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

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



Case Details (Reverse Sorted by Onset Date)

This is page 113 out of 3,524

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VAERS ID: 1341742 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Aspiration joint, Chills, Gait inability, Headache, Joint lock, Joint swelling, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: The same day, my doctor here in my deployed locationSince Tuesday, I have also had terrible headaches, fever and chills. drained my knee twice and Sent me to another military hospital for further treatment. I was given antibiotics as the size of the swelling continues to grow. I am currently on day two with no improvement.
CDC Split Type:

Write-up: Two days after receiving the vaccine, I woke up and could not walk due to pain in my left leg. My knee could not be extended, retracted, or left hanging. My left knee was swollen to the size of a softball and add immense pain on top and to the left but not under. There were no trauma related incidences, no working out nor was there anything out of the norm that happened . Since Tuesday, I have also had terrible headaches, fever and chills.


VAERS ID: 1341854 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Cold sweat, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Symptoms started roughly five hours after receiving the vaccine. It began with cold sweats, where I was shivering but sweating. Then I began experiencing nausea overnight coupled with a headache.


VAERS ID: 1341890 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Amylase increased, Blood alkaline phosphatase increased, Blood glucose decreased, Blood lactic acid increased, Blood potassium increased, Dysarthria, Lethargy, Mental status changes, Pyrexia, Tachycardia, White blood cell count decreased
SMQs:, Liver related investigations, signs and symptoms (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol 25 mg q12h Famotidine 20 mg Atorvastatin 20 mg Nifedipine 30 mg Pantoprazole 40 mg Aspirin 81 mg Carvedilol 12.5 mg q12h Vitamin D 1025 mcg Acetaminophen 975 mg TID PRN for pain s/p abdominal pain due to hernia repair Levemir
Current Illness: recent hernia repair (4/29/21- 5/13/21) fluid overload (4/22/21- 4/28/21) due to ESRD and HFpEF (now HFrEF)
Preexisting Conditions: ESRD on HD (MWF) after failed DDRT (active from 2002-2019) T1DM (a1c 7.1 4/23/21) c/b retinopathy, neuropathy, and nephropathy HTN PAD s/p b/l BKA 2018 HFrEF (EF 40% 5/21) c/b moderate TR and ascites requiring frequent paracenteses gastric ulcer
Allergies: NKDA
Diagnostic Lab Data: 5/21- Lactate 2.6, K 5.6, Glucose 61, Alk Phos 166, Amylase 154, WBC 4.6
CDC Split Type:

Write-up: Fever to T max 105.3, tachycardia to HR 135, altered mental status (lethargic, nonsensical speech)


VAERS ID: 1341896 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Loss of consciousness, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None, unless there''s an immediate issue we will call a doctor for an appt Monday.
CDC Split Type:

Write-up: Has gotten hot, nauseous and then blacked out and throws up, this has happened now 4 times.


VAERS ID: 1342052 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline 50mg
Current Illness: non
Preexisting Conditions: overweight, otherwise healthy
Allergies: possibly allergic to the *-cillin family of antiboitics (developed hives after amoxicillin at a younger age)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart Palpitations - Friday afternoon 5/21/21 about 72 hours after vaccination. Patient complained of heart palpitations after school Friday. he said he felt them after PE class. He also experienced them on Saturday, 5/22 about 96 hours post-vaccination. I didn''t make the connection to his vaccine dose until his mom sent me a news report about it on 5/23.


VAERS ID: 1342066 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Shingles Vaccine
Other Medications: Olmesartan Medoxomil Tabs 20Mg, Claritin Reditabs 10Mg, Symbicort Inhaler
Current Illness: None
Preexisting Conditions: Asthma, Allergies - grass, pollen, High Blood Pressure, Watching for Type 2 Diabetes
Allergies: Not aware of any
Diagnostic Lab Data: None at this reporting
CDC Split Type:

Write-up: headache, very tired, achy muscles, chills, fever, nausea, chest discomfort


VAERS ID: 1342100 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling cold, Headache, Hot flush, Hyperhidrosis, Nausea, Oropharyngeal pain, Pain, Skin sensitisation
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: The evening of the shot, I felt a wave of chills through my body. I felt a sore throat begin. I felt light headed and nausea. By the time I went to bed, my body was extremely sensitive. Entering my bed was painful due to the cold sheets, the cold was contrasted by the occasional heat flash. The night was full of body aches, hot and cold flashes, and loads of sweating. I woke up with a headache and body soreness. That was the worst of it. Spent the remainder of the day resting in bed. Notes: I rarely get sick, maybe like this once every few years. I probably could have drank more water to flush out my system following the shot.


VAERS ID: 1342103 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-05-21
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Haematoma muscle, Iliac vein stenosis, Peripheral vein stenosis, Ultrasound Doppler abnormal, Vena cava filter removal
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin, Oxybutynin, Tiotropium, Pantoprazole, Metoprolol, Eliquis
Current Illness: N/A
Preexisting Conditions: Factor V Leiden gene mutation, HLD, HTN, CAD, Overactive Bladder, GERD, COPD, Morbid Obesity
Allergies: Azithromycin, Colchicine, Nickel, Sulfa, Acyclovir, Ciprofloxacin, Doxycycline
Diagnostic Lab Data: Ultrasound findings of the LLE acute nonocclusive superimposed upon chronic DVT in the proximal left superficial and profunda femoral veins in the upper thigh. Chronic nonocclusive DVT in the bilateral popliteal veins. Right medial thigh hematoma. -was on eliquiss pta bid and compliant
CDC Split Type:

Write-up: Past hx of dvt/pe/factor 5 leiden gene mutation- initially diagnosed in 2008 as a complication of back surgery-occurred post op. Was treated with warfarin for 11 yrs and due to constant blood draws was switched to xarelto 1 year ago 20mg which she didn''t always take with food. She was admitted on 10/20 with respiratory failure and at that time u/s of b/l le showed b/l dvts without PE thought to be provoked by her illness and hospitalization. She apparently had mx attempts at b/l femoral tlc in the ER.she was started on lovenox for the dvt''s but then developed a large hematoma and she was transferred to unity for placement of an ivc filter on 10/30/20 and was eventually placed back on eliquis. She had a venous doppler 3/3/21 with no evidence of acute dvt and mild narrowing of the L common femoral vein and prox superficial femoral vein c/w residual from old prior dvt. Because Recent ultrasound report showed resolution of prior extensive bilateral DVTs and Only minimal chronic thrombus was seen it was recommended that her IVC filter be removed and Her IVC filter was removed on 4/29/2021. At that time they noticed small caliber bilateral external and common iliac veins; she is scheduled to be seen in IR clinic next week to discuss potential venography, IVUS and angioplasty with stenting of the bilateral iliac veins. She was continued on eliquis after. Admitted to medical center with LLE acute nonocclusive superimposed upon chronic DVT in the proximal left superficial and profunda femoral veins in the upper thigh requiring lovenox 1mg/kg every 12 hours.


