feeling fatigue; This spontaneous case was reported by a consumer and describes the occurrence of COUGH (Cough), ASTHENIA (He had no energy), PYREXIA (Low grade fever) and FATIGUE (was feeling fatigue) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, the patient experienced COUGH (Cough), ASTHENIA (He had no energy), PYREXIA (Low grade fever) and FATIGUE (was feeling fatigue). At the time of the report, COUGH (Cough), ASTHENIA (He had no energy), PYREXIA (Low grade fever) and FATIGUE (was feeling fatigue) outcome was unknown. No Concomitant product use was reported. The patient post receiving their Moderna booster was having low grade fever and cough the next day. The patient had no energy and was feeling fatigue. The patient had not been seen by a doctor although they were planning to. No treatment information was provided.


VAERS ID: 2000230 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-11
Onset:2021-12-30
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Hypoaesthesia, Inappropriate schedule of product administration
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), 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: USMODERNATX, INC.MOD20214

Write-up: It is driving her insane; Eye numb, Whole left side numb/ more stuff''s numb, Whole left side of face is numb, Whole left side of legs is numb/her leg, toes numb, Whole left side arm, chest numb, Whole left side neck numb; Almost fell; First Dose 11Oct2021, Second dose 30Dec2021; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (It is driving her insane), HYPOAESTHESIA (Eye numb, Whole left side numb/ more stuff''s numb, Whole left side of face is numb, Whole left side of legs is numb/her leg, toes numb, Whole left side arm, chest numb, Whole left side neck numb), DIZZINESS (Almost fell) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 11Oct2021, Second dose 30Dec2021) in a 45-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 059H21A and 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced FEELING ABNORMAL (It is driving her insane), HYPOAESTHESIA (Eye numb, Whole left side numb/ more stuff''s numb, Whole left side of face is numb, Whole left side of legs is numb/her leg, toes numb, Whole left side arm, chest numb, Whole left side neck numb), DIZZINESS (Almost fell) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 11Oct2021, Second dose 30Dec2021). On 30-Dec-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First Dose 11Oct2021, Second dose 30Dec2021) had resolved. At the time of the report, FEELING ABNORMAL (It is driving her insane), HYPOAESTHESIA (Eye numb, Whole left side numb/ more stuff''s numb, Whole left side of face is numb, Whole left side of legs is numb/her leg, toes numb, Whole left side arm, chest numb, Whole left side neck numb) and DIZZINESS (Almost fell) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported. Patient stated she just tried to kept moving everything, but it was not helped her.


VAERS ID: 2000279 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone 100mg nightly as needed for sleep
Current Illness: Upper Respiratory Infection symptoms at time of Vaccination
Preexisting Conditions: none
Allergies: Penicillins Hydrocodone/APAP causes nausea/vomiting
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diffuse Urticaria and L upper face angioedema starting about 2 days after vaccine


VAERS ID: 2000310 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-16
Onset:2021-12-30
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Eye swelling
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: XANAX
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: After getting the Moderna COVID-19 booster on 30Dec2021 it swelled up again.; This spontaneous case was reported by a consumer and describes the occurrence of EYE SWELLING (After getting the Moderna COVID-19 booster on 30Dec2021 it swelled up again.) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 059H21A, 006B21A and 042B21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included ALPRAZOLAM (XANAX) for Sleep disorder. On 16-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EYE SWELLING (After getting the Moderna COVID-19 booster on 30Dec2021 it swelled up again.). At the time of the report, EYE SWELLING (After getting the Moderna COVID-19 booster on 30Dec2021 it swelled up again.) outcome was unknown. Treatment information for dose 3 event was not provided. Reporter states lot number of the Moderna COVID-19 booster vaccine: 059H21A but she says it may also be 054H21A. This case was linked to MOD-2021-435946.


VAERS ID: 2000313 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-15
Onset:2021-12-30
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Diarrhoea, Feeling abnormal, Headache, Mobility decreased, Myalgia, Pyrexia, Vaccination site pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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:
Current Illness: Diabetic
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 100F
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Diarrhea; She can hardly move; Side effects hit her like a ton of bricks; Headache; Body aches so bad she can hardly move; Temperature over 100F; Left arm is so sore from injection she feels like it''s going to fall off.; Vomiting; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea), MOBILITY DECREASED (She can hardly move), FEELING ABNORMAL (Side effects hit her like a ton of bricks), HEADACHE (Headache) and MYALGIA (Body aches so bad she can hardly move) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 068H21A and 030A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetic and Cancer. On 15-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced DIARRHOEA (Diarrhea), MOBILITY DECREASED (She can hardly move), FEELING ABNORMAL (Side effects hit her like a ton of bricks), HEADACHE (Headache), MYALGIA (Body aches so bad she can hardly move), PYREXIA (Temperature over 100F), VACCINATION SITE PAIN (Left arm is so sore from injection she feels like it''s going to fall off.) and VOMITING (Vomiting). At the time of the report, DIARRHOEA (Diarrhea), MOBILITY DECREASED (She can hardly move), FEELING ABNORMAL (Side effects hit her like a ton of bricks), HEADACHE (Headache), MYALGIA (Body aches so bad she can hardly move), PYREXIA (Temperature over 100F), VACCINATION SITE PAIN (Left arm is so sore from injection she feels like it''s going to fall off.) and VOMITING (Vomiting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100 (High) 100F. Patient stated that she felt 50 times worse after the booster than with the 2nd dose. No relevant concomitant medications were reported. No treatment information was provided. This case was linked to MOD-2021-052027 (Patient Link).


