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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 115 out of 3,524

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VAERS ID: 1347352 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

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

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

Write-up: PFIZER REQUIRES 1.8ML OF DILUENT TO BE USED BEFORE ADMINISTERING THE VACCINE. ONLY 0.8ML WAS USED, CAUSING ONLY 4 FILL DOSES TO BE IN THE VIAL. UPON GOING TO DRAW UP THE 5TH DOSE FOR THE DAY, I NOTICED THERE WAS NOT ENOUGHT LIQUID IN THE VIAL.


VAERS ID: 1347364 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: PFIZER REQUIRES 1.8ML OF DILUENT TO BE USED BEFORE ADMINISTERING THE VACCINE. ONLY 0.8ML WAS USED, CAUSING ONLY 4 FILL DOSES TO BE IN THE VIAL. UPON GOING TO DRAW UP THE 5TH DOSE FOR THE DAY, I NOTICED THERE WAS NOT ENOUGHT LIQUID IN THE VIAL.


VAERS ID: 1347380 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: PFIZER REQUIRES 1.8ML OF DILUENT TO BE USED BEFORE ADMINISTERING THE VACCINE. ONLY 0.8ML WAS USED, CAUSING ONLY 4 FILL DOSES TO BE IN THE VIAL. UPON GOING TO DRAW UP THE 5TH DOSE FOR THE DAY, I NOTICED THERE WAS NOT ENOUGHT LIQUID IN THE VIAL.


VAERS ID: 1347406 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Pain in extremity, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pain on left arm from shoulder to fingertips. Three inches in diameter red, itchy, and painful rash on left shoulder were vaccine was injected. Felt very fatigued and feverish for Two days after shot.


VAERS ID: 1347449 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Headache, Peripheral swelling, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: the day following vaccination she described worsening of chronic fatigue, headache, chest/rib cage discomfort, swelling of left arm and left face, hives under eyes and left face


VAERS ID: 1347506 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PHIZER / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Cough, Diarrhoea, Dyspnoea, Eye pain, Hypoaesthesia, Limb discomfort, Nausea, Pain in extremity, Palpitations, Pruritus, Pyrexia, Skin burning sensation, Uterine haemorrhage
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Numbness in left hand. Left arm heavy and sore.Fever. Chills. Cough. Heart palpable. Shortness of breath. Stomach cramps. Nausea. Diarrhea. Pain behind eyes. Burning itchy skin. Uterine bleeding.


VAERS ID: 1347513 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatine phosphokinase MB increased, Borrelia test, C-reactive protein increased, Cardiac telemetry normal, Chest pain, Computerised tomogram thorax normal, Coxsackie virus test, Cytomegalovirus test, Dyspnoea, Echocardiogram, Echovirus test, Ejection fraction, Electrocardiogram ST segment abnormal, Magnetic resonance imaging heart, Mononucleosis heterophile test, Mycoplasma test, Myocarditis, N-terminal prohormone brain natriuretic peptide increased, Parvovirus B19 test negative, Respiratory viral panel, Troponin T increased, Troponin increased, Varicella virus test
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Occasional multivitiamin; otherwise none
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA, no known allergies
Diagnostic Lab Data: Included in #18 - cardiac enzyme levels, transthoracic echocardiogram, cardiac MRI, etc.
CDC Split Type:

Write-up: Patient developed chest pain and difficulty breathing when lying down; symptoms started at 7pm on 5/21/2021. Seen in the emergency room at Hospital for chest pain, found to have elevated troponin level of 11.6 ng/mL (normal <0.05). CT chest negative for pulmonary embolism. Patient transferred to Medical Center. Initial high sensitivity Troponin-T level 1224 ng/L (normal <15), BNP 805 pg/mL (nl <300). EKG with diffuse ST segment changes. Echocardiogram (5/23 AM) with normal systolic and diastolic function, LVEF 58%; no pericardial effusion, no pathologic valve regurgitation. Patient admitted to telemetry monitoring bed (no arrhythmias noted during hospitalization). Patient treated initially with Ibuprofen 400 mg PO q6 hours and famotidine 20 mg PO q12 hours for presumed myopericarditis. Workup sent for viral causes of myocarditis: Respiratory viral panel negative. Infectious Myocarditis workup sent: CMV, Cocksakievirus A and B antibody, CMV IgG/IgM, Echovirus antibody, Infectious Mononucleosis Screen, Lyme C6 AB IgG/IgM, Mycoplasma IgG/IgM, Parvo IgG/IgM, Varicella IgG/IgM. Follow-up echocardiogram on 5/23 (PM) and 5/24 (AM) demonstrated no change in LV systolic or diastolic function. Cardiac enzymes, including high-sensitivity troponin T, CK and CKMB, were trended. Cardiac MRI was performed - preliminary results show evidence of myocarditis Lab Trends (earliest to most recent, as of 1 pm on 5/25/2021): High sensitivity Troponin T: 1224, 732, 664, 1058, 1332, 1141 CKMB: 65.6, 41.6, 19.3, 11.4, 6.3, 3.2 Pro-NT-BNP: 803,493, 392, 293 CRP: 58.2, 32.8, 28.6, 14.9. At the time of sumission of this report, the patient remains in the hospital. Further results will be communicated to VAERS.


VAERS ID: 1347516 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ECHO was normal on 5/24 and 5/25 and multiple ECGs with non-specific ST changes. Results of possible viral triggers of myocarditis are pending. Patient was transferred to the hospital for cardiac MRI, results unknown.
CDC Split Type:

Write-up: Myocarditis. Patient presented with chest pain and was found to have a troponin of 9.75. Pain resolved and troponin down-trended after treatment with IVIG and Solu-medrol. Patient''s brother has history of MIS-C after Covid. Patient had documented Covid in 10/2020.


VAERS ID: 1347522 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: Patient was only 11 at time of vaccination. Parent wrote "12" in age box on COVID-19 Vaccine Consent Form. No adverse events were reported.


VAERS ID: 1347568 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Not reported
Preexisting Conditions:
Allergies: Not on file
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Patient presents with a potential reaction to the COVID19 vaccine. The patient was evaluated in his vehicle as a passenger. He was responsive. He presented with signs and symptoms consistent with vasovagal syncope. He was placed supine with legs elevated and given oral hydration. Vasovagal syncope with rapid return to baseline with repositioning and hydration. Returned home with mother as the driver.


VAERS ID: 1347570 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Feeling abnormal, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4th day headache, brain fog, diarrhea, stomach pain, nausea 5th day dizzy, very dizzy, all day


VAERS ID: 1347601 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Diarrhoea, Electrocardiogram, Feeling hot, Headache, Myalgia, Nausea, Urine analysis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tacrolimus Mycophenolate Prednisone Magnesium Vitamin D3 Baby aspirin
Current Illness: None
Preexisting Conditions: Organ transplant recipient , kidney and pancreas
Allergies: None
Diagnostic Lab Data: 5/22 @ 7:30 pm - 1:30 am - emergency room visit. ECG, blood tests, urine test. Received IV fluids and anti nausea meds.
CDC Split Type:

Write-up: 5/21 @ 10:00 pm - 3:00 am extreme chills 5/22 @ 3:00 am - 5:00 am burning up, muscle aches 5/22 @ 5:00 am - 9:00 pm dull headache, nausea 5/22 @ 5:00 am - 6:00 pm diarrhea 5/22 @ 11:30 am - 5:00 pm vomiting


VAERS ID: 1347602 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: Buspirone
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given Pfizer vaccine instead of Moderna. Interval correct and CDC guideline says series is considered complete. No adverse reaction.


VAERS ID: 1347705 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Mobility decreased, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I called the clinic Mon (24th) and the nurse said this in normal is working good. Not good for me!!
CDC Split Type:

Write-up: Weds (19th) and Thurs (20th) tired no big deal arm wasn''t even sore. But Friday (21st) woke up about 7am couldn''t even stand up I was so dizzy. About 10 30am I started vomiting. I stayed in bed because of the dizziness for the next 4.5 days, until 2pm Tues (25th). During those days I vomited 2-3 times per day except Tues (25th) just 1 time of vomiting. However, I am able to get out of bed but I am still having the dizziness.