VAERS ID: 1342391 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anosmia, Dyspnoea, Hypoaesthesia oral, Immediate post-injection reaction, Neck pain, Oral discomfort, Paraesthesia, Pharyngeal swelling, Taste disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega3 fish oil sporadically
Current Illness:
Preexisting Conditions: Occasional facial herpes flare ups
Allergies: Cayenne pepper, some antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in face, then numbness sensation on lips, numbness sensation on tongueminutes after injection. Later sensation of palate and tongue having been burned by hot liquid or hot food. Slightly feeling of swollen throat. Altered sense of taste (example coffee did not taste the same as usual) slight loss of smell Feeling winded when breathing. Pain on let side of neck on Sunday. Still numbness and feeling burnt on Sunday


VAERS ID: 1342398 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, gliprizide , ozempic
Current Illness:
Preexisting Conditions: Type 2 diabetes
Allergies: N/a
Diagnostic Lab Data: I have not seen a doctor. (Yet)
CDC Split Type:

Write-up: On the evening I received my shot I ran fever, my body ached terribly my from my neck down and BOTH epitrochlear nodes located on the inside of my elbows were swollen (large - like small round balls). The right side was larger than the left one. They are still swollen today. I have not seen a doctor.


VAERS ID: 1342402 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Eye irritation, Muscle swelling, Myalgia, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Burning in eyes, ears and throat, swelling and pain of left deltoid


VAERS ID: 1342404 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site induration, Injection site mass, Injection site pruritus, Injection site warmth, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slightly more than a month, but tested positive for COVID-19 on 3/29/21 along with pneumonia as a result.
Preexisting Conditions: Pregnant and gave birth
Allergies: Avocado, Nickle
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccine was received at approximately 3:45 PM on 3/20/21; that night there was only mild arm pain and chills just before bed. Chills and a fever continued the next day (temperature at one point was 100.2 F). A small redness was found at the injection site. The following day (3/22) I found that the spot was much larger, warm to the touch, and there was a hardened lump if pressing down. I drew a circle around the redness to see if it was growing. On 3/23 there was some brief itchiness and the redness only seems to have expand slightly (this could also have been my husband not being 100% accurate as he traced it in a poorly lit hotel room). The lump is about the size of an orange.


VAERS ID: 1342406 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Cyanosis, Dizziness, Heart rate decreased, Hyperhidrosis, Hypotension, Vomiting projectile
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Blood pressure is taken at Hospital on May 21st, 2021 appx. 9pm
CDC Split Type:

Write-up: Shortly after vaccination felt dizzy and sweaty. After the feeling had passed patient felt 100 percent. 15 Mins later a second wave of dizziness happened, and the patient projectile vomited. Shortly after they vomited, her blood pressure was checked and was really low as well as heart. The collar bone to the bottom lip was blue. After 40 mins her heart rate and blood pressure slowly went back to normal. Was advised to go to the hospital via ambulance. At the hospital patient was 100 percent feeling good, and dotocrs checked her blood pressure to see if it was stable. It was.


VAERS ID: 1342425 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Fatigue, Pain
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: Losartan, Fluticasone nasal spray, advair inhaler, Otc allergic allergy medicine
Current Illness: None
Preexisting Conditions: Asthma. High blood pressure.
Allergies: Cleaning products, fragrance additives (asthma ), walnuts, bananas, cantaloupe. Mold.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 12 hours post vaccination, joint pain in hips and legs. 16 hours post vaccination chills and body aches. Followed by fatigue, continued body aches and loss of appetite for about 36 hours


VAERS ID: 1342430 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Chills, Dizziness, Fatigue, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft Wellbutrin Multivitamin Vit A and D
Current Illness: None
Preexisting Conditions: Arthritis Depression
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First 24 hours fever up to 101.5 nausea headache chills fatigue general body pains and aches. Then about 36 hours after injection dizziness and off balance, feeling like falling. Fever has resolved but mild headache persists.


VAERS ID: 1342589 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-07
Onset:2021-05-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram thorax, Fibrin D dimer increased, Pulmonary embolism
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None per patient
Current Illness: Patient denies
Preexisting Conditions: History of cerebral venous sinus thrombosis
Allergies: None known
Diagnostic Lab Data: Seen in ED on 5/23/21. Positive d. dimer led to CT pulmonary angiogram which showed bilateral PE''s. No evidence of cardiac effect.
CDC Split Type:

Write-up: Patient presented with chest pain and found to have bilateral pulmonary emboli. He was 2 weeks post 2nd dose of Moderna vaccine. He has personal history of cerebral venous sinus thrombosis and also has positive family history of DVT''s (mom had 2 DVT''s during pregnancies)


VAERS ID: 1342609 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

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

Write-up: Observed pt. sitting in a wheel chair with mom and EMT. Pt. awake, alert, verbal, complaining of feeling flush after taking 1st dose of Pfizer vaccine@12:43pm. Vitals taken by site EMT. Vitals within normal range. BP 114/72, O2Sat 100%. 12:55 pt. stated, "I''m feeling better now." Pt. observed by staff for 30 min. before leaving to go home. 1:20pm pt. left vaccine site to go home with mom with no signs of acute distress. Patient and parent educated by staff about Pfizer vaccine. Verbalized understanding.


VAERS ID: 1342918 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1342933 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Hypoaesthesia, Paraesthesia, Syncope, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: TINGLING IN FEET


VAERS ID: 1342943 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

Write-up: Child''s skin on forearm started peeling and is continuing to peel with a slight spread to upper arm. The top layer is the only layer that is peeling right now.