VAERS ID: 2000329 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-04
Onset:2021-12-30
   Days after vaccination:301
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Muscle injury, Pain in extremity, Vaccination complication, Vaccination site pain
SMQs:, Accidents and injuries (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Side effects; Feeling of a strained hamstring; Pain in legs; Pain in knees; General soreness where the shot was given; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Side effects), MUSCLE INJURY (Feeling of a strained hamstring), PAIN IN EXTREMITY (Pain in legs), ARTHRALGIA (Pain in knees) and VACCINATION SITE PAIN (General soreness where the shot was given) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 070H21A, 036B21A and 07A21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 30-Dec-2021 at 2:30 PM, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced MUSCLE INJURY (Feeling of a strained hamstring), PAIN IN EXTREMITY (Pain in legs), ARTHRALGIA (Pain in knees) and VACCINATION SITE PAIN (General soreness where the shot was given). On 31-Dec-2021 at 10:00 AM, the patient experienced VACCINATION COMPLICATION (Side effects). At the time of the report, VACCINATION COMPLICATION (Side effects) had not resolved and MUSCLE INJURY (Feeling of a strained hamstring), PAIN IN EXTREMITY (Pain in legs), ARTHRALGIA (Pain in knees) and VACCINATION SITE PAIN (General soreness where the shot was given) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient was on some concomitant medication. Treatment information was not provided.


VAERS ID: 2000358 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Unable to move arm; Body aches; Started feeling chills; Injection site pain; Headache; Feeling tired; This spontaneous case was reported by a consumer and describes the occurrence of MOBILITY DECREASED (Unable to move arm), PAIN (Body aches), CHILLS (Started feeling chills), INJECTION SITE PAIN (Injection site pain) and HEADACHE (Headache) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 30-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, the patient experienced MOBILITY DECREASED (Unable to move arm), PAIN (Body aches), CHILLS (Started feeling chills), INJECTION SITE PAIN (Injection site pain), HEADACHE (Headache) and FATIGUE (Feeling tired). At the time of the report, MOBILITY DECREASED (Unable to move arm), PAIN (Body aches), CHILLS (Started feeling chills), INJECTION SITE PAIN (Injection site pain), HEADACHE (Headache) and FATIGUE (Feeling tired) outcome was unknown. Patient reported that on same day paitent had unknown manufacturer fl u shot as well along with Moderna. No Treatment medication reported. Most recent FOLLOW-UP information incorporated above includes: On 31-Dec-2021: Follow Up received contain Additional information updated about Vaccine received.


VAERS ID: 2000369 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-12-20
Onset:2021-12-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Lymph node pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Have lymph node pain; Began to feel joint pain/aches; Swelling; This spontaneous case was reported by an other health care professional and describes the occurrence of SWELLING (Swelling), LYMPH NODE PAIN (Have lymph node pain) and ARTHRALGIA (Began to feel joint pain/aches) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Dec-2021, the patient experienced SWELLING (Swelling). On 31-Dec-2021, the patient experienced ARTHRALGIA (Began to feel joint pain/aches). On 01-Jan-2022, the patient experienced LYMPH NODE PAIN (Have lymph node pain). At the time of the report, SWELLING (Swelling), LYMPH NODE PAIN (Have lymph node pain) and ARTHRALGIA (Began to feel joint pain/aches) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant information was not provided. Treatment information was not provided.


VAERS ID: 2000376 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-01
Onset:2021-12-30
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate, Heart rate increased, Illness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL.
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia (it was controlled); Suspected COVID-19.
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: Heart rate; Result Unstructured Data: went up from 60 to high 100s; Test Date: 20220101; Test Name: Heart rate; Result Unstructured Data: heart rate went up
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: sick; nauseated; fever; heart rate went up from 60 to high 100s/heart rate went up; This spontaneous case was reported by a consumer and describes the occurrence of HEART RATE INCREASED (heart rate went up from 60 to high 100s/heart rate went up), ILLNESS (sick), NAUSEA (nauseated) and PYREXIA (fever) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Arrhythmia (it was controlled) and Suspected COVID-19 in March 2021. Concomitant products included METOPROLOL for an unknown indication. In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced HEART RATE INCREASED (heart rate went up from 60 to high 100s/heart rate went up). On 01-Jan-2022, the patient experienced ILLNESS (sick), NAUSEA (nauseated) and PYREXIA (fever). The patient was treated with METOPROLOL for Heart rate increased, at an unspecified dose and frequency. At the time of the report, HEART RATE INCREASED (heart rate went up from 60 to high 100s/heart rate went up), ILLNESS (sick), NAUSEA (nauseated) and PYREXIA (fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Dec-2021, Heart rate: high (High) went up from 60 to high 100s. On 01-Jan-2022, Heart rate: high (High) heart rate went up. It was reported that on 01 Jan 2022,the heart rate went up again which she took metoprolol again.Patient reported that being blind and not being able to provide certain information at this time.


VAERS ID: 2000381 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: 0.25mL administered at the second dose of primary series; This spontaneous case was reported by a pharmacist and describes the occurrence of UNDERDOSE (0.25mL administered at the second dose of primary series) in a 63-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058H21A) for COVID-19 vaccination. No Medical History information was reported. On 30-Dec-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 ml. On 30-Dec-2021, the patient experienced UNDERDOSE (0.25mL administered at the second dose of primary series). On 30-Dec-2021, UNDERDOSE (0.25mL administered at the second dose of primary series) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications was not provided by the reporter. Treatment information was not provided.


VAERS ID: 2000431 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-22
Onset:2021-12-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal, fish oil, vitamin c, zinc, beef liver, vitamin D3, probiotics,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Miscarriage


VAERS ID: 2000488 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Insomnia, Myalgia, Somnolence, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Hard to stay awake/Feeling drowsy; Wasn''t able to sleep last night; Body aching; Huge headache; Arm aching; This spontaneous case was reported by an other health care professional and describes the occurrence of MYALGIA (Body aching), SOMNOLENCE (Hard to stay awake/Feeling drowsy), INSOMNIA (Wasn''t able to sleep last night), HEADACHE (Huge headache) and VACCINATION SITE PAIN (Arm aching) in a 29-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032H21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Dec-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Dec-2021, the patient experienced MYALGIA (Body aching), SOMNOLENCE (Hard to stay awake/Feeling drowsy), INSOMNIA (Wasn''t able to sleep last night), HEADACHE (Huge headache) and VACCINATION SITE PAIN (Arm aching). At the time of the report, MYALGIA (Body aching), SOMNOLENCE (Hard to stay awake/Feeling drowsy), INSOMNIA (Wasn''t able to sleep last night), HEADACHE (Huge headache) and VACCINATION SITE PAIN (Arm aching) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were mentioned. No treatment details were reported.