VAERS ID: 1347717 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known at this time
Current Illness: Not known at this time
Preexisting Conditions: Not known at this time
Allergies: Not known at this time
Diagnostic Lab Data:
CDC Split Type:

Write-up: This was an error on the part of our pharmacy for not catching this individual''s age prior to vaccine administration. All of our information and website is very clear about Pfizer being the only vaccine indicated under the age of 18 at this time, yet the parent signed this individual up for Moderna. The rest of the fault falls on our pharmacy for not catching the date of birth prior to administration as we just starting vaccinating individuals under the age of 18 last week.


VAERS ID: 1347722 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA WEST / 2 LA / SYR

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

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

Write-up: I have a red and itchy blotchy rash all over my torso that started from my vaccination site and spread. It started spreading slowly but it is spreading more rapidly now and is starting to spread lower onto my legs and bikini area as well. It is super itchy and painful, and more and more just keep popping up on my body at alarmingly increasing rates.


VAERS ID: 1347736 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Partial seizures
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Aspirin 81mg Chew Tab. Chew and swallow one ACTIVE tablet by mouth every day to reduce risk of heart attack or stroke crush prior to administering Galantamine Hydrobromide 8mg Tab. Take one tablet ACTIVE by
Current Illness: Active problems - Computerized Problem List is the source for the following: 1. Epistaxis 2. Herpesviral infection of perianal skin and rectum 3. Hematuria 4. Seizure 5. Hypertension 6. Chronic hepatitis C 7. Urinary incontinence 8. Dementia 9. Impaired mobility 10. Recurrent major depression 11. Syncope and collapse 12. Chronic Pain Syndrome 13. Low Back Pain * 14. Mood Disorder in conditions classified elsewhere 15. Cognitive Disorder NOS 16. Nasal Polyps * 17. Contact dermatitis and other eczema 18. Tinnitus * 19. Hematuria co-occurrent and due to irradiation cystitis 20. Spermatocele, epididymis 21. Hallux Rigidus 22. Closed Foot Fracture 23. Sleep disturbances * 24. Atypical Chest Pain 25. Barrett''s Esophagus 26. Hyperlipidemia 27. Alcohol Dependence * 28. Cannabis Abuse 29. Impotence of organic origin 30. Rhinitis 31. GERD * 32. Presbyopia 33. Hernia, Inguinal 34. Prostate Cancer 35. Hepatitis C * 36. Posttraumatic Stress Disorder * 37. Head Injuries, Closed * 38. Unspecified Housing or Economic Circumstance 39. Posttraumatic stress disorder (provisional) 40. History of positive purified protein derivative 41. Status post splenectomy 1971 42. Hyperlipidemia.
Preexisting Conditions: Active problems - Computerized Problem List is the source for the following: 1. Epistaxis 2. Herpesviral infection of perianal skin and rectum 3. Hematuria 4. Seizure 5. Hypertension 6. Chronic hepatitis C 7. Urinary incontinence 8. Dementia 9. Impaired mobility 10. Recurrent major depression 11. Syncope and collapse 12. Chronic Pain Syndrome 13. Low Back Pain * 14. Mood Disorder in conditions classified elsewhere 15. Cognitive Disorder NOS 16. Nasal Polyps * 17. Contact dermatitis and other eczema 18. Tinnitus * 19. Hematuria co-occurrent and due to irradiation cystitis 20. Spermatocele, epididymis 21. Hallux Rigidus 22. Closed Foot Fracture 23. Sleep disturbances * 24. Atypical Chest Pain 25. Barrett''s Esophagus 26. Hyperlipidemia 27. Alcohol Dependence * 28. Cannabis Abuse 29. Impotence of organic origin 30. Rhinitis 31. GERD * 32. Presbyopia 33. Hernia, Inguinal 34. Prostate Cancer 35. Hepatitis C * 36. Posttraumatic Stress Disorder * 37. Head Injuries, Closed * 38. Unspecified Housing or Economic Circumstance 39. Posttraumatic stress disorder (provisional) 40. History of positive purified protein derivative 41. Status post splenectomy 1971 42. Hyperlipidemia.
Allergies: Causative agent: ATORVASTATIN Nature of Reaction: Unknown Signs/symptoms: LIVER ENZYMES ABNORMAL Drug Classes: ANTILIPEMIC AGENTS Originator: NURSE PRACTITIONER Originated: Dec 09, 2019@16:17 Verified: Diagnostic Lab Data:
CDC Split Type:

Write-up: CONTACT NOTE: Patient and spouse on campus today for scheduled covid vaccine. Spouse is also caregiver. 1442- this RN responded to alert from Front desk identifying the patient and the report of his wife whom had brought him to the lobby for help as he had had a "Focal seizure". Unknown baseline moving forward- evident patient totaly dependent, unknown speech baseline. Right hand and bilateral legs contacted. This RN donning PPE as per above walked onto lobby scene with Wife controlling patient''s home wheelchair of which he was secured into with a gait belt. Per wife "He had his covid shot about 3 hours ago, he has a history of seizures" Patient unresponsive to name or sternal rub, radial pulse present, thready, even chest rise, eyes open, equal bilateral pupils. This RN wheeled patient to hallway also responding to the FD message, Team Nurses involved in patient''s care. This RN attempting to illicit response, some grimace to sternal rub. 1443 74/40 BP HR: 56 SPO2 87% RA- eyes open and reactive to light. Oxygen 4L applied. 1444- Patient responsive to sternal rub, follows commands to blink when he hears his name consistent with the assessment command "blink if you can hear me". 90/57 HR: 80 SPO2 100% 4 L NC 1450- able to grip with left hand, right hand contracted and with pulse oximetry applied. Respirations continue even and unlabored, saturations satisfactory, no verbal response, blinks at will, appears to be gaining lucidity. Decreased to 2L NC, moving head freely. 1500 86/56 78hr 1 L NC 99% with good non-verbal response, pupils contracting bilaterally equally in harmony, remains non-verbal. Able to grip and release RN fingers, move head freely, blink at command. Patient transferred to Gurney and transported. OF Note: EMS on standby for all of assessment from ~1445 forward. SBAR provided with known history, presentation, and known Dx on file. Wife/Caregiver to go with patient via ambulance, patient wheelchair stored, name on chair. All personal belongings : yellow cap, black bag, given to wife. Wife informed staff will follow up post discharge,understands to notify via call to staff of discharge from Hospital Facility: Hospital. OUTPATIENT MEDS: DRUG LIST As of May 21, 2021 This object does not handle Complex Pharmacy Orders. --------------------------------------------- ASPIRIN 81MG CHEW TAB GALANTAMINE HYDROBROMIDE 8MG TAB HYDROPHILIC (EQV AQUAPHOR) TOP OINT METOPROLOL TARTRATE 25MG TAB MULTIVITS W/MINERALS TAB/CAP (NO VIT K) OMEPRAZOLE 20MG EC CAP SERTRALINE HCL 100MG TAB TAMSULOSIN HCL 0.4MG CAP


VAERS ID: 1347753 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-12
Onset:2021-05-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Full blood count, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline, Aspirin, Atorvastatin, Betamethasone Cream, Cetirizine, Clotrimazole Cream, Flonase, Gabapentin, Glipizide, Lisinopril, Janumet, Metoprolol
Current Illness: None
Preexisting Conditions: Type 2 Diabetes Mellitus, Hypertension, Atorvastatin, Previous history of Stroke,
Allergies: NKDA
Diagnostic Lab Data: Severe Thrombocytopenia- CBC: 5/12/2021- Platelet Count: 11,000 Platelet count 5/14/2021: Platelet count: 21,000
CDC Split Type:

Write-up: Fatigue. Did Blood counts and had Platelet count of 11,000


VAERS ID: 1347767 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 5 minutes after receiving his first dose of the pfizer covid vaccine, the patient began feeling faint and ended up fainting while sitting down. He laid his head on his girlfriend''s shoulder and fainted. He was alert and conscious within 2 minutes. At that time, the patient said he does suffer from vasovagal syncope and frequently passes out when his anxiety is high. He denied our attempts to call for 911. After 30 minutes, the patient left under his own strength. His girlfriend drove them both home.