VAERS ID: 1342949 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Hyperventilation-Mild


VAERS ID: 1342953 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Systemic: Weakness-Medium


VAERS ID: 1342977 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: 1:16 Pt. c/o that she feels faint, also has nausea and vomiting. 1:25 Pt. report feeling better. 1:45 left site. BP 133/66, 81hr, O2Sat 100%1. 1:47 Patient reported feeling better. Mom was advised that if patient (daughter) still experiencing symptoms to consult 911 or family physician. Understanding verbalized.


VAERS ID: 1342980 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2021-05-21
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RA / IM

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

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

Write-up: WAS TESTED FOR PRE-ADMISSION TESTING 5/21/21 AND TESTED POSITIVE. PATIENT IS ASYMPTOMATIC


VAERS ID: 1343003 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2020-12-23
Onset:2021-05-21
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Person was vaccinated for COVID in January 2021. Tested positive for COVID 5/21/21


VAERS ID: 1343017 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01387 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dry throat, Pallor, Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Dry, itchy throat with some throat swelling. Clamminess, dizziness and paleness. Local emergency services requested for assistance


VAERS ID: 1343020 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C12A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SEVERE ARM PAIN, CHEST PAIN, WEAKNESS
Other Medications: tylenol pre vaccine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: SEEN AT URGENT CARE
CDC Split Type:

Write-up: HIVES 2 HOURS POST VACCINE NEEDED PO BENADRYL AND IM BENADRYL


VAERS ID: 1343032 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Mixed series. Patient is a deployed to an environment. Patient received Moderna vaccine on 21 April, was not available to receive second dose within required timeline due to mission requirements. Soldier then received Janssen vaccine on 21 May 2020. Patient has had no adverse health effects.


VAERS ID: 1343042 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMINS CITALOPRAM 10MG
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: TREE NUTS POLLEN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: BODY ACHES, HEADACHE


VAERS ID: 1343045 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

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

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

Write-up: Mixed series. Patient is a deployed to an environment. Patient received Moderna vaccine on 15 April, was not available to receive second dose within required timeline due to mission requirements. Soldier then received Janssen vaccine on 21 May 2020. Patient has had no adverse health effects.


VAERS ID: 1343047 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt came to desk stating felt like throat was "closing up and tongue swelling". Pt able to speak clearly, no audible wheezing or stridor noted, denies difficulty breathing. Taken immediately to ED, placed into room, nurse with pt and report given, Dr. with pt. No overt signs of anaphylaxis, but discharged with steroids, epi-pen, and benadryl and consulted on returning if new, worsening, or concerning symptoms arise


VAERS ID: 1343055 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: 1:28 108/57 - 90 - O2Sat 99%, Presented self with complaint of nausea, vomited digested food, color pale, no resp. distress. 1:40am Stated felt better after vomiting. Color pink. 1:57pm left obs. area. Inc to call 911 if symptom reappear.


VAERS ID: 1343063 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: List not available at time of this report
Current Illness: None
Preexisting Conditions: None
Allergies: Penacillin,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen injection site, red itchy, hard, painful. Whole arm pain. Tylenol and also Benadryl at night.


VAERS ID: 1343064 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral blood blister
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: seasonal allergies
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: blood blister on tongue, black looking in the middle of tongue slightly towards the left, raised about the size of the backside of a needle, no pain but feels something stuck on tongue.


VAERS ID: 1343069 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest pain, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity
Allergies: RX to other vaccines, not anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was extremely anxious prior to injection. Pt experiences chest, nausea, extreme anxiety immediately post injection. Immediate post injection symptoms and monitoring included pulse ox 99% for entirety of monitoring, BP 187/97 not typical for patient. 10 minutes into monitoring period, chest pain 6/10, BP 154/82. 15 minutes into monitoring CP 6/10, bp 167/84. Initiated EMS. EMS Arrived at 12:30. Transported to ED


VAERS ID: 1343077 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 KCHD / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Skin tightness, Swelling face
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Metformin, Hydrochlorothiazide
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: "Pfizer-BioNTech COVID-19 Vaccine EUA" Received vaccine Thursday evening, Friday evening noticed tightness in right side of face. Saturday morning woke up with right side of face very swollen. Did a video dr appt they advised to visit the ER, ER prescribed antibiotics. Facial swelling has continued to get worse and I have scheduled an appointment with my primary dr today. NO other symptoms just very swollen right side of face with no relief.


VAERS ID: 1343103 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Dry skin, Fatigue, Skin warm, Yawning
SMQs:, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BS - 137.
CDC Split Type:

Write-up: 9:35 c/o feeling really tired + continuously yawning, no resp. distress, skin W/D. BP 110/60-82, 99%. Advised to wait an additional 5 mins. Left observation area. Stated he still felt tired. In no distress. Mom driving.


VAERS ID: 1343122 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, Dizziness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BS 190
CDC Split Type:

Write-up: 3:10pm C/O Dizziness 3:30pm Patient reported feeling better. 182/87, 170/100, HR 82, O2Sat 97.


VAERS ID: 1343133 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12 1000 mcg tablet 1 tab(s) orally once a day Emgality Prefilled Pen 120 mg/mL solution 120 mg SQ qmonth Lo Loestrin Fe with iron biphasic 10 mcg-1 mg tablet 1 tablet po qday Vitamin D2 50,000 intl units capsule 1 ca
Current Illness: Seasonal Allergies
Preexisting Conditions: Arnold Chiari Malformation Type1 - complicated by hearing loss and vertigo Migraines with Aura Seasonal allergies Vitamin B12 Deficiency Vitamin D Deficiency Mild Thrombocytosis Hepatic Steatosis Mild mixed Hyperlipidemia
Allergies: NKDA, Seasonal Allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pruritic rash appeared on trunk next day, spread to down trunk and into arms


VAERS ID: 1343144 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lymph nodes swelled and tender around collar bone, in arm pit, and neck on right side about 12 hours after receiving the vaccination.


VAERS ID: 1343173 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-22
Onset:2021-05-21
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: famotidine 40mg 1 tablet PO BID
Current Illness: no
Preexisting Conditions: sleep disorder
Allergies: No known food, drug or medication allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: delayed urticaria


VAERS ID: 1343175 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin e/minerals/ complex vitamin/ natural sulfur/ digestive enzymes/ a & d (cod liver) vitamins and magnesium .
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: swelling, burning and itching in both feet (front area of toes)


VAERS ID: 1343195 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-16
Onset:2021-05-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Vertigo


VAERS ID: 1343199 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

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

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

Write-up: Itchy rash and bumps on upper body and in hairline. Some disappeared with use of benadryl cream within a couple of hours. Those in hairline and behind ears have itched for about 2 days.