VAERS ID: 2000543 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-17
Onset:2021-12-30
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Vaccination site erythema, Vaccination site mass, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Dementia (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: TELMISARTAN; SOMATOSTATIN; JANTOVEN; METOPROLOL; VITAMIN D 2000; OMEPRAZOLE.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: The feeling is worse; Can touch a big lump on the arm; Arm is red / Arm has a great big round circle; Arm hurts; Arm is swelling,when she lifts her arm up she can touch a big lump.; Arm is hot to the touch; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Arm is hot to the touch), FEELING ABNORMAL (The feeling is worse), VACCINATION SITE MASS (Can touch a big lump on the arm), VACCINATION SITE ERYTHEMA (Arm is red / Arm has a great big round circle) and VACCINATION SITE PAIN (Arm hurts) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included TELMISARTAN for Blood pressure, SOMATOSTATIN, WARFARIN SODIUM (JANTOVEN), METOPROLOL, CALCIUM CARBONATE, COLECALCIFEROL (VITAMIN D 2000) and OMEPRAZOLE for an unknown indication. On 17-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 30-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Dec-2021, the patient experienced VACCINATION SITE WARMTH (Arm is hot to the touch), VACCINATION SITE MASS (Can touch a big lump on the arm), VACCINATION SITE ERYTHEMA (Arm is red / Arm has a great big round circle), VACCINATION SITE PAIN (Arm hurts) and VACCINATION SITE SWELLING (Arm is swelling,when she lifts her arm up she can touch a big lump. ). On 02-Jan-2022, the patient experienced FEELING ABNORMAL (The feeling is worse). At the time of the report, VACCINATION SITE WARMTH (Arm is hot to the touch), FEELING ABNORMAL (The feeling is worse), VACCINATION SITE MASS (Can touch a big lump on the arm), VACCINATION SITE ERYTHEMA (Arm is red / Arm has a great big round circle), VACCINATION SITE PAIN (Arm hurts) and VACCINATION SITE SWELLING (Arm is swelling,when she lifts her arm up she can touch a big lump. ) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The patient stated she had no trouble at all after receiving the first and second dose. The symptoms started the same day she received the Booster dose, in the afternoon. Concomitant medications Telmisartan 8mg stated description as Blood Pressure. Patient reported when she lifts her arm up she can touch a big lump. Patient thought it was normal and it would go away, and that it was not that bad, but it?s still bothering her and it doesn?t go away. No treatment was given.


VAERS ID: 2000653 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-12-30
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 - / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, HTN
Allergies:
Diagnostic Lab Data: COVID test: positive
CDC Split Type:

Write-up: Event occurred after 2nd Dose. Patient diagnosed of COVID Discharged home


VAERS ID: 2000718 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Diarrhoea, Fatigue, Insomnia, Pain in extremity, Sleep disorder
SMQs:, Retroperitoneal fibrosis (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicilin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in the arm that received the shot for 2 days, tiredness, diarrhea, problems to fall asleep and wakening up at night, back pain.


VAERS ID: 2001043 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypersensitivity, Injection site erythema, Injection site swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received COVID-19 vaccine. Five minutes later, developed redness and swelling around vaccine administration site in left arm. Patient complaining of itching. No difficulty breathing, dyspnea, etc. Weight today 50 pounds. Patient has done well with other vaccines in the past Given 10 mL children''s benadryl. Improvement in itching. Stable. Emergency precautions reviewed with mother. Give children''s Benadryl 10 mL nightly over the next 2-3 nights. Would not advise on continuing COVID vaccine series given quickness of reaction. Follow up as needed for any acute concerns. 12/31/21 rash has returned from her allergic reaction to the covid vaccine. it''s on her arms and legs. She is not having any difficulty breathing. I gave her benadryl dose to her early this evening which helps it go away. As of 1/3/22, still using benadryl to control rash as it returns when therapy is stopped. In person follow up physician visit today.


VAERS ID: 2001096 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 LA / IM

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

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

Write-up: Patient received his booster dose 1.5 months earlier than he was supposed to. I followed up with the patient''s mother, on 01/03/2022, and she said that he was doing fine and had no issues.


VAERS ID: 2001125 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-04
Onset:2021-12-30
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: 12/30/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: 12/30/21: FEVER, SORE THROAT


VAERS ID: 2001126 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-22
Onset:2021-12-30
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013084 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Discharge, Exposure to SARS-CoV-2, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novsc 10mg, takes other supplements such as vitamins but can not get to them because she is self-isolating.
Current Illness: no
Preexisting Conditions: High blood pressure
Allergies: Prevlex- swollen face.
Diagnostic Lab Data: Covid test- positive
CDC Split Type: vsafe

Write-up: Particpant tested positive for Covid on 01/02/2022 at urgent care. Symptoms began on 12/30/2021. Mild dry cough, drainage, and sneezing 01/04/2022 losing taste and smell. Taking Coricidin. Exposed from family who went to a party prior to coming to my house


VAERS ID: 2001199 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-19
Onset:2021-12-30
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

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

Write-up: Weakness


VAERS ID: 2001264 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-23
Onset:2021-12-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PEELING FINGERS AND TOES BEGAN ON 12-30-21 TX: AQUAPHOR OR VASELINE WILL REFER TO DERMATOLOGIST IF PEELING WORSENS


VAERS ID: 2001329 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-28
Onset:2021-12-30
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

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

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

Write-up: Covid positive contact through work


VAERS ID: 2001359 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Erythema, Eyelid margin crusting, Lacrimation increased, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2 days after booster pt reported eye watering and crusting. Next day eyes almost swollen shut. now gradually improving but still complaining of redness crusting and mild eyelid swelling.


VAERS ID: 2001368 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, SARS-CoV-2 test negative, Streptococcal infection, Streptococcus test positive
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness:
Preexisting Conditions: heart murmur
Allergies: unknown
Diagnostic Lab Data: yes COVI D test(negative) and Strep test (positive
CDC Split Type:

Write-up: He had difficulty swallowing. Went to the urgent care.