VAERS ID: 1347826 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-05-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Mango Shellfish
Diagnostic Lab Data: Pelvic ultrasound 5/21/21
CDC Split Type:

Write-up: 24 year old female with last menstrual period 3/26/21, received Pfizer mRNA COVID vaccine on 4/20/21. she had yet to take a pregnancy test. She received her 2nd vaccine on 5/18/21. Ultrasound was done on 5/21 when patient was expected to be 8 weeks pregnant, showing pregnancy loss.


VAERS ID: 1347845 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

Write-up: Swollen lips


VAERS ID: 1347857 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ear pain, Injection site pain, Neck pain, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (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: valacyclovir
Current Illness:
Preexisting Conditions: herpes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain in left arm (side of injection) but also pain in left neck, left ear, sore throat, pain and throat congestion continues 3 days later


VAERS ID: 1347862 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fatigue and low grade fever started 5/21 about 24 hours. Arm sore as well. Felt tingly skin n chest and stomach for 3 days. That has quit now. 5/24. Continued having low grade temp between 99 and 101 still on 5/25. No real appetite but probably due to fever. Can smell and taste. Just curious as to how much longer temp will continue to come and go? Assume fatigue is tied to fever.


VAERS ID: 1347892 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Erythema, Headache, Nausea, Pain, Pain in extremity, Pyrexia, Tenderness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st COVID VACCINE similar symptoms, but the COVID arm was not as bad
Other Medications: Estradiol patch Lexapro Vitamin E Citrical Vitamin D
Current Illness: None
Preexisting Conditions: Depression
Allergies: Dermabond Amitriptyline
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID Arm redness almost circumferential Arm pain and tenderness elbow to neck Should joint tenderness Fevers, severe headache, nausea, severe body aches


VAERS ID: 1347895 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07B21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Nausea, Pain, Pyrexia, Rash, Rash macular, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), 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: N/a
Current Illness: No
Preexisting Conditions: No
Allergies: Unknown
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Nausea vomiting rash fever body aches chills tiredness red spots again but day 4 this time


VAERS ID: 1347896 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactic acid, Blood test, Blood thyroid stimulating hormone, Chest X-ray, Computerised tomogram, Electrocardiogram, Full blood count, Loss of consciousness, Metabolic function test, Seizure, Thyroxine, Toxicologic test, Troponin, Urine analysis
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), 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: Zyrtec, traditional birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: LACTIC ACID, CT HEAD WO CONTRAST, URINALYSIS WITH REFLEX CULTURE, URINALYSIS WITH REFLEX CULTURE, TOXICOLOGY SCREEN URINE, XR CHEST PA OR AP 1 VW, CBC WITH DIFFERENTIAL, COMPREHENSIVE METABOLIC PANEL, TROPONIN, HCG QUALITATIVE SERUM, PROLACTIN, TSH, T4 FREE, EKG 12-LEAD (ALL TESTS LISTED PERFORMED 5/21/21)
CDC Split Type:

Write-up: Seizure and loss of consciousness, resulting in emergency room visit


VAERS ID: 1347900 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Deafness, Fall, Fatigue, Feeling abnormal, Hyperhidrosis, Palpitations, Sluggishness, Tinnitus, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Wellbutrin, fluoxetine, propranolol, vitamin D, vitamin B, vitamin C, daily probiotic, birth control pills, Prilosec
Current Illness: None
Preexisting Conditions: Anxiety, major depressive disorder, PCOS
Allergies: Sulfa drug allergy, food allergies to celery and sesame seed
Diagnostic Lab Data:
CDC Split Type:

Write-up: While at my doctors office for a routine visit, I experienced my body attempt to pass out, suddenly, as a blood sample was taken for a vitamin D test. I lost hearing with a ringing in my ears, was sweating profusely, could not support myself to sit up and my vision was going in and out, as I couldn?t keep my eyes open. My heart was racing, and the nurse said my lips went blue. The doctor and his nurses were able to get me into a bed and raise my feet above my head for 5-10 minutes to get the blood to come back to my head. I recovered within about 30 mins, as my heart beat slowly calmed, and my vision and hearing restored. The rest of the day and the following day I experienced severe fatigue and brain fog - it felt like I was moving and thinking in slow motion. A couple of days later I had a follow up with my primary care physician, as I was fearful from what I experienced. The doctor told me it happened because I had just been vaccinated with the 2nd shot the day before the blood was taken, and it somehow caused my body to go into shock. I have given dozens of blood samples over my life time and never experienced anything like that. I do not have fear of needles and am completely comfortable with having blood taken. What I experienced was scary. I genuinely felt I was going to die and it happened with no warnings, and at a seemingly random time. I experienced my heart racing uncontrollably after the first dose, but didn?t report it as I wasn?t sure it was significant. I want to share this experience because it was very traumatic for me.


VAERS ID: 1348068 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Pain in extremity
SMQs:, Retroperitoneal fibrosis (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: None
Current Illness: Stomach pain
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in arm, headache, temporary backpain


VAERS ID: 1348282 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-07
Onset:2021-05-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chills, Headache, Hyperhidrosis, Laboratory test, Myalgia, Nausea, Pyrexia, Tinnitus, Vertigo, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Celexa
Current Illness: none
Preexisting Conditions: thyroid
Allergies: none
Diagnostic Lab Data: General labs run on bloodwork performed on 5/25/21 detected no abnormalties.
CDC Split Type:

Write-up: Severe Vertigo with vomiting, fever, chills, sweating, nausea, muscle pain headache, and ringing ears.


VAERS ID: 1348292 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-02
Onset:2021-05-21
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood fibrinogen decreased, Blood lactic acid, Caesarean section, Coagulation test, Disseminated intravascular coagulation, Exposure during pregnancy, Fibrin D dimer increased, Full blood count, Haematocrit decreased, Haemoglobin decreased, Intensive care, International normalised ratio increased, Platelet count normal, Premature separation of placenta, Procedural haemorrhage, Prothrombin time prolonged, Transfusion, Vaginal haemorrhage, White blood cell count normal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: maternal coags initial postpartum: PT 18.6/INR 1.6/fibrinogen 159/D-Dimer 17.79. lactic acid 2.7 maternal discharge CBC: WBC 9.7/Hg 8.4/Hct26/plts 187 initial neonate ABG: 7.2/BE-12 APGARS 3/7 initial Hct: 48.9% Hct at time of neonatal code: 23% neonatal head US grade 1/2 intraventricular hemorrhage
CDC Split Type:

Write-up: Patient is a 32yo G3 now P2102 with EDC 7/20/2021 who was admitted with vaginal bleeding at 31w1d on 5/21/2021. She had an emergent C-section for presumed abruption with EBL 3700ml and subsequent diagnosis of DIC requiring mass-transfusion and ICU admission. Patient stabilized following transfusion, ultimately discharged from hospital 5/25/2021. Neonate died DOL#2 from prematurity/RDS/Anemia/suspected sepsis/metabolic acidosis/cardiopulmonary arrest..


VAERS ID: 1348293 (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: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st covid vaccine April 2021- fever, chill, body aches.
Other Medications: none
Current Illness: the mild adverse reactions reported after first vaccination dose.
Preexisting Conditions: Chronic neck/back pain, ulcerative colitis
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever, chills, body aches, dizzy, tired, nausea, weakness


VAERS ID: 1348321 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram oxalate 10mg daily. Over the counter vitamin d, vitamin e, iron
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None taken.
CDC Split Type:

Write-up: An irregular shaped 5inx5in bright red mark appeared about 1 inch below injection site and lasted three days. It was warm to the touch, looked a little swollen, and felt slightly itchy. Under the marking, one part of the skin/muscle felt firmer and more dense (hard to describe). It was not painful. The skin was not raised at all. This side effect only happened with 2nd shot in the series (first shot was also in the right arm).