VAERS ID: 1343203 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zertriline and guanfacine the night before receiving the vaccine (05/20/21)
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Eggs
Diagnostic Lab Data: Mother called PCP and would ask him to make recommendation
CDC Split Type:

Write-up: Patient reported feeling "nauseous" about 5 minutes after having received vaccine. Patient had an episode of syncope in the restroom. Assisted patient to sitting position was A&O x4, no signs of active bleeding or cuts. O2 saturation was 99% with HR of 83. Patient was able to swallow and answer basic commands.


VAERS ID: 1343206 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vit. D3, VIT. B-12, fluoxetine, folic acid, lamotrigine, levetiracetum, ondansteron, proair HFA, vimpant
Current Illness: history of seizures, PMH asthma and anxiety
Preexisting Conditions: seizures PMH asthma and anxiety
Allergies: chicken, derived latex/natural rubber
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given vaccine and shortly after experienced seizure activity, EMS was called and pt. was transported to ER.


VAERS ID: 1343228 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Pain, Peripheral swelling, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Swelling in the left armpit that spread to the left upper arm and the left rib cage. Feels like there is a baseball in my left armpit. It is painless most of the time, just uncomfortable. I did wake up in the middle of the night once due to pain associated with the swelling. The swelling started more than 24 hours after my second dose. It is still swollen four full days after my second dose.


VAERS ID: 1343229 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Diplegia, Dizziness, Dyspnoea, Gait disturbance, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, Pharyngeal swelling, SARS-CoV-2 test negative, Sensory disturbance, Spinal pain, Swelling face, Swollen tongue
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Takes Sprintec daily at bedtime. Last dose on Thursday, 5/20/21 at bedtime. No medications the day of vaccination
Current Illness: none
Preexisting Conditions: Asthma, chronic constipation
Allergies: Amoxicillin, Zithromycin, Shellfish, Contrast used for MRI
Diagnostic Lab Data: Tested for COVID as protocol to be admitted to Acute Care, it was negative.
CDC Split Type:

Write-up: Friday, 5/21 around 11:55 she received her first dose. 20 minutes later she complained that it felt like someone punched her in the face, and her left cheek was swelling. She looked woozy, with her eyes closing, and the nurses laid her down on the floor on a mat. Her tongue and throat began swelling, and she was having extreme difficulty breathing. She then could not feel anything from her neck down, like she was paralyzed. The nurse administered an Epipen and EMS showed up minutes later. In the ambulance, EMS administered another Epipen, gave her a steroid and Benadryl and rushed her to the hospital. Once at the ER, she was still having a hard time breathing, and could not feel anything from the waist down and could not move her legs. She also complained about her spine being in extreme pain around the mid to lower back. When her symptoms did not resolve, she was admitted to the hospital for observation and treatment. She had extreme pain in her joints - spine, hips, knees, ankles and toes, if someone tried to move them, she could not move on her own. She also had tingling and numbness that would travel up and down her body - weakness in her arms and legs. The medical staff continued with Bendryl - switched to Adderax, and Motrin and steroids (Prednisone?). She was discharged from the hospital Sunday, 5/23/21 in the afternoon. This morning (Monday 5/24/21) she is still experiencing back and leg pain, weakness and cannot walk with out assistance and it is extremely painful.


VAERS ID: 1343236 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ES0186 / 2 - / 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? 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: none
CDC Split Type:

Write-up: 72 yo man received Dose 1 Pfizer covid vaccine prior to acute admission. On 5/11/21, patient was admitted for lower extremity osteomyelitis unrelated to vaccinations. During this stay, Dose 2 Pfizer covid vaccine became due. On 5/21/21 a vial of Pfizer covid vaccine was sent to the patient care area for administration. The nurse drew up and administered 0.3 mL without first diluting. The patient did not experience any adverse reactions or adverse effects as of 5/24/21. Discharge is planned for 5/24/21.


VAERS ID: 1343239 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Ear pain, Feeling abnormal, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Low grade fever for 24 hours. Pain in muscles and joints, similar to flu. Pain in left ear still present 48 hours later. Fogginess of mind for first 24hours.


VAERS ID: 1343254 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Body temperature increased, Burning sensation, Lymphadenopathy, Pain, Rash, Rash erythematous, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, zyrtec ,hydrochlorothiazide
Current Illness: none
Preexisting Conditions: pcos
Allergies: morphine, ceclor, erythromyicen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: body aches, temp of 101 even while alternating advil and tylenol, swollen lymph nodes, red painful swollen rash on arm that burns and itches


VAERS ID: 1343259 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Lisinopril Lunesta
Current Illness:
Preexisting Conditions: High Blood Pressure
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Chills, Nausea, Headache, Hives (rash) on lower extremities - started at 4:30 a.m. following day (about 13 hours after injection), lasted approximately two days. Hives still present day 3.


VAERS ID: 1343277 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same redness, swelling & arm pain no fever
Other Medications: Keppra, xcopri, aspirin, losartain
Current Illness: 0
Preexisting Conditions: Epilepsy
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness at injection site which spread to entire upper arm combined with swelling & pain. Still exists today. On night after vaccine fever of 102 combined with chills for several hours


VAERS ID: 1343279 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Patient reported tingling/numbness of her right face at the corner of her lips and right temporal area. She did not reports or demonstrate any paralysis. She did not report or demonstrate any cardiorespiratory symptoms. She was observed for 30 minutes and released in stable condition. Later that day she reported resolution of symptoms after about 1.5 hours.