VAERS ID: 2001480 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Pain in extremity, Product preparation issue
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: The client was given undiluted Pfizer COVID-19 5-11 vaccine. The orange cap was removed and 0.2cc drawn up and given to client. The mother was notified on 12-30-21 at noon. No issues noted at that time. 1-3-22 interview with mother completed. She reported that the child had a fever 100.1 the night of 12-30-21 with a sore arm. By 12-31-21 am, the child''s symptoms were resolved without medication.


VAERS ID: 2001528 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-23
Onset:2021-12-30
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 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: positive covid test in fully vaccinated pt


VAERS ID: 2001543 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heart rate irregular, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 10mg, Vallarta 320mg
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: Manual pulse check only.
CDC Split Type:

Write-up: Heart palpitations, possibly premature arrhythmia, occurring approximately 6 times per minute. Regularly occurred over the course of approximately 20 hours. Issue first noticed 12/30/2021 at 8pm (the day after receiving the shot), and lasted until 12/31/2021 at 3pm. Symptoms included feeling one irregular heartbeat, repeating approximately 6x/minute. No chest pain, dizziness, shortness of breath. No other known contributing factors present, such as change in activity or ingestion of stimulants (caffeine, pseudoephedrine, etc.)


VAERS ID: 2001547 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-30
Onset:2021-12-30
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E / 3 - / -

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

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

Write-up: SOB and positive covid test in fully vaccinated and boostered pt


VAERS ID: 2001548 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Client takes a Multivitamin daily. Has take the same multivitamin for years per parent report. Alive Multivitamin by Natures Way 2 tabs by mouth once daily. Parent denied any other prescriptions, over the counter medications, dietary supp
Current Illness: Client had a respiratory illness in min Nov. 2021 with cough and fever Client had a GI illness in Early Dec. 2021 with vomiting and diarrhea. Parent denies that child is ill at time of vaccination.
Preexisting Conditions: No chronic or long standing health conditions.
Allergies: Client developed a rash after amoxicillin treatment at an early age, but parent reports no further reactions to medications, food, products or prior vaccinations.
Diagnostic Lab Data: None were obtained.
CDC Split Type:

Write-up: No adverse event occurred immediately following vaccination. The child experienced an approximately "1/4 inch raised red area at injection site for less than a day" otherwise the parent denied that the child had any adverse events after vaccination. Patient was vaccinated on the morning of 12/30/2021 , by mid afternoon, parent reported the child with out adverse events. By 1/4/2022 parent reported the raised red area mentioned above but nothing further. Reported, "honestly she is fine"


VAERS ID: 2001588 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

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

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

Write-up: Patient is only 8 years old and received ADULT Pfizer instead of pediatric


VAERS ID: 2001616 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Lethargy, Pain in extremity
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament 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: None.
Current Illness: None.
Preexisting Conditions: MCAD- Medium-Chain Acyl- CoA dehydrogenase Deficiency.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 12/30/2021 No adverse events occurred immediately after vaccination. 1/4/2022 Mother reports child felt, "run down and lethargic and had and achy arm for about 1 day after but that was it."


VAERS ID: 2001655 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-12
Onset:2021-12-30
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 - / -

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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diverticulitis, arthritis, HTN, High cholesterol, Coronary artery disease
Allergies: Penicillins
Diagnostic Lab Data: Covid test: Positive
CDC Split Type:

Write-up: Event occurred after 2nd dose. Patient was diagnosed with COVID 19 Remdesivir In-patient


VAERS ID: 2001679 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-07
Onset:2021-12-30
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Rapid Ag test administered at a local Urgent care on 01/02/2022
CDC Split Type:

Write-up: Patient contracted COVID-19


VAERS ID: 2001708 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: Client was given undiluted COVID-19 Pfizer 5-11 vaccine 0.2cc Left Deltoid. Mother was notified at noon. No problems at that time. Mother interviewed 1-3-22. Mother denies any changes in behavior, no redness or swelling at the site, afebrile. Mother does not feel there were any side effects.


VAERS ID: 2001783 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Chills, Fatigue, Nodule, Pain in extremity, Skin warm
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Started out with soreness in the arm then a knot the size of a golf ball hot to the touch. Raised my blood sugar really high. Along with fatigue and chills.


VAERS ID: 2001817 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-12-30
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, fatigue Seizure on 12/30/2021


VAERS ID: 2001849 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: no adverse outcome but the nurse administrated expired vaccine


VAERS ID: 2001941 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vomiting and swollen red circle around shot site on arm


VAERS ID: 2001952 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-22
Onset:2021-12-30
   Days after vaccination:311
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hyperlipidemia
Allergies:
Diagnostic Lab Data: Covid test: Positive
CDC Split Type:

Write-up: Event occurred after 2nd dose. Patient was diagnosed of COVID 19 Discharged home


VAERS ID: 2001992 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 - / -

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

Write-up: Covid +


VAERS ID: 2002013 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 - / -

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

Write-up: COVID +


VAERS ID: 2002024 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-18
Onset:2021-12-30
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid+


VAERS ID: 2002027 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-26
Onset:2021-12-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with normal low-grade fever. Went away after 3 days. Then came persistent Tinnitus and pressure above jaw, behind ears. No drainage or sinus-like problems. No congestion.


VAERS ID: 2002124 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

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

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

Write-up: Covid vaccine was expired for 7 days. not apparent reaction.


VAERS ID: 2002147 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02121A / 3 - / IM

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

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

Write-up: Covid vaccines were administrated with the expired day. Not reactions


VAERS ID: 2002151 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gout, X-ray
SMQs:, Arthritis (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: Glipizide Lasix Carvedelol Diltiazem Eliquis Atorvastatin
Current Illness:
Preexisting Conditions: Diabetes High blood pressure Multiple Myeloma
Allergies:
Diagnostic Lab Data: Xray
CDC Split Type:

Write-up: Gout


VAERS ID: 2002160 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol, atorvastatin, tamsulosin, sildenafil, metformin, lisinopril, potassium, bumetanide, warfarin, benzonatate prescribed 10 days prior
Current Illness: got cough medicine prescribed 10 days prior
Preexisting Conditions: gout, afib, diabetes
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated he has been very tired and run down ever since he got the shot. He asked if that was normal. I said usually people only feel it for 1 to 2 days but if it''s not getting better he should follow up with his Dr.