VAERS ID: 1348629 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Eye swelling, Feeling abnormal, Headache, Heart rate increased, Lethargy, Pain, Palpitations, Pharyngeal swelling, Pyrexia, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Gastritis
Allergies: Amoxicillin, dairy, wheat, nuts, pineapple, watermelon other fruit
Diagnostic Lab Data:
CDC Split Type:

Write-up: At site-rapid heart rate, slight swelling of tongue abs slight throat ?swelling? (as though mistakenly ate nuts allergy trigger foods) -brief Fri 5/218pm severe body aches throughout the night. Slight fever. Aches not highly responsive to ibuprofen. Severe body aches stopped after valerian root was used 5/22 evening. 5/22 1:28 pm left Eye swollen. Ache on skull. Pain even when hair touched later in the day.Swelling gone following day. 5/ 24 Palpitations on left chest top. Palpitations gone by evening. 5/25 Brain fog and lethargy but no other symptoms.


VAERS ID: 1348630 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: the patient felt faint and had to sit down about 5 minutes after receiving the vaccine. He was found pale, but awake and coherent but groggy. He was able to call a ride, and get a ride home, so EMS was not activated. He did seem better after drinking a glass of water


VAERS ID: 1348645 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram normal, Full blood count normal, Metabolic function test, Nausea, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) 90 mcg/actuation inhaler Inhale 2 puffs into the lung busPIRone (BUSPAR) 5 mg tablet Take 5 mg by mouth BUSPIRONE HCL PO Take by mouth. cetirizine (ZyrTEC) 10 mg tablet Take 10 mg by mouth Cholecalciferol (VITAMI
Current Illness:
Preexisting Conditions: GERD Asthma Mixed anxiety and depressive disorder
Allergies: diphenhydramine (no rxn listed); carbamazepine (=hives)
Diagnostic Lab Data: BP=115/70, HR=62, RR=18, Temp=98.4, SpO2=99%, Wt=70.3kg, Ht=65in EKG=sinus rhythm, rate=75, narrow QRS, normal ST segments Troponin I = 4 ng/L CBC/metabolic panel within normal limits
CDC Split Type:

Write-up: [Chest Pain ] This is a 20 year old female who received the 1st Pfizer dose on 5/17/21. On 5/21/21 at 1723, the patient reported to our urgent care facility with a chief complaint of chest tightness (hurts when laying down), difficulty breathing, and nausea since the evening of 5/20/21. Given a recent Nexplanon insertion the day prior (5/20/21), the provider had a concern for possible PE so the patient was referred to the Emergency Department. The patient arrived at the ED and was seen by the provider on 5/22/21 at 0416. The patient continued to report chest discomfort as a heaviness, squeezing, ache. The pain was constant and worse upon taking a deep breath. Following a review of labs, EKG, Troponin, physical exam, the ED provider diagnoses ''chest wall pain'' and the patient was discharged home with instructions to f/u as an outpatient for any ongoing symptoms. No additional chart documentation as of this report date (5/25/21).


VAERS ID: 1348826 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: PATIENT FELT FAINT, HAD PALPITATIONS. EVENTUALLY FELT BETTER AND RETURNED HOME.


VAERS ID: 1349033 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Hyperhidrosis, Intermenstrual bleeding, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (very rarely); Non-smoker
Preexisting Conditions: The patient have no known drug allergies and being healthy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544617

Write-up: MENSTRUAL BLEEDING (VAGINAL BLEEDING); SLIGHTLY SWEATY; ARM PAIN; This spontaneous report received from a patient concerned a 36 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-smoker, and alcohol use, and other pre-existing medical conditions included the patient have no known drug allergies and being healthy. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 207A21A, expiry: 23-JUN-2021) dose was not reported, administered on 21-MAY-2021 14:00 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced menstrual bleeding (vaginal bleeding). On 21-MAY-2021, the subject experienced slightly sweaty. On 21-MAY-2021, the subject experienced arm pain. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from menstrual bleeding (vaginal bleeding), slightly sweaty, and arm pain. This report was non-serious.


VAERS ID: 1349034 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVETIRACETAM
Current Illness: Seizure (Takes seizure medication.)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544627

Write-up: VOMITING; This spontaneous report received from a patient concerned a 65 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included seizure. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included levetiracetam for seizures. On 21-MAY-2021, the subject experienced vomiting. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vomiting was not reported. This report was non-serious.


VAERS ID: 1349041 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Gastric dilatation, Headache, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SIMPONI
Current Illness: Intervertebral disc degeneration; Rheumatoid arthritis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544894

Write-up: DIARRHEA; REALLY BLOATED/STOMACH DISTENSION; BODY ACHES WORSENING FROM PREVIOUS LEVEL; ABDOMINAL PAIN; RASH ON THE FRONT OF THE RIGHT SHIN / RASH THAT GOES AROUND THE LEFT SHIN; POSSIBLE WORSENING OF PREVIOUS HEADACHES; This spontaneous report received from a patient concerned a 56 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included degenerative disc disorder, and rheumatoid arthritis. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. Concomitant medications included golimumab for rheumatoid arthritis. On 21-MAY-2021, the subject experienced diarrhea. On 21-MAY-2021, the subject experienced really bloated/stomach distension. On 21-MAY-2021, the subject experienced body aches worsening from previous level. On 21-MAY-2021, the subject experienced abdominal pain. On 21-MAY-2021, the subject experienced rash on the front of the right shin / rash that goes around the left shin. On 21-MAY-2021, the subject experienced possible worsening of previous headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from diarrhea, really bloated/stomach distension, body aches worsening from previous level, possible worsening of previous headaches, rash on the front of the right shin / rash that goes around the left shin, and abdominal pain. This report was non-serious.


VAERS ID: 1349046 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Body temperature, COVID-19, Fatigue, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cholesterol
Preexisting Conditions: Comments: Patient had no known allergies. Patient was on low dose of statin and taking medication for blood pressure.
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: Body temperature; Result Unstructured Data: 101.2; Test Date: 20210521; Test Name: Antibody test; Result Unstructured Data: unspecified; Test Date: 20210522; Test Name: Body temperature; Result Unstructured Data: 100.8; Test Name: COVID-19; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210544962

Write-up: BODY ACHES; HEADACHE; FEVER; FATIGUE; This spontaneous report received from a patient concerned a 67 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19 test negative, and antibody test, and concurrent conditions included cholesterol, and other pre-existing medical conditions included patient had no known allergies. patient was on low dose of statin and taking medication for blood pressure. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 21-MAY-2021 10:30 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced body aches. On 21-MAY-2021, the subject experienced headache. On 21-MAY-2021, the subject experienced fever. On 21-MAY-2021, the subject experienced fatigue. Laboratory data included: Body temperature (NR: not provided) 101.2. On 22-MAY-2021, Laboratory data included: Body temperature (NR: not provided) 100.8. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from body aches, headache, fever, and fatigue. This report was non-serious.


VAERS ID: 1349048 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210545077

Write-up: PUNCTURED JANSSEN VACCINE ON 20 MAY 2021 AT 11.45 AM ADMINISTERED TO A PATIENT ON 20 MAY 2021 IN THE MORNING; This spontaneous report received from a pharmacist concerned a 28 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1808986 expiry: 04-JUL-2021) .5 ml, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced punctured janssen vaccine on 20 may 2021 at 11.45 am administered to a subject on 20 may 2021 in the morning. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of punctured janssen vaccine on 20 may 2021 at 11.45 am administered to a patient on 20 may 2021 in the morning was not reported. This report was non-serious.