VAERS ID: 1343288 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Decreased appetite, Dizziness, Dry mouth, Dry throat, Ear pain, Emotional distress, Fatigue, Feeling abnormal, Head discomfort, Headache, Hyperhidrosis, Injection site pain, Injection site warmth, Limb discomfort, Musculoskeletal pain, Nausea, Pain, Pain in extremity, Pain in jaw, Paraesthesia, Pyrexia, Sleep disorder, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: During injection, felt pins and needles from injection site to fingertips which faded to tingling and stopped entirely after about 7 minutes. Intense nausea and sweating beginning 1-2 minutes post injection; unable to sit up. Lasted approximately 7-10 minutes before clearing up 2 hours later (7:10 pm), arm at and above injection site felt hot to the touch and had mild dull pain at every movement. Slightly dizzy and nauseous. Arm periodically ached without movement. By 7:26 pm, arm pain from movement was a sharp pain, though still pretty mild. Around 9:30 pm, gently pressed at site of injection and a jolt of pain went all the way down to my fingers Nausea increased at 10:13, still mild. Decided to go to sleep. Woke up at least 5 times before 12:30 am in various states of pain and discomfort, including nausea when attempting to sit up; dry throat/mouth; pins and needles throughout my glutes and thighs accompanied by pain in my left hip, knee, ankle, and jaw; and mild to moderate arm pain at the injection site. Took about 15 minutes to be able to get up due to nausea and got some water. Was cold so wrapped myself in a blanket. Nausea and arm pain with movement remained but I was able to go back to sleep around 1:15 am. Woke up at 2:53 am - arm pain minimal and nausea gone, blanket felt nice but unnecessary, went back to sleep Woke up at 5:34 am with pins and needles in glutes and thighs and pain in my right jaw, knee, hip, and ankle (all sites of previous moderate injuries) along with a low grade headache. Went back to sleep. Woke up after an hour or so feeling relatively normal, arm pain and headache returned after sitting up. Got out of bed but ended up taking another nap. Woke up after another hour with just a headache and brain feeling fuzzy, but strong tingles began returning to my glutes and thighs like they had fallen asleep (referred after this point as tingles). Arm hurt. Drank some more water and took another nap. Woke up around 9:15 am with a low grade headache and slight tingles; fuzzy brain feeling was gone. Legs wobbly when I walked. Realized that tingling got worse anytime I was sitting down or lying on my back. Around 10:20 am started crying - no known cause. Couldn''t stop for a few minutes. This is not normal for me. Around 1 pm realized I had a pretty high fever; unsure how high it was or how long I''d had it. Took another nap at 1:30 pm and woke up at 2:20 pm feeling much less hot so I thought it had broken, but I was told by my friend who dropped by that I was still feverish just much lower. Slept from about 2:45-3:55 pm; headache was much better when I awoke; tingles and sore arm remained. Realized at 4:13 pm that I''d had no appetite the whole day. I''d also barely been able to force myself to drink water; too cold and it hurt, room temperature didn''t feel right. No times, but felt periodic stabbing pain in my left ear until about 6:30 pm. Much else also recovered by 6:30 pm: felt well enough to drink cold stuff, tingles were low grade, fever was present but low. Arm was still sore. 7:08 pm headache was gone. 8:49 pm felt much better and able to do things and take care of myself with minimal discomfort, but felt a little lousy overall - low grade headache, head felt like there was some pressure in it, periodic tingles, achy arm. 9:29 pm felt exhausted and slightly achy but otherwise mostly normal. Felt some hunger twinges for the first time that day but nothing felt appealing (realized I had only eaten about 5 spoonfuls of soup the whole day). Fell asleep getting ready for bed; woke up at 10:49 pm and finished getting ready for bed then went back to sleep. Summary: Friday: Symptoms: mild to moderate nausea, mild dizziness, mild to moderate injection site pain, pins and needles in glutes and thighs, joint pain Treatment: drinking water Saturday: Symptoms: mild to moderate pain at injection site, headache, fever, nausea, tiredness, glute and thigh tingles, lack of appetite, periodic stabbing pain in left ear Treatments: ice/cold pack on arm (helped with arm pain while on), drinking water, sleeping


VAERS ID: 1343297 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast mass, Breast pain
SMQs:, Lipodystrophy (broad)

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

Write-up: Painful solid lumps developed in both breasts. I can not decide whether this has to be qualified as permanent damage or none of the above in Item 21, but out of precaution I prefer to have it referred to as a permanent damage as we are trying to understand what''s going on.


VAERS ID: 1343319 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Medical provider notified. Patient scheduled for a "third" dose 28 days from his early second dose. Patient verbalized understanding.
CDC Split Type:

Write-up: Patient received his second dose, 14 days after his first dose.


VAERS ID: 1343325 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Heart rate increased, Lymphadenopathy, Palpitations, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None until after to aid in symptoms experienced. Used: Onnit Labs: Shroom Tech Viru-Tech, Alpha Brain, Bullet Proof: Polyphenomenal and Eye Armor and Life Support: Super Greens (Usually Taken daily, in the afternoon, did not take these on d
Current Illness: None
Preexisting Conditions: None
Allergies: Allergies to Shellfish, and onions
Diagnostic Lab Data: Just used BP cuff at work to take pulse and pressure on 5/21.
CDC Split Type:

Write-up: Resting heart rate (HR) was at 64, resting blood pressure (BP) prior to vaccine was at 107/68 (Which is historically normal for me) About 30 minutes after vaccination the lights in the room started to appear as streaks. My HR shot up to 99 and BP was at 135/83. (My heart felt like it was going to burst out of my chest.) This level of elevated cardiovascular output was endured for about 3 hours. Treatment included meditation and conscious, focused intent to slow HR down and reduce BP. Lymph nodes were rock hard and it became difficult to talk or swallow. This seemed more of a normal vaccine response, it only lasted for about an hour, after I took my immune boosting supplements.