VAERS ID: 2002191 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (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: The expired Covid vaccine was administrated. no adverse outcome was reported from the patient.


VAERS ID: 2002196 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (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: expirid covid vaccine was administrate. no adverse reaction


VAERS ID: 2002214 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Generalised tonic-clonic seizure, Loss of consciousness, Screaming, Tremor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No known medications
Current Illness:
Preexisting Conditions: PMH of meningitis, syncopal episodes over the last few years, hx of needle phobia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated: 11:18 Reaction: 11:20 2 minutes after vaccination, patient had a tonic-clonic seizure lasting 30-45 seconds. Patient''s head was turned to side and supportive care was given. 911 was called and patient left by EMS at 11:50. Per patient''s mother at ED, patient was in the backseat after having gotten her COVID-19 vaccination when she immediately started to scream for her mom and left hand began shaking. Then, the patient lost consciousness and mother called for help. She notes that the patient urinated on herself and was back to being alert 30 seconds to a minute later. Patient reported to be very anxious about getting the vaccine. Patient noted to hvae rhinorrhea and sneezing prior to getting COVID-19 vaccine. Vitals: @9:44: 150/110, 10 -$g @1142: 125/84, 101, O2 93% -$g @13:36: 116/66, 87, 18, O2 99% Patient reports she is back to baseline in ED taking PO and ambulating normally. Patient also appeared nontoxic in appearance with normal vital signs and normal neurologic exam. and provider recommended patient be discharged with Keppra. During follow-up call, mother expressed concern over using Keppra on daily basis and was reassured that because it was a singular event triggered by getting a vaccine, routine use of Keppra will not be necessary at this time. Mother also plans on getting next COVID vaccine in controlled environment with proper observation and provider advised that if she has any involvement of left side that is concerning for seizure, patient will need daily anticonvulsant.


VAERS ID: 2002217 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (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: Expired covid vaccines was administrated per error. no adverse outcome


VAERS ID: 2002356 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Expired covid vaccines were given per error


VAERS ID: 2002363 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 041J21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood test, Cheilitis, Chills, Cough, Decreased appetite, Dehydration, Headache, Hypoacusis, Nasal congestion, Nausea, Pain, Peripheral swelling, Pyrexia, SARS-CoV-2 test negative, Sneezing, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot.
Other Medications: Klonopin; Tramadol; Cambia; Donnatal; Lomotil; Fiorinal,; Spironolactone; Atarax; Vitamin C; Garlic; Zinc; Vitamin D; Grapefruit Seed Extract; Venlafaxine
Current Illness: None
Preexisting Conditions: Post-infectious IBS/IBD (Recurrent C Diff); Centrally Mediated Abdominal Pain Syndrome, Chronic Migraine; Fibromyalgia; Asthma.
Allergies: Erythromycin; Contrast dye; Codeine; Sulphur based drugs; Soy; Milk; Beef; Eggs; Pork; Doxycycline
Diagnostic Lab Data: Blood work - abnormal; Dehydration- white blood count was slightly elevated; COVID -19 test-negative.
CDC Split Type: vsafe

Write-up: Severe headache, fever, body ache, chills, slight cough, nausea, loss of appetite, my hearing was going in and out, severe abdominal pain, sneezing, stuffy nose, sore on my lip, swollen arm.


VAERS ID: 2002945 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Decreased appetite, Fatigue, Headache, Lymph node pain, Lymphadenopathy, Myalgia, Nausea, Neck pain, Pain in extremity, Peripheral swelling, Photophobia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alendronate Sodium 70 mg tabs, Montelukast 10 mg tabs, Olopatadine Ophthalmic Drops, Topiramate 25 mg tabs, Zonisamide 100 mg tabs, Citracal, and Vitamin D 3.
Current Illness: None
Preexisting Conditions: Asthma, Migraines, Osteoporosis
Allergies: Peanuts, Penicillin, and Sumatriptan
Diagnostic Lab Data: None. Just treating with Tylenol and hydration.
CDC Split Type:

Write-up: Chills, muscle aches, joint pain, severe headache, neck pain, nausea, arm swelling and soreness, severe fatigue began gradually that night. Next day, I had increased need to sleep, no appetite, headache and photophobia intensified. Axilla lymph node was swollen on side of injection, later, left neck lymph node became tender as well as the one on groin area. Back pain started. Side effects continued for 3 days. At the time of this writing (6 days after booster), muscle aches, joint pain have improved. All other symptoms continue. Most prominent are lymph node enlargement on axilla, groin, and neck, fatigue, headaches, and nausea.


VAERS ID: 2003144 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

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

Write-up: Vertigo


VAERS ID: 2003148 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-16
Onset:2021-12-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Beg spray CMS B vitamins Vitamin D Zoloft
Current Illness: CIRS
Preexisting Conditions: CIRS
Allergies: Peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed dermatoprahia and hives. Systemic and random. Persistent with no improvement.


VAERS ID: 2003179 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-12-19
Onset:2021-12-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mechanical urticaria, Oesophageal discomfort, Pruritus
SMQs:, Anaphylactic reaction (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 B12 tablets Restasis
Current Illness: None
Preexisting Conditions: Dry eyes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme itchiness accompanied with dermatographia on most of my body. Additionally light tightness in asophagus


VAERS ID: 2004218 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Inflammation, Ocular discomfort, Ocular hyperaemia, Photophobia, Uveitis
SMQs:, Anaphylactic reaction (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Possible related uveitis case during first dose of Pfizer covid-19 vaccine in May 2021. Uveitis case was already involved at tim
Other Medications: None
Current Illness: None
Preexisting Conditions: Acute bilateral anterior uveitis with presence of HLA B-27
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flare up of acute uveitis in left eye only. Redness, discomfort, sensitivity to light. First flare up in 6 months. First noticed two mornings (42+ hours after day of vaccine dose. First day after dose included general body inflammation, which I suspected might trigger uveitis, now knowing my HLA B-27. Currently self-treating with leftover Durezol steroid drops from my previous case. I am now realizing that while that previous case came before my first dose in the Pfizer vaccine series (May 2021), my uveitis symptoms did persist for 2-3 weeks after that first vaccine dose, which may have prolonged the inflammation. No signs of uveitis during my second Pfizer dose in June 2021. Current uveitis case still ongoing.