VAERS ID: 1349055 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Decreased appetite, Feeling cold, Headache, Injection site pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Penicillin allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210545389

Write-up: STOMACH HURT; VOMITING /THREW UP BROWN LIQUID; CAN''T EAT OR DRINK ANYTHING; FEELING COLD; BODY CHILLS; WEAKNESS; LEFT ARM PAIN; HEADACHE; NAUSEA; This spontaneous report received from a patient concerned a 40 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included penicillin allergy, non smoker, and non alcoholic. The patient experienced drug allergy when treated with amoxicillin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, expiry: UNKNOWN) dose was not reported, administered on 21-MAY-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced stomach hurt. On 21-MAY-2021, the subject experienced vomiting /threw up brown liquid. On 21-MAY-2021, the subject experienced can''t eat or drink anything. On 21-MAY-2021, the subject experienced feeling cold. On 21-MAY-2021, the subject experienced body chills. On 21-MAY-2021, the subject experienced weakness. On 21-MAY-2021, the subject experienced left arm pain. On 21-MAY-2021, the subject experienced headache. On 21-MAY-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from vomiting /threw up brown liquid, left arm pain, and nausea on 21-MAY-2021, had not recovered from headache, body chills, stomach hurt, weakness, and feeling cold, and the outcome of can''t eat or drink anything was not reported. This report was non-serious.


VAERS ID: 1349062 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210545686

Write-up: ADMINISTERED 2.5ML OF VACCINE; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-MAY-2021, the subject experienced administered 2.5ml of vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administered 2.5ml of vaccine was not reported. This report was non-serious.


VAERS ID: 1349076 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hepatic enzyme, Hepatic enzyme increased
SMQs:, Liver related investigations, signs and symptoms (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:
Current Illness: Non-smoker; Social alcohol drinker (Two weeks prior to having J&J Covid-19 vaccine the patient stated to have been heavily drinking at college.)
Preexisting Conditions: Comments: The patient had no history of any drug abuse or illicit drug use and no pre-existing conditions.
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: Hepatic enzyme; Result Unstructured Data: Elevated liver enzymes
CDC Split Type: USJNJFOC20210546894

Write-up: ELEVATED LIVER ENZYMES; This spontaneous report received from a health care professional concerned a 21 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included social alcohol drinker, and non smoker, and other pre-existing medical conditions included the patient had no history of any drug abuse or illicit drug use and no pre-existing conditions. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 16-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-MAY-2021, the subject experienced elevated liver enzymes. Laboratory data included: Hepatic enzyme (NR: not provided) Elevated liver enzymes. The action taken with covid-19 vaccine was not applicable. The outcome of elevated liver enzymes was not reported. This report was non-serious.


VAERS ID: 1349080 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Back surgery; Heart valve replacement NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210547006

Write-up: FEVER; This spontaneous report received from a patient concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included valve replacement surgery, and back surgery, and concurrent conditions included diabetes. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced fever. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride, and paracetamol. The action taken with covid-19 vaccine was not applicable. The patient recovered from fever. This report was non-serious.


VAERS ID: 1349089 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Cigarette smoker (Half a pack a day, every other day.)
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210547439

Write-up: LITTLE PAIN IN ARM; RED DOTS ON LEGS LIKE PURPURA; This spontaneous report received from a patient concerned an 80 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cigarette smoker, and non alcoholic, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. The patient experienced drug allergy when treated with azithromycin, and clindamycin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 07-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced red dots on legs like purpura. On an unspecified date, the subject experienced little pain in arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from little pain in arm, and had not recovered from red dots on legs like purpura. This report was non-serious.


VAERS ID: 1349707 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: My medications are Minocycline, Blackburn mixture, tacrolumis ointment ,clindamycin phosphate, and sodium sulfacetamide and Sulfur.
Current Illness: None
Preexisting Conditions: Sickle cell trait Morphea Scleroderma Adolescent seizures Heart murmur IBS Artritis Hearing loss as a child
Allergies: Sun allergy Oranges Grass Citrus acid Lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash began to occur around the vaccine site by the morning after given. Then by Saturday Morning it had spread across my upper back and shoulders. On Sunday , it was on my right arm and face. I used Benadryl and Calamine lotion to stop itching and spread.


VAERS ID: 1349762 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anger, Anxiety, Arthralgia, Chills, Depressed mood, Depression, Dizziness, Fatigue, Feeling drunk, Injection site pain, Irritability, Limb discomfort, Malaise, Mania, Restlessness, Tachyphrenia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Arthritis (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: Tetnus shot
Other Medications: Levothyroxine
Current Illness:
Preexisting Conditions:
Allergies: Tetanus shot, Zithromax antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the first 15 minutes started to feel very dizzy, 30 minutes after the shot depression and darkness came over me and lasted for about 90 minutes, still dizzy and felt like I was drunk plus my shoulder felt tight and heavy. Depression left after 1,5 hours , started to feel manic episode for 5 hours with racing thoughts, restlessness, irritation, anger, and not calm. Still dizzy, had chills. The next day and the day after that felt fatigued and not well, the place of a shot hurt.


VAERS ID: 1350377 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Pneumonia vaccination, 11/2020, Difficulty Breathing, Age 61
Other Medications: Arnuity Ellipta, Garlic, Olive Leaf, Omega 3 Fish Oil, D3, Collagen, B12
Current Illness:
Preexisting Conditions: Arthritis, Factor V Leiden
Allergies: Tomatoes, Erythromycin, Penicillin, sulfa drugs, Demoral, Darvacet, Percacet
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 5.5 hrs after vaccination - High fever with severe full body shakes lasting about 3 hours followed by a slight fever of 99.7 for about 16 hours, severe headache lasting about 24 hours, Full body aches lasting about 16 hours, tiredness lasting about 36 hours, moderate headache lasting about 3 days.


VAERS ID: 1350421 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Immediate post-injection reaction, Injection site discolouration, Injection site rash, Injection site swelling, Mobility decreased, Pain, Pain in extremity, Rash erythematous, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Immediately following the vaccine my arm was sore, hot and swelling started to occur. Throughout the day it got worse. The next day it was extremely painful, and hard for me to lift my arm. A rash was forming on the site of injection and injection point is yellow in color also extreme swelling. As of today May 26, 2021 I have a red rash patch approx. 4inches x3 inch on my right arm and a yellow dot where needle was injected. I feel fine, I can lift arm w/out pain, swelling has gone down completely. Rash remains.


VAERS ID: 1350426 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

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

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

Write-up: Patient came for second Pfizer vaccine. Vaccine was administered, then it was noted that first vaccine was given 5-7-21, and second dose was not due to be given before 5-28-21. No immediate side effects noted with after care.


VAERS ID: 1350443 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 014C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)