VAERS ID: 1343334 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Bruising at injection site. Bruising still present 5 days later


VAERS ID: 1343359 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: IBUPROPHEN 800 MG QID PRN PROTONIX 40 MG BID CARAFATE 1 GM QID OMEPRAZOLE 40 MG QAM ZOFRAN 4 MG Q 4-6 HOURS PRN
Current Illness: BARRETTS ESOPHAGUS, FIBROMYALGIA, ULCERS
Preexisting Conditions: HX OF CANCER, HX OF DVT, ULCERS, BARRETTS ESOPHAGUS, FIBROMYALGIA, GASTRITIS, DIVERTICULITUS
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: SEVERE HEADACHE AND LOWER EXTREMITY MUSCLE WEAKNESS


VAERS ID: 1343370 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Feeling hot, Hyperhidrosis, Influenza like illness, Migraine, Neck pain, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (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: zyrtec, Duloxetine, Trazodone, Zonisamide, Oxcarbazepine, Generic for Zomig as needed
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Currently on Migraine Diet so only eating 20 foods to avoid headaches. Known intolerances are dairy, soy, gluten and nuts.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received the injection at 10am. I felt fine until 3:15. Around 3:15, I started feeling like I was coming down with the flu. I could tell I was starting to run a fever because my eyes were feeling hot. That is how I always know I have a fever. By 6:30, I had to go to bed and was freezing cold with chills. My body was aching extremely bad as well. I was in flannel pajama''s and covered in blankets but could not get warm. I just shook and shivered for hours. My highest temperature got to 101.7. I was not able to sleep during any of this time also. My body hurt no matter how I laid. At 12:15am, my fever broke and I was sweating. My body still ached and for a few hours I laid sweating. I was not able to go to sleep until about 3:45am that night. The next day I felt better but my body still ached some, but less that the night before. My neck however was really hurting. Could possibly have been due to the chills??? I had a migraine and had to take a Zomig to relieve the pain. Sunday my body was still aching a bit but better than the day before. Overall just tired and run down on Sunday.


VAERS ID: 1343386 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Patient returned to the site of vaccination 4 hours after being vaccinated with bilateral forearm hives and erythema. This area was mildly pruritic. Treated with Diphenhydramine 25mg and VS were normal. She was observed and left without incident in the care of her mother.


VAERS ID: 1343402 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

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

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

Write-up: patients fainted, low blood pressure, transported for follow up


VAERS ID: 1343404 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-17
Onset:2021-05-21
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute coronary syndrome, Arteriogram coronary abnormal, Myocarditis
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Highly suspicious clinical scenario for myocarditis
Current Illness: None
Preexisting Conditions: Asthma GERD OSA
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute coronary syndrome with normal coronary arteries on coronary angiogram. Clinical presentation suggestive of myocarditis.


VAERS ID: 1343405 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-05-21
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, COQ10, Prolia, Diltiazem, Zetia, Levothyroxine, Magnesium, Multivitamin, Pantoprazole, Ropinirole, Sodium chloride tablets, Tumeric, Vitamin B complex
Current Illness: CAD, osteoporosis, hypertension, atrial fibrillation
Preexisting Conditions: CAD, osteoporosis, hypertension, atrial fibrillation
Allergies: Latex, Clarithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke despite being on anticoagulation. Patient ultimately discharge to hospice.


VAERS ID: 1343410 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Mood altered
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Prozac
Current Illness: Bacterial Vaginosis, Chlamydia
Preexisting Conditions: Major Depressive Disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mood changes (usually occur when I haven''t taken Prozac medication)


VAERS ID: 1343413 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage, Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: The patient called us and said she received her COVID vaccine of Pfizer on 5-21-21. She said when she received her vaccine she bleed and the person administering the vaccine wiped up the blood twice after administering the vaccine. She said he has a bruise from the shot.


VAERS ID: 1343433 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dizziness, Electrocardiogram, Flushing, Nausea, Pallor, Palpitations
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: NKA
Diagnostic Lab Data: 5/21/2021-EKG 5/21/2021-Ativan
CDC Split Type:

Write-up: Client received Janssen vaccine approximately 11 am on 5/21/2021. Complained of heart racing, panic feeling, anxiety, facial flushing, nausea soon after receiving injection. Appeared pale in color. Reports she was very anxious about getting the injection. Heart rate 149, blood pressure 161/92. 911 called and client was transported to hospital approximately 11:20 am. Blood pressure at that time 154/91, heart rate 130. Client was called at 3:53 pm 5/21/2021 and reports she was sent home from hospital earlier after receiving a shot of Ativan. She stated she did have an EKG while at the hospital and they took her vitals. She reports she was told it was anxiety and discharged. She had actually went back to work at 12:50 pm earlier in the day and was at work when I spoke with her. She said she "felt a little woozy but heart rate was good now and she was feeling pretty calm at work?. Had no other complaints at 3:53pm when I spoke with her.


VAERS ID: 1343435 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 RA / JET

Administered by: Private       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, Flonase, Flovent, Singulair, Zyrtec, Vitamin A, C, E
Current Illness: NA
Preexisting Conditions: Asthma, Obesity
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is here today for a covid vaccination. It was noted by RN that he was complaining of a headache. At 14:23, call placed to outside EMS. History of: Asthma Nursing Assessment: Airway: Open Breathing: Spontaneous Circulation: Pulse present Mentation: Alert Skin: Normal Patient monitored., Vital signs obtained and recorded. and Oxygen saturation level obtained. BP 118/70, pulse 88, O2 100. He was transported to the emergency department at Clinic via ambulance at 1423. Call type: Minor Time event completed: 1450


VAERS ID: 1343460 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient is here today for his covid vaccination. It was noted that he was unconscious. At 11:00, monitored by EMS for 15 minutes. History of:NA Nursing Assessment: Airway: Open Breathing: Spontaneous Circulation: Pulse present Mentation: Alert Skin: Normal Patient fainted after receiving Pfizer vaccine and was lowered to the floor, feet were raised, cold towels were applied to the patient''s face, and patient was monitored on site by EMS with no further incidence and released to home care with his parent at 11:20.


VAERS ID: 1343493 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt c/o flushing/sweating and lightheaded/dizziness immediately after vaccination. H/o lightheadedness with flu vaccine in the past. Pt ate rice and eggs at 2pm today, no breakfast. Pt''s symptoms resolved after drinking 500mL apple juice and laying down with knees bent. Advised taking 2nd dose supine. BP 109/69, HR 63, RR 18 -- $g 108/68, 64, 16 -- $g 112/79, 75, 16. Pt stable and released from the vaccination site.


VAERS ID: 1343494 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood gases abnormal, Chills, Dizziness, Heart rate abnormal, Hypoaesthesia, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Respiratory failure (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: bayer, flonase, cetirizine, azolastine, effexor, vitamins
Current Illness: N/A
Preexisting Conditions: headaches, allergies
Allergies: ABX (rash), demoral (vomiting), phenergan (RLS)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 5/21: aches that worsened into the night 5/22: 11 am- feeling faint, extreme N/V, shivering, numb hands halfway up forewarm, abnormal HR; 5 pm - feeling resolved 5/23-24: "feeling off" w/out the above or new sxs took 2 tab bayer 500 mg throughout ; stopped taking on Saturday


VAERS ID: 1343506 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt c/o lightheadedness. BP 129/67, HR 66, RR 18 -- $g 115/75, 75, 18 -- $g standing BP 115/78, HR 76 Pt given fluids. Pt stable and released from the vaccination site with father.