VAERS ID: 2005475 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Product administered to patient of inappropriate age, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow)

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

Write-up: Given outside of recommendations. Follow up with Mother on 12/31/21 - Mother stated was having vomiting and diarrhea but she felt it was not related to the vaccine that was given.


VAERS ID: 2005531 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Injection site pain, Product administration error, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20 mg daily
Current Illness: none reported
Preexisting Conditions: ADHD
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 0.2cc undiluted Pfizer 5-11 administered in Left Deltoid on 12-30-21 at 1030. the error was noted after administration and the mother was notified at 1200 that day. At that time, the client had no side effects. On 1-5-22 the mother was interviewed. She reported that the client had "a little soreness" at the site of administration and "a little headache". No fever, No redness, No swelling. the mild symptoms lasted one day.


VAERS ID: 2005553 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Had booster while under observation developed mild erythema (not rash) on both arms appears was likely due to anxiety- Resolved after a few minutes


VAERS ID: 2005557 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-21
Onset:2021-12-30
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

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

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

Write-up: uri sx


VAERS ID: 2005567 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-28
Onset:2021-12-30
   Days after vaccination:336
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: Employee on vacation, returned to work not feeling well. Rapid test done with positive results for Covid


VAERS ID: 2005604 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-30
Onset:2021-12-30
   Days after vaccination:334
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Facial discomfort, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), 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: Metformin, synthroid, Loratadine( otc claritin)
Current Illness: none
Preexisting Conditions: asthma, pcos, obesity, hashimoto''s, insulin resistance
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: this was a booster my 1st two injections were moderna earlier in 2021. I experienced left side facial issues, started with burning and turned to numbness feeling like a dental block within 1hr of injection, left side of face from scalp to upper-lip and left ear. muscle movements lagging in area. numb sensation lasted 8-12 hrs (overnight), delayed muscle feeling lasted 24hrs. no fever experienced


VAERS ID: 2005676 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-30
Onset:2021-12-30
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / -

Administered by: Unknown       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? Yes
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+ test
CDC Split Type:

Write-up: covid vaccine breakthrough


VAERS ID: 2005679 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 33H21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Dizziness, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient felt nauseated, dizzy, lethargic, and cannot eat solid food from the day she received the vaccination (12/30/2021). She informed the doctor''s office and the doctor gave her anti-nausea medication.


VAERS ID: 2005694 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: PER ERROR WAS ADMINISTRATED EXP. COVID VACCINE


VAERS ID: 2005752 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: School       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: One women?s a day multivitamin
Current Illness: N/a
Preexisting Conditions: Na
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node on the left arm. Took OTC advil, rubbed Vick under armpit


VAERS ID: 2005837 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-05
Onset:2021-12-30
   Days after vaccination:300
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline 50 mg, Adderall ED 30 mg, Abilify 15 mg, linaclotide 290 mg, omeprazole 20 mg
Current Illness: none
Preexisting Conditions: hyperlipidemia, COPD, fibromyalgia, metabolic syndrome, GERD, irritable bowel syndrome, alcohol abuse in remission
Allergies: Augmentin, ciprofloxacin, desipramine, erythromycin, hydrocodone, morphine, NSAIDs
Diagnostic Lab Data: Sars-Cov-2 RNA NAAT positive test
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2005879 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-26
Onset:2021-12-30
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR 12/30/21
CDC Split Type:

Write-up: Breakthrough COVID-19 infection


VAERS ID: 2005884 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Headache, Injection site bruising, Injection site erythema, Injection site mass, Lethargy, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, citalopram, buprprion, bit D, fish oil, calcium
Current Illness:
Preexisting Conditions: Depression
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, redness radiated over 4 day period from injection site and eventually covered most of upper arm, hard lump and bruise at injection site lasted 5 days, body aches, severe headache, nausea that would come and go, lethargy.


VAERS ID: 2005898 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Pain, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced fever, body aches and chills the same day the vaccine was given. Then on Sunday 1/2/2022 she started getting a rash all over whole body. Rash was diagnosed as Hives.


VAERS ID: 2005932 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Given expired Covid vaccine per error


VAERS ID: 2006018 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-27
Onset:2021-12-30
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, Chest X-ray normal, Chills, Electrocardiogram abnormal, Pyrexia, SARS-CoV-2 test positive, Troponin increased, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN aspirin, 81 mg, PO, Daily bumetanide 1 mg oral tablet, 1 mg= 1 TAB, PO, Daily Coreg 12.5 mg oral tablet, 12.5 mg= 1 TAB, PO, BID (2 times a day) dilTIAZem 240
Current Illness:
Preexisting Conditions: Carotid artery stenosis Chronic diastolic heart failure Chronic kidney disease, stage 3 Coronary artery disease Elevated troponin ESBL Escherichia coli Hypertension Personal history of bladder cancer Personal history of prostate cancer Postprocedural anterior bulbous urethral stricture, male S/P CABG (coronary artery bypass graft) Subclavian artery stenosis Ureteral calculi Ureteral stricture, right Urethral stricture in male
Allergies: shrimp iodine compounds
Diagnostic Lab Data: 12/30/2021 troponin 622 12/31/2021 COVID19 PCR positive 12/30/2021 CXR no focal infiltrate, effusion or pneumothorax is seen
CDC Split Type:

Write-up: 12/30 Patient to ER with fever, weakness recently with UTI and did not complete antibiotics EKG with afib heart in the 70s Tmax 101.5 Elevated troponin Reported chills and fever (1 day prior admission, 12/29) so covid test was obtained patient not requiring supplemental oxygen


VAERS ID: 2006053 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-28
Onset:2021-12-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Fatigue, Fibrin D dimer increased, Injection site pain, Intensive care, Lung opacity, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, Troponin increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies to medications foods or environmental agents
Diagnostic Lab Data: Troponin on admission 7370, reduced to 4217 day 2 and 2750 day three. ECHO normal. EKG normal D-Dimer initial 560 with day 2 1165. CTA negative for pulmonary embolism but lung fields had ground glass appearance. Respiratory PCR negative for SARSCOVID2. Covid nuclear capsid IGM pending
CDC Split Type:

Write-up: Developed fatigue and soreness at injection site one day following immunization. 2 days following immunization developed chest pain, and shortness of breath. which progressively worsened over next two days. Evaluated in ER then admitted to Hospital with elevated troponin. Developed need for supplemental O2 and eventually place on High-Flow O2 @ 40 lpm over night with resolution of chest pain and oxygen need on hospital day 2. Discharged on third hospital day on Colchicine. Follow-up to include cardiac MRI and cardiac clinic follow up in 1 week


VAERS ID: 2006092 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-07
Onset:2021-12-30
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: history of gallstones
Allergies: none
Diagnostic Lab Data: Sars-Cov-2 positive on 12/30/2021
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2006137 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The Pfizer vaccine was not reconstituted. The patient received 0.3mL of unmixed Pfizer. We have not heard from the patient on any adverse effects.