VAERS ID: 1350470 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-05-21
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood albumin decreased, Blood chloride decreased, Blood creatinine normal, Blood culture, Blood glucose increased, Blood lactic acid normal, Blood magnesium normal, Blood phosphorus decreased, Blood sodium decreased, Blood urea increased, Blood urine present, Brain natriuretic peptide increased, Bundle branch block right, COVID-19, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Electrocardiogram abnormal, Fatigue, Full blood count abnormal, Glucose urine absent, Haematocrit decreased, Haemoglobin decreased, International normalised ratio increased, Lung consolidation, Lung opacity, Metabolic function test abnormal, Neutropenia, Oxygen saturation decreased, Platelet count decreased, Pneumonia, Protein urine absent, Prothrombin time normal, Pyrexia, Red blood cell count decreased, SARS-CoV-2 test positive, Sinus rhythm, Urine analysis abnormal, White blood cell count decreased
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hospital Medications aspirin chewable tablet 81 mg(Held by provider) atorvastatin (LIPITOR) tablet 10 mg bisacodyl (DULCOLAX) suppository 10 mg calcium citrate-vitamin D (CITRACAL) 315-250 MG-UNIT tablet 2 tablet cholecalciferol (VITAMIN D3
Current Illness: Hospital Diabetes mellitus due to underlying condition with hyperglycemia, without long-term current use of insulin (HCC) Status post heart transplant (HCC) COVID-19 COVID-19 in immunocompromised patient (HCC) Neutropenic fever (HCC) Acute respiratory failure with hypoxemia (HCC) Chronic deep vein thrombosis (DVT) of left popliteal vein (HCC) Chemotherapy induced neutropenia (HCC) Thrombocytopenia (HCC) Steroid-induced hyperglycemia Moderate protein-calorie malnutrition (HCC) Non-Hospital Mixed hyperlipidemia Essential hypertension, benign Hypogonadism male Hx of steroid therapy Other depression Aftercare following organ transplant Anticoagulated on Coumadin Deep vein thrombosis (DVT) of other vein of left lower extremity, unspecified chronicity (HCC) Osteopenia, unspecified location Immunosuppressed status (HCC) Abnormal stress echocardiogram Rhegmatogenous retinal detachment of left eye Overweight (BMI 25.0-29.9) Prostate cancer (HCC)
Preexisting Conditions: Hospital Diabetes mellitus due to underlying condition with hyperglycemia, without long-term current use of insulin (HCC) Status post heart transplant (HCC) COVID-19 COVID-19 in immunocompromised patient (HCC) Neutropenic fever (HCC) Acute respiratory failure with hypoxemia (HCC) Chronic deep vein thrombosis (DVT) of left popliteal vein (HCC) Chemotherapy induced neutropenia (HCC) Thrombocytopenia (HCC) Steroid-induced hyperglycemia Moderate protein-calorie malnutrition (HCC) Non-Hospital Mixed hyperlipidemia Essential hypertension, benign Hypogonadism male Hx of steroid therapy Other depression Aftercare following organ transplant Anticoagulated on Coumadin Deep vein thrombosis (DVT) of other vein of left lower extremity, unspecified chronicity (HCC) Osteopenia, unspecified location Immunosuppressed status (HCC) Abnormal stress echocardiogram Rhegmatogenous retinal detachment of left eye Overweight (BMI 25.0-29.9) Prostate cancer (HCC)
Allergies: Heparin: Other Imdur [Isosorbide Dinitrate]Unknown Nsaids Spironolactone
Diagnostic Lab Data: COVID19 PCR, RAPID - Abnormal; Notable for the following components: Result Value Ref Range Status COVID-19 PCR Detected (*) Not Detected Final Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. All other components within normal limits COMPREHENSIVE METABOLIC PANEL - Abnormal; Notable for the following components: Sodium Level 128 (*) 134 - 146 mmol/L Final Chloride 95 (*) 98 - 112 mmol/L Final Glucose Level 303 (*) 70 - 99 mg/dL Final Blood Urea Nitrogen 28 (*) 8 - 20 mg/dL Final Albumin Level 2.5 (*) 3.5 - 5.0 g/dL Final All other components within normal limits PHOSPHORUS - Abnormal; Notable for the following components: Phosphorus Level 2.1 (*) 2.5 - 4.5 mg/dL Final All other components within normal limits URINALYSIS - Abnormal; Notable for the following components: Urine Glucose 100 (*) Negative, 30 mg/dL Final Urine Protein 100 (*) Negative mg/dL Final Urine Blood Trace-Intact (*) Negative Final All other components within normal limits PROTIME-INR - Abnormal; Notable for the following components: Prothrombin Time 12.1 (*) 9.5 - 12.0 Seconds second(s) Final All other components within normal limits COMPLETE BLOOD COUNT (CBC) W/O DIFFERENTIAL - Abnormal; Notable for the following components: White Blood Cell 0.04 (*) 4.00 - 10.80 x10*3/uL Final Red Blood Cell 2.95 (*) 4.60 - 6.00 x10*6/uL Final Hemoglobin 9.3 (*) 14.0 - 18.0 g/dL Final Hematocrit 26.9 (*) 42.0 - 52.0 % Final Platelet 21 (*) 140 - 400 x10*3/uL Final All other components within normal limits LACTIC ACID - Normal MAGNESIUM - Normal PRO B NATRIURETIC PEPTIDE BLOOD LVL - Normal PERIPHERAL BLOOD CULTURE PERIPHERAL BLOOD CULTURE Imaging: DR CHEST SINGLE VIEW Final Result Airspace opacities are seen involving both the lungs, more prominent in the right lung, as described above. These are likely due to consolidation/pneumonia. Viral pneumonia can also have similar appearance. Correlate clinically.
CDC Split Type:

Write-up: 71-year-old male with history of lymphoma on chemotherapy and heart transplant in 2011 on immune suppressants presenting with fever, fatigue, cough, shortness of breath x4 days. Patient is afebrile upon arrival with otherwise normal vital signs. He did desaturate to 88% while at rest and was placed on 2 L nasal cannula. He has clear breath sounds bilaterally without any focal findings. Work of breathing is not increased and very stable in my opinion. He appears clinically euvolemic and denies history of heart failure. No wheezing warranting treatment beta agonist. Patient will require admission given his acute respiratory insufficiency, will need to discuss appropriate Campus placement with the Heart Transplant Service and anticipate he will require transfer to Grand Rapids. Given his reported dyspnea, EKG ordered. Will obtain routine screening labs, COVID-19 swab. With his reported fever, although not objectively present during this visit, and current immunocompromised state, will treat via the emergency department sepsis protocol and collect blood cultures. Fri May 21, 2021 1059 EKG with a normal sinus rhythm, rate of 88 beats per minute, no acute ischemic changes are noted. Patient has a right bundle-branch block. EKG is unchanged from that of January 21, 2021. BNP is 404, no chest pain to warrant cardiac biomarkers. [SR] 1113 COVID-19 is detected. [SR] 1125 CMP was sodium of 128, chloride 95, glucose 303, creatinine 0.87. Magnesium is 1.9. Phosphorus 2.1. Urinalysis with trace blood, no urinary tract infection. Urinalysis without urinary tract infection. [SR] 1147 INR subtherapeutic at 1.2. [SR] 1149 Received a critical result from lab, white blood cell count is 0.04, patient is by definition therefore neutropenic. Platelets are 21 K without reported active bleeding. Hemoglobin is 9.3. Have a call out to Oncology to discuss need for IV cefepime given the reported fevers at home although etiologies presumably viral with COVID-19 test. Further, I do not know if IV Decadron is appropriate given his profound neutropenia, especially having recently finished a high-dose course of 100 mg prednisone orally x5 days. [SR] 1150 CXR: Airspace opacities are seen involving both the lungs, more prominent in the right lung, as described above. These are likely due to consolidation/pneumonia. Viral pneumonia can also have similar appearance. Correlate clinically. [SR] 1218 Discussed case with Dr. from transplant team who agreed with admission to his service . He did recommend that I broaden his antibiotic regimen to include both IV vancomycin and IV cefepime. He recommended that I do provided dose of IV Decadron despite the neutropenia to treat his acute respiratory failure secondary to COVID-19. Still awaiting call back from Oncology. [SR] 1454 After multiple pages, I have not been connected to Oncology. Patient was transported by EMS. He will need a formal oncology consult upon arrival to admitting facility. [SR]


VAERS ID: 1350479 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product storage error
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: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine left Health District at 10:45 AM and was mixed and given to patient at 1:30 PM. This was 45 minutes outside of two hour window.


VAERS ID: 1350508 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram T wave abnormal, Myocarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: past medical history of chronic paranoid schizophrenia and anxiety
Allergies:
Diagnostic Lab Data: Per his medical record, he had an elevated troponin and ST T wave changes on an EKG and was taken to the cath lab. Per medical record, he had left heart catheterization which did not show any coronary artery disease. The diagnosis that was reported was Myopericarditis/myocarditis
CDC Split Type:

Write-up: Per the nursing supervisor and medical records, this patient developed chest pressure, dizziness and shortness of breath 3 days after his second moderna vaccination.


VAERS ID: 1350529 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Unknown to provider, client was at mass clinic site for second dose of vaccine. Client had received first dose of Pfizer vaccine on 04/18/2021 from the site. She received Moderna vaccine from us on 05/21/21. Client had no adverse reaction to the incorrect series, but this was an administration error.