VAERS ID: 1343509 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-09
Onset:2021-05-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, fish oil, multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: mild milk allergy
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Itchiness starting in lower legs, arms, head, and back, started on Thursday, May 20, peaking on Saturday and Sunday, diminishing today, Monday, May 24. No related redness, splotches, or marks. No other symptoms related to shot.


VAERS ID: 1343518 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Chills, Diarrhoea, Dyspnoea, Fatigue, Hyperventilation, Myalgia, Pyrexia, Respiratory rate increased, Seizure
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Latex, shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: at 4pm the same day my stomach was really hurting and I was really tired with severe diarrhea. I went to bed at 8pm and woke an hour later at 9pm with a high fever of 102.2 I was shivering, I was convulsing and hyperventilating so I was having trouble breathing. I was unable to take any medication because I wasn''t fully alert at the time my husband got my to take chewable Tylenol my fever broke at about 2am. the next day I had a severe headache and muscle aches and bad back pain and still had diarrhea. It is not the 24th and my back is still hurting and my stomach hurts I''m still having diarrhea and am breathing like I ran a marathon.


VAERS ID: 1343523 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma - No chronic medications used at this time.
Allergies: Previous reaction to dose #1 Moderna
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o rapid breathing, dizziness, chest tightness. Pt has a hx of reaction to the first dose w/ "very fast heartbeats, wheezing, and sweating" that had started several hours after vaccination 3/23/21. PCP authorized second dose of Moderna. BP 112/79, HR 77, RR 20 -- $g 118/70, 70, 18 -- $g BP standing 119/70, 67, 14. Pt given Albuterol 2puffs ~20min post vaccination. Pt also given crackers, juice, water. Pt stable and released from the vaccination site. Recommended that the patient follow up with their healthcare provider, f/u instructions provided. Pt has a hx of Asthma but is not currently taking routine medications.


VAERS ID: 1343538 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o lightheadedness, dizziness, flushing/sweating, nausea. Pt vomited 200mL digested food. Pt given PO fluids. BP 93/42, HR 66, RR 20 -- $g 105/57, 59, 18 -- $g 108/60, 65, 16 -- $g 109/68, 68, 16. Pt was COVID positive Jan 2021 (s/sx body ach). No h/o fainting with vaccines or blood draws. Pt''s symptoms resolved after drinking water and laying down with knees bent. Advised taking 2nd dose supine.


VAERS ID: 1343554 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 RA / IM

Administered by: Private       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Patient denied any recent illnesses.
Preexisting Conditions: Pt denied any immunocompromising conditions or bleeding disorder, as per vaccine screening questions. No other medical history known or reported.
Allergies: Patient denied any allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A 16 year old male patient was vaccinated with the Moderna vaccine by this reporter, RN, while working wit Health Center''s street medicine team during efforts to vaccinate people experiencing homelessness in encampments in city. The patient was located in an encampment near the clinic. He screened negative for allergies and other contraindications to the vaccine prior to administration. This reporter realized after vaccinating the patient that he was 16 years old and below the eligibility age for the Moderna vaccine (18 years old). The patient was monitored post-administration, and no adverse reactions to the vaccine were noted. No treatment was necessary.


VAERS ID: 1343579 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / SYR

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna was inappropriately given to an individual <18 years of age. No adverse reaction to the vaccine.


VAERS ID: 1343586 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / IM

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

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

Write-up: The second dose was administered one week too early.


VAERS ID: 1343589 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / SYR

Administered by: Public       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: N/A
Current Illness:
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna was inappropriately given to an individual <18 years of age. No adverse reaction to the vaccine.


VAERS ID: 1343590 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Pt c/o dizziness. BP 103/84, HR 90, RR 16. Pt stable and released from the vaccination site.


VAERS ID: 1343594 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Sever fatigue , migraine, chest pain


VAERS ID: 1343595 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt c/o dizziness. BP 103/84, HR 90, RR 16. Pt stable and released from the vaccination site.


VAERS ID: 1343596 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022BZ1A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Headache, Injected limb mobility decreased, Malaise, Pain, Pyrexia, Sleep disorder, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm after a flu shot about 5 years ago. Age 55
Other Medications: No prescription meds. Vitamin C, vitamin D and echinacea. Motrin taken for pain and fever.
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 12 hours after vaccine was administered my arm at the vaccination site was very sore. I was extremely fatigued. Even so I had a fitful nights sleep feeling cold and under blankets. The next morning I was quite ill. I had a fever, aches and pains, extreme headache even after taking Motrin. My arm at the vaccination site was so painful that I had trouble moving my arm. I spent the day in a reclined position only getting up to go to the bathroom. The next night I slept better and my fever broke in the middle of the night. I woke up the next day feeling better but still had aches and pains and fatigue. I basically spent the day sitting around and taking naps. My arm was still sore but I could move it on this day. By the end of the day I felt much better. I was able to move my arm freely at this time. The next morning (today) I felt almost well but extremely fatigued.


VAERS ID: 1343605 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-05-21
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Constipation, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D Weekly Dose: 1 tablet Weekly carvedilol Oral 25 mg Dose: 1 tablet(s) 2 Times A Day trimethobenzamide Oral 300 MG Dose: 300 MG After Meals PRN lisinopril Oral 5 mg Dose: 1 tablet(s) 2 Times A Day linaclotide Oral 290 mcg Dose: 1
Current Illness:
Preexisting Conditions: Patient reports being diagnosed with diabetic gastroparesis. patient reports EGD 2mo ago, showing mild esophagitis.
Allergies: strawberry, Penicillins
Diagnostic Lab Data: SARS-COVID-19 resulted positive 5/21/21
CDC Split Type:

Write-up: PT admitted 5/21/21. SARS-COVID-19 resulted positive 5/21/21. Patient received Janssen covid vaccine 04/9/21 Lot 1808982. PT had presented to ER for with 1 week history of intractable nausea, vomiting and constipation. PT documented to be COVID -19 asymptomatic.