VAERS ID: 2006146 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient received a booster dose of the Pfizer vaccine that was not reconstituted. The patient received 0.3mL of unmixed Pfizer. The patient has not reported any adverse effects.


VAERS ID: 2006166 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Dizziness, Malaise, Pain
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre 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: PANTOPRAZOLE 20MG, ESCITALOPRAM 20MG
Current Illness: N/A
Preexisting Conditions: DEPRESSION, ANXIETY
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Started to feel ill night of vaccination. Had chills, weakness and aches, dizziness and some loss of appetite. Symptoms were worst the next day (Friday). Each day the symptoms got lighter, by Sunday I felt almost back to normal. By Monday symptoms were gone. Used Advil to treat symptoms Thursday and Friday, by Saturday no longer needed Advil. All in all, felt like a small replay of many of the symptoms I had back in mid November when I tested positive for COVID itself.


VAERS ID: 2006171 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin d, multi vitamin, fish oil, metoprolol, simvastatin, aspirin
Current Illness:
Preexisting Conditions: trple bypass
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: joint pain


VAERS ID: 2006178 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-12-30
   Days after vaccination:338
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Diarrhoea, Dyspnoea, Ear pain, Headache, Pain, Respiratory tract congestion, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking Vitamin D 1000 UNIT Tablet 1 tablet Orally Once a day, Taking Vitamin B12 100 MCG Tablet 1 tablet Orally once a day, Taking Levothyroxine Sodium 50 MCG Tablet 1 tablet in the morning on an empty stomach Orally Once a day, Taking Zinc
Current Illness: none
Preexisting Conditions: Migraine headaches, Depression, Environmental allergies, Fibromyalgia 7/2008, History of abnormal pap smear 4/2000, LEEP-HPV 8/1/2001, Endometriosis, Post-partum thyroiditis 2015, resolved 2016, Hypothyroid.
Allergies: Sulfa: hives - Allergy, Ceclor: hives - Allergy, Amoxicillin: hives - Allergy, Septra: hives - Allergy, PENICILLIN DRUGS: hives - Allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, congestion, nonproductive cough, chills, shortness of breath (mild, hx of asthma, has been using albuterol which has been helpful), body aches, loss of taste, loss of smell, diarrhea, ear pain, post nasal drainage. starting 12/30/21


VAERS ID: 2006179 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Body temperature increased, Chills, Fatigue, Headache, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Pfizer Covid vaccine; age 63; 04/30/2021
Other Medications: Tamsulosin; Fluticozone; Ipratroprium; Clobetosol; Vit D3.
Current Illness: None.
Preexisting Conditions: Non-allergic Rhinitis.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Fatigue, all over body aches, headache, fever, chills, 101-102 temp, blood pressure raised above normal, rapid heartbeat.


VAERS ID: 2006190 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-17
Onset:2021-12-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041JZ1A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Differential white blood cell count, Full blood count, Metabolic function test, Rash pruritic, Red blood cell sedimentation rate increased
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, sertraline, iron, omeprazol, sharobel
Current Illness: None
Preexisting Conditions: Gerd, obesity, hypothyroidism
Allergies: knda
Diagnostic Lab Data: esr 22 cmp and cbc with diff are normal
CDC Split Type:

Write-up: Pt received her moderna booster vaccine on 12/17/2021. She was previously vaccinated with moderna vaccines on 3/19/21 and 4/17/21 without incident. On 12/30/2021 she suddenly developed a diffuse, pruritic body rash that has persisted since. She was seen in the office for documentation of this rash on 1/4/2021. The rash involves her trunk, chest, arms and face/neck. It involves multiple, small, papular lesions without crusting, drainage. they are blanchable and non tender but are pruritic. she has no fever. She has never has a rash before. No hx of allergies. No change in medications, soaps, no recent illness. No other cause to attribute this rash other than recent vaccination. pt using benadryl and hydrocortisone cream to treat symptoms.


VAERS ID: 2006205 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-12-30
   Days after vaccination:339
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Diarrhoea, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: She has a past medical history of Fibromyalgia, Hypertension, and Thyroid disease.
Allergies: none
Diagnostic Lab Data: 12/30/21 COVID19: positive 1/1/22 chest xray: Findings compatible with COVID pneumonia.
CDC Split Type:

Write-up: Received Pfizer COVID19 vaccine on 01/25/21 and 02/15/21. COVID positive 12/30/21. Presented to ER on 1/1/22 for evaluation of SOB for the past few days. She tested positive for COVID on 12/30. She has also been having some diarrhea. In ER she was found to be hypoxic, placed on 3 liters O2 with good improvement in her saturation. Patient was admitted. Patient started on dexamethasone and remdesivir. Completed three days of remdesivir and 4 of steroids. Patient discharged with the remaining steroid course given nicotine use and possible underlying COPD. Dischaged without oxygen on 1/4/22


VAERS ID: 2006299 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Dizziness, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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: Pt reports history of heart palpitations x4-5 years- loop recorder is implanted
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The following day Dec 30 after vaccination she felt increased heart palpitations- rapid, hard beats. Dec 31 pt reported she felt dizzy, "almost passed out, but didn''t." Her cardiologist called her due to irregular recording from the loop recorder. He told her he would continue to monitor. She reports most symptoms have resolved, but she does feel weak when up with a rapid heart beat.