VAERS ID: 1350535 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Diarrhoea, Feeling abnormal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Severe vomiting for 8 hours and some diarrhea. Head fuzziness comes and goes along with nausea. Started May 21st, still have some nausea, slight diarrhea and fuzziness on May 26.


VAERS ID: 1350721 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Flank pain, Headache, Nasal congestion
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: HA, congestion, flank pain


VAERS ID: 1350724 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

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

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

Write-up: On Friday morning at work, I felt a sharp pain around the left side of my chest. It sharp pain comes and goes very often throughout the morning and day. I would describe the pain as a mini heart attack even though I never experienced a heart attack. Today, the sharp pain around my chest area isn?t as strong as before but I do not feel 100 percent. There is a feeling in my chest area that I can?t shake out. It could be all psychological but who knows.


VAERS ID: 1350728 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0011M20A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chapped lips, Glossodynia, Headache, Lip swelling, Musculoskeletal stiffness, Nausea, Pyrexia, Rash, Tongue erythema
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Multi Vitamin/Mineral Supplement, Heartburn Medicine (Prevacid)
Current Illness: none
Preexisting Conditions: Mycosis Fungoides
Allergies: Sulfur drugs, Codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 24 hours after the vaccine, my symptoms became much worse. My fever spiked to 103.3 and I had a severe headache, nausea, and muscle stiffness. My lips also swelled and chapped. After another 24 hours passed, I developed a rash on the lower part of my neck which has spread downward and covered the rest of my body now. As well, my tongue has become very sensitive and sore and has red streaks and tiny white bumps towards the back. After my first dose, I did have a higher fever and headache but not nearly as bad as the second time. I did have COVID in December 2020 but only had a fever of 101-102 and fatigue for a couple of days.


VAERS ID: 1350758 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysarthria
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None per Vaccine administration Record
Preexisting Conditions: None per Vaccine administration Record. Patient did write that she did not know if she has a reaction after receiving a vaccination including fainting or feeling dizzy.
Allergies: None per Vaccine administration Record
Diagnostic Lab Data: Patients blood pressure was taken with results of: 88/50 with pulse of 66 Second time 15 min later: 99/66 with pulse of 79 Third BP: 102/70 with pulse of 80
CDC Split Type:

Write-up: Patient felt faint and dizzy, the pharmacist and the patients mother talked to the patient but the patients words were slurred. Breathing exercises were tried with the patient. EMS were offered to be called but were declined twice. Blood pressure was taken and the patients mother purchased Gatorade to hydrate her.


VAERS ID: 1350827 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest pain, Coronary artery disease, Myocarditis, Palpitations, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Inappropriate Sinus Tachycardia Obesity Degenerative Joint Disease of the Spine Depression/Anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis with troponinemia to 4, no volume overload/heart failure. Presented with chest pain the day after vaccination, did not abate, associated with palpitations, went to the ED and found to have troponinemia. Treated conservatively. Left heart cath showed non obstructive CAD, preserved LVEF 55%, discharged home on colchicine.


VAERS ID: 1350842 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eyelid disorder, Injection site erythema, Injection site pruritus, Injection site rash, Pain in extremity, Rash, Rash macular, Swelling face, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen, Gabapentin, zinc, Vitamin D3, L-lysine, Simvastatin, Topiramate, Trazadone.
Current Illness: None.
Preexisting Conditions: Polycystic kidney disease, MS, COPD, high cholesterol.
Allergies: Morphine, Celexa, bees. Peanuts and Brazil nuts.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she only had her arm hurting. The next morning it itched where she got her shot and then she started breaking out with a rash that continued to get worse. She went to the doctor today as it was down both arms, on her hands, blotchy with bumps and this morning she started getting spots on her eyelids and the side of her face that started to swell. She saw a NP today who gave her a steroid shot as her right eye was starting to swell shut. Told her to continue taking Benadryl and to take Allegra in-between for the itching and to report this to VAERS. She has been taking Benadryl and the itching, which has helped some but not a lot, but was wearing long sleeves so she wouldn''t itch it. She still has a large red circle at the injection site and that''s where she initially scratched her arm.


VAERS ID: 1350857 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

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

Write-up: First dose was Pfizer vaccine; unavailable for 2nd dose in series-Moderna administered.


VAERS ID: 1350879 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Moderna COVID-19 Vaccine EUA : fever and muscle pain.


VAERS ID: 1350887 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LL / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Condition aggravated, Migraine, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole 40 mg, Famotidine 40 mg, Gabapentin 300 mg , Paxil 5 mg , Promethazine 25 mg , Cyproheptadine, Hyoscyamine 0.375 mg , Magnesium 250 mg , Rizatriptan Benzoate , Zofran 8 mg , Fluocinolone 0.1% , Eucrisa 2% , QVAR Rdeihaler , Midod
Current Illness:
Preexisting Conditions: Migraine history; Benign Hypermobility Syndrome Type III; on an NG feeding tube due to GI stomach problems, acid reflux; seasonal allergies
Allergies: Lactose intolerant; allergic to Amoxicillin, grasses, ant bites, dust; adhesive and latex sensitivities
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 103 degree fever, migraine, severe joint pain, GI got significantly worse (pain in stomach); went to ER; admitted overnight to hospital since they could not get the fever and migraine resolved; spent two days in the hospital treated with various medications including Tylenol and magnesium


VAERS ID: 1350951 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Constipation, Dehydration, Feeling abnormal, Feeling cold, Hallucination, Headache, Hyperhidrosis, Inflammation, Mobility decreased, Musculoskeletal pain, Pain, Pain in extremity, Somnolence, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Orencia quick click 3/31/21 and then again on 5/24/21.
Current Illness: None.
Preexisting Conditions: Rheumatoid arthritis with inflammation, fibromyalgia.
Allergies: None.
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: She got her vaccine, she came home, little soreness in the arm, was otherwise OK. She cooks all the time, and at about 6:30 she felt really sleepy, weak. She sat on the couch and told him that she felt weird, and started having chills. It was 90 that day and she was freezing, put an electric blanket on her and was feeling worse and worse. She called her husband at 9:30 as she was weak, dehydrated, severe banging headache not able to lift her head, weakness and she took 2 Tylenol. She kept freezing throughout the night and then going into sweats. She was out of it. She was hallucinating and seeing people that had already died in her life, her mother, father, sister and woke up not knowing where she was. She felt like she had to go to the bathroom, but her bottom was sore too. About 24 hours later when she tried to move from the couch to go to the bathroom which is 8 steps, she had shooting sharp pains in her lower back. She felt it was inflammation and she slowly got to the bathroom, and she is now in agony as she cannot sit to use the restroom. She is now having problems with her stomach and is constipated, and it got worse and worse. Her husband has a cane and he went to get it, and she is having a hard time to sit up to even move as the pain is unbearable. The pain got worse and worse, and she laid down all Saturday and they brought her food and drink as she cannot make any food, cannot bed, stretch or get into the shower as it is upstairs and she is not able to go up stairs. She feels terrible due to the pain that is in the lower back and shoots down to her legs, and having problems stretching her arm to reach, lift or bend. She feels crippled at this point. She went to her rheumatologist on Monday and got her Orencia shot for her RA. She is a walker, walks everywhere and is used to moving around, cooking and very mobile and now she cannot do anything of that. She is scared, wanting to know if she is going to get better or is she going to get worse. She lives on $1000.00 a month and cannot afford the copays to get her medicines and visits to her doctor and does not have the money to be able to take care of herself. Her regular PCP died in a car accident 3 weeks ago and is not able to see a doctor as she owes everybody due to the copays. She is now wondering where to go from there. She went to the ER yesterday and they were honest with her and told her that they did not know what to call it. They took x-rays of her spine and they saw inflammation and they told her that if she continues to have the symptoms that she needed to return to the ER. She said she would not go back as she has such severe pain and it is a struggle to get in and out of the car and the potholes cause severe pain. They gave her steroids and to get Lidocaine patches. She did not have this problem before the vaccine. She was very active and could dance, paint, etc., and has been doing the same thing for years ago and had to use a cane 8 years ago when she had minor knee surgery and now cannot walk without one.


VAERS ID: 1350960 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-13
Onset:2021-05-21
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Famotidine
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed Shingles 4 months after receiving the 2nd dose of Pfizer vaccine for COVID


VAERS ID: 1350965 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

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

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

Write-up: Patient received Moderna COVID-19 vaccine at the age of 15.


VAERS ID: 1350979 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Dyspepsia, Feeling abnormal, Pain
SMQs:, Dementia (broad), Gastrointestinal nonspecific dysfunction (narrow), Other ischaemic heart disease (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: Multivitamin
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Not yet
CDC Split Type:

Write-up: An hour after vaccination, it hurt around my heart and for 3 days there was pain in my collar bone on the left side, a lot of heart burn or air bubbles in my chest also, and now I''m scared to get the 2nd dose and I''ve not felt right since.


VAERS ID: 1351017 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 - / IM

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

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

Write-up: received Pfizer for 2nd dose; 1st dose was moderna


VAERS ID: 1351055 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis, Injection site reaction, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: Malignant melanoma, LE DVT
Allergies: NKDA, Seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Itchy raised dermatitis, non-hive appearance, distal to injection site


VAERS ID: 1351099 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydroxyzine, venlafaxine, metoprolol, B12, gabapentin, HCTZ
Current Illness: none
Preexisting Conditions: - sequelae of demyelinating disease (likely B12 deficiency in setting of alcohol use), residual weakness and lower extremity neuropathy bilaterally -HTN - alcohol use disorder - panic attacks and generalized anxiety
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe vertigo (symptoms highly c/w vertigo) accompanied by vomiting. unclear if symptoms more c/w labrinthitis or BPPV. pt does report episodic but frequently triggered. denies focal symptoms suggestive of vestibular stroke/central etiology. symptoms improving by 5/26 when reported, but not yet resolved.


VAERS ID: 1351126 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C210 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Oral contusion, Urticaria, Vertigo
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient started experiencing vertigo 10 minutes after receiving shot. She stated that she also developed hives on her hips and thighs. The following day She had bruising under her lips and chin. She went to healthcare provider who had her take discontinue her wellbutrin


VAERS ID: 1351144 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Hives
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving Covid 19 vaccine, patient reported airway felt like it was closing. Epi Pen was administered and 911 was called. BP 162/90, Pulse 75, Pulse Ox 99%. 10 minutes post Epi pulse 80, Pulse Ox 99%, BP 166/96. Patient discharged to ED via ambulance. Patient was stable in the ED and eventually discharged. Patient was not admitted to the hospital.


VAERS ID: 1351175 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear pruritus, Feeling hot
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulpha and Phenergan
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 45 minutes after the first vaccine of the Pfizer had a reaction that consisted of ears itching and getting hot. Patient took prednisone and better within hours.


VAERS ID: 1351209 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1069 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest X-ray normal, Chest pain, Computerised tomogram head normal, Computerised tomogram thorax normal, Fibrin D dimer normal, Headache, Laboratory test abnormal, Pain, Pain in extremity, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: Ddimer 2.00 Troponin 1658 Sed rate 52 CRP 74.9 CXR normal CT pulm arteries normal CT head normal Cardiac cath normal
CDC Split Type:

Write-up: Patient started having significant chest pain with radiating pain down right arm 3 days after vaccination. ED labs pulled showed possible NSTEMI. Admitted with workup. Cath showed no CAD. Developed headache on day 5. CT performed. Sent home on oxycodone and ibuprofen. Seen in my office today with some continued chest pain but headache unchanged.


VAERS ID: 1351213 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram, Magnetic resonance imaging, Pericarditis, X-ray
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate, divalproex sodium, levetiracetam, trazodone hci, guanfacine hcl, sertraline hi Now on colchicine, ibuprofen
Current Illness: No
Preexisting Conditions: Epilepsy. Autism,
Allergies: Trileptal, diazapam
Diagnostic Lab Data: Ekg, mri,x-rays
CDC Split Type:

Write-up: Chest pain, inflammation of heart sac, hard to breath


VAERS ID: 1351234 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Grip strength decreased, Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Approximately 12 hours after the vaccination, "extreme" arm pain and subsequent numbness occurred. She reports today that she has been to the emergency room twice in the subsequent days after the vaccination and is still having significant pain, numbness, and issues with her grip strength.


VAERS ID: 1351245 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Chief complaint: Fainting post vaccination 1500: Sat up and briefly felt better. Needed to lay back down due to feeling lightheaded and faint again. 1515: Reports feeling "a little better". Able to sit up again. Slight headache 1522: Sitting up in chair, drinking water, reports feeling fine. Went home with his mother


VAERS ID: 1351300 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Initial complaint: Feeling faint (holding head), both eyes starting to go black 1046 BP 110/70 HR 60 Said "feeling better" did not eat breakfast. Drank water and ae granola bar, vision improved. 1057 BP 115/72 HR 84 She stated she was feeling better after granola bar and water.


VAERS ID: 1351341 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Headache, Hyperhidrosis, Hypoaesthesia, Skin warm, Vertigo
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: Fluoxetine
Current Illness: denied
Preexisting Conditions: Celiac''s
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Initial complaint at 1353: Lightheaded, hot, cold, headache on right side, diaphoretic to the touch 1406 BP 110/70 HR 64 Denies SOB, tingling throat. Ate at 12 noon fruit and chips 1410 BP 122/72 HR 66 Worsening of headache on right side of head, room spinning. Hot/Cold flashes have passed. 1413 Spinning has stopped. Everything is bright. Clamminess has subsided 1417 R side of face numb. symmetrical grimace/smile 1419 Sitting up. Reports dizziness. Feeling melting down right side face. ***Documentation provided stops here.


VAERS ID: 1351343 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-05-21
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202!21A MDG 2 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: Na
Preexisting Conditions: Diabetes type2
Allergies: None
Diagnostic Lab Data: Nasal swab instant test at family doctor
CDC Split Type:

Write-up: Tested positive for covid 19 on 05/25/21


VAERS ID: 1351363 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Moderna COVID-19 Vaccine Fever, body aches, chills. Treated with acetaminophen, ibuprofen, and aspirin. Symptoms resolved in 48 hours. Left arm soreness, injection site swelling, redness, tenderness to palpation, skin around injection site itchiness, and warmth to touch. These symptoms present on 05/21/2021, and progressed throughout 5/22/21. Also treated with acetaminophen, ibuprofen, and aspirin. Used over the counter cortisone cream to address skin itchiness which provided short-term relief. Swelling , general left arm soreness, and warmth to touch nearly resolved on 05/26/2021. Slight red discoloration about the injection site remains as well as skin itchiness, and tenderness to hard touch/pressure.


VAERS ID: 1351452 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein increased, Red blood cell sedimentation rate increased
SMQs:, Arthritis (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: Wellbutrin XR 150 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Some labs done in ED, mostly normal, very mild elevation in ESR/CRP
CDC Split Type:

Write-up: Polyarthralgia significant enough to require ED evaluation for pain management (received Toradol and discharged)


VAERS ID: 1351543 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Lethargy, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received covid vaccination. Became lethargic, diaphoretic and pale in observation. Patient taken to ER for further evaluation. Pt left the ED after only being seen by triage RN; pt did not stay to see a provider.


VAERS ID: 1351590 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Dizziness, Lip discolouration
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Z pack
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of hearing and vision, everything dizzy for about 15 minutes Fainted Lips turned grey


VAERS ID: 1351620 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Autoantibody test, C-reactive protein increased, Chills, Dizziness, Flavivirus test, Full blood count, Headache, Metabolic function test, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV vaccine
Other Medications: Unknown
Current Illness: Developed a red popular rash over