VAERS ID: 1343618 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Cyanosis, Dissociation, Pyrexia, SARS-CoV-2 test, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg, Effexor 75mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: Blood tests, chest x-ray, rapid covid test, urinalysis
CDC Split Type:

Write-up: Lips, finger nails, and toe nails turned blue/purple. Body convulsions caused by feverish chills, fever of 102.4. Unresponsive moments.


VAERS ID: 1343626 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Urticaria, Vaccination site pain, Vaccination site pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm/fatigue/rash on arm, 23, 4/28/2021, left arm intramuscular, Pfizer dose 1
Other Medications: Mirena IUD, Tums
Current Illness: Urinary tract infection
Preexisting Conditions: Chronic UTIs
Allergies: Fire ant bites, Tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue - onset: 2 pm after 10 am dose, lasting 48 hours Full-body muscle aches - onset: 7 pm after 10 am dose, lasting 15 hours Full-head headache - onset: 5 pm after 10 am dose, lasting 2 hours Hives on toes - onset: 8 am 48 hours after dose, lasting 1 day (still continuing) Itchiness and painful vaccination site - onset: 11 am after 10 am dose, lasting 72 hours


VAERS ID: 1343630 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW167 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Breast tenderness, Chest X-ray, Pain in extremity
SMQs:, Tendinopathies and ligament 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: None.
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Sending to have an PA/Left Lateral Cxr.
CDC Split Type:

Write-up: She presents complaining of tenderness over the left breast. Pain began this morning and worsened after a friend socked her in the left arm. Pain is rated 7 out of 10. Approximately, 15 minutes after sucking a 325 mg ASA in the Office pain is down to a "2."


VAERS ID: 1343642 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blindness transient, Cough, Dyspnoea, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PLAVIX, ZOCOR, CYMBALTA, BUSPAR, PROSCAR, SYNTHROID, LOPRESSOR, COQID
Current Illness: STATED ON 5/24/21 THAT HE HAD SEVERE SORE THROAT OVER A MONTH AGO THAT LASTED FOR ABOUT 3 WEEKS
Preexisting Conditions:
Allergies: PENICILLIN, ASPARTANE, PEANUTS
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT SAID HE HAS SEVERE MUSCLE ACHES, JOINT PAIN, COUGHING, HAD TROUBLE BREATHING AND WENT BLIND FOR A PERIOD OF TIME. ALSO NOTED HE HAS COUGHED UP STUFF SINCE THEN. DID NOT SEEK MEDICAL ATTENTION .


VAERS ID: 1343647 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspepsia, Feeling abnormal, Headache
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir, Inderal, Levothyroid
Current Illness:
Preexisting Conditions: Arthritis, Fibromyalgia, Hypothyroid, Asthma, IBS, Arrythmia, Urticaria, Herpes Simplex, Cornea Dystrophy
Allergies: Sulfa, Old Tetanus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, brain fog, weakness, sever indigestion, headaches (lasting more than 3 days)


VAERS ID: 1343653 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Disturbance in attention, Fatigue, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (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: MAGNESIUM, B12, MELATONIN, VITAMIN B, C, ZINC, OMEGA 3 (VEGAN), BCAA, MILK THISTLE, GYMNEMA SYLVESTRE
Current Illness: NONE
Preexisting Conditions: INSOMNIA, ANXIETY
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: After the first inoculation, I started having the side effects two weeks in with fever, chills and muscle pains throughout the body. I also experienced a certain mental restlessness and adrenaline rush while feeling physically tired. It went away after 3-4 days. Following the 2nd shot, I started feeling hazy and mentally restless again with physical fatigue the day after the inoculation. A week later, I had really strong stomach cramps with numbness in the entire right shoulder where I got the 2nd inoculation. Mental restlessness and physical fatigue were also common daily,


VAERS ID: 1343707 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Seizure
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 1 minute after receiving vaccine, patient experienced what appeared to be a generalized tonic-clonic seizure, lasting 4-4.5 minutes. The patient regained consciousness and was awake, alert and oriented x3. Patient and father refused transport by EMS to ED for evaluation. The patient''s father reported prior history of seizures after needlestick.


VAERS ID: 1343729 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fall, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted hospital on 5/21/2021 for vaccine reaction, received first moderan vaccine 5/20/21, severe nausea, vomiting, weakness, falls, history of severe COVID-19 infection with pneumonia and resp. failure requiring hospitalization and 02 in October 2020, had been well after, feeling back to normal 5/21/2021 AM, discharged home, follow up in clinic 1 week, Dr followed in hospitalization.


VAERS ID: 1343735 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Pain in opposite arm BP 143/92, HR 76, RR 18. Pt stable and released from vaccination site. Known hx of Right shoulder surgery. No Known hx of HTN.


VAERS ID: 1343753 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Immediate post-injection reaction, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt had a vasovagal episode right after the vaccine was administered. Pt c/o Flushing/sweating and dizziness. Initial BP 88/31 -- $g 124/66, 76, 16 -- $g 135/68, 67, 18. Pt recovered and was stable. Released from the vaccination site.


VAERS ID: 1343761 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Neuralgia, Pulmonary pain, Toothache
SMQs:, Peripheral neuropathy (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Pt states that he was around people who were sick a week ago, but did not get sick himself. Pt states that the person who was sick, did not have COVID.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt states the day after he received the vaccine, pt teeth hurt and he was having lung pain. Pt also stopped smoking the day he received the vaccine. Pt is unsure if symptoms are related to incident. Pt lung pain has resolved. Pt states that 2 days after he received the vaccine, he complains of hand nerve pain, with his middle and ring finger. The nerve pain is still present. Pt also complains about after getting the vaccine, days later that patient complains of foot/nerve pain. Pt was shot with a bullet in past and had nerve pain before in similar spot and it has returned after receiving the vaccine. Bullet fragments are still in patient.


VAERS ID: 1343767 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1343769 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt c/o dizziness. BP 121/69, HR 68, RR 18 -- $g 103/68, 67, 18. Pt reports that she did not drink much water today. Pt given water and juice, laid down/rest. Pt reports feeling much better after laying down. Pt stable and released from the vaccination site.


VAERS ID: 1343781 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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 (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: Na
Current Illness: No
Preexisting Conditions: No
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm is swollen, itches, hot and cold chills


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