VAERS ID: 2006307 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-12-18
Onset:2021-12-30
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspepsia, Oesophageal spasm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Woke up with hives 12/30. Took Benadryl, Claritin. No relief. Continued to worsen over weekend. Also onset of heartburn and esophageal spasms. Received medrol dose pack and protonix Monday, January 3.


VAERS ID: 2006331 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-08
Onset:2021-12-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / UNK - / -

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? 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 positive contact unknown


VAERS ID: 2006491 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-01
Onset:2021-12-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site rash, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe headache onset at 9pm. Chills, rigors overnight. Severe fatigue the following day. R arm significant swelling, redness, and pain which worsened over 48 hrs. Arm also became very itchy. Continues to be itchy on 1/5 and rash present near injection site. Headaches daily since injection.


VAERS ID: 2006499 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was diagnosed with Myocarditis as a result of the booster. Symptoms of chest pain showed up 3 days after the vaccine. The patient was released after a day in the hospital. He was prescribed anti-inflammatories to help with the inflammation. Ongoing check-ins are needed.


VAERS ID: 2006595 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-18
Onset:2021-12-30
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 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? 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: Collection time: Dec 20, 2021 at 13:29:49. SARS-CoV-2 RNA Q-39448: Not detected.
CDC Split Type:

Write-up: Routine COVID-19 screening.


VAERS ID: 2006775 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-21
Onset:2021-12-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Differin gel at bedtime, Emgality Injection 120 mg once a month, zonisamide 300 mg at bedtime, magnesium oxide 250 mg at bedtime, aspirin EC 81 mg every morning, Vyvanse 50 mg every morning, vitamin D3 5000 IU gummies every morning, systan
Current Illness: None
Preexisting Conditions: Persistent migraine aura (PMA) Undifferentiated Connective Tissue Disorder (UCTD) Ocular Migraine Eczema Raynouds Syndrome Rosacea
Allergies: Sulfa antibiotics Latex Dogs Peanuts Treenuts Macrobid
Diagnostic Lab Data: Today is 1/5/22. I will be following up at my primary care office tomorrow 1/6/22 and then following up at my allergist on 1/7/22. Hopefully more data to come.
CDC Split Type:

Write-up: 12/22/21 The day after my injection, i had my third round of ?COVID arm.? This was my third Moderna shot and each shot gave me COVID arm and an injection site reaction. This booster also made my armpit lymph nodes swell up for about a week and a half. 12/30/21 Days after the injection was given, I began to itch all over. Slowly, I began to break out in hives all over my body. It started slowly then gradually increased to the point I was going into anaphylaxis after two days. My throat was tight, had trouble breathing, and my mom drove me to the ER. upon arrival they gave me prednisone which got stuck in my throat and told me to follow up with my PCP. Told me I probably ate an allergen? and that I wasn?t anaphylactic? although I was in a complete wheeze. Didn?t make much sense to send me home but when every other patient was a COVID patient I guess they didn?t want me to get infected. I?m not entirely sure if this reaction was from the Moderna vaccine but the woman who called me from Vsafe encouraged me to file this report. I hope this helps and I?m happy to do my part.


VAERS ID: 2007031 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: no know adverse affects, shot given outside of the approved booster age range


VAERS ID: 2007064 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Muscular weakness, Pyrexia, Tremor, Vomiting projectile
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvistatin 40mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102+, projectile vomiting, tremors, muscle weakness, fatigue lasting 30 hours


VAERS ID: 2007214 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-19
Onset:2021-12-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thyroiditis
SMQs:, Hypothyroidism (broad), Hyperthyroidism (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride 1mg
Current Illness: Covid
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Inflammation of thyroid


VAERS ID: 2007236 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-06
Onset:2021-12-30
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Metabolic encephalopathy, SARS-CoV-2 test positive, Viral sepsis
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), Noninfectious encephalopathy/delirium (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inh, benzonatate, vitamin d3, divalproex dr, levetiracetam, magnesium, Xarelto,
Current Illness:
Preexisting Conditions: epilepsy, bilateral subsegmental PE in the setting of prothrombin gene mutation on Xarelto, and OSA on CPAP
Allergies: NKDA
Diagnostic Lab Data: COVID status positive 12/30/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/16/21 and 4/6/21. On 12/30/21, patient tested positive for COVID. On 1/2/22, patient admitted to our facility med/surg unit with acute respiratory failure due to COVID-19, viral sepsis and acute metabolic encephalopathy (hx of epilepsy). As of today (1/5/22), patient is still admitted in our med/surg unit receiving dexamethasone and remdesivir.


VAERS ID: 2010067 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-20
Onset:2021-12-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Emotional distress, Insomnia, Loss of personal independence in daily activities, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 12-30-21 starting experiencing itching on stomach. Over night hives formed and spread to neck. Over the course of the next two days hives became widespread and extremely itchy, could not function normally, could not sleep. Took antihistamines which provided no relief and colloidal oatmeal baths. used steriod cream on the flare ups. On Monday 1-3-22, PCP telehealthed in prescription for prednisone. On prednisone and daily antihistimine hives are 50% controlled, however flare ups still occuring. I cannot hold a phone to my ear or a pen in my hand without breaking out. Taking an extreme toll on my physical and mental health.


VAERS ID: 2010120 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-30
Onset:2021-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 1 RA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin, sunflower lecithin
Current Illness: none
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: numbness in right side of face lasting about 15 minutes


VAERS ID: 2010156 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Unknown  
Location: South Carolina  
Vaccinated:2021-12-27
Onset:2021-12-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Skin exfoliation, Swelling face
SMQs:, Severe cutaneous adverse reactions (broad), 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: Ramipril, Carviderol, Vitamin B-12 (1,000ml), Alprazalam, Tramadol, bupartin (not sure of correct spellng!
Current Illness:
Preexisting Conditions: heart difib., constant urinary track infections,
Allergies: Penacillin, mycin, Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Face became blood red and swollen as well as around eyes. Went to ER at local hospital, was given dphenhydramine Benadryl 25 mg, Famotidne (pepcid) 40 mg and prednisone 50 mg ! Face is now still very pink and beginning to peal. Wear mask at work and have not used any make-up. Put face cream on at night to help with pealling.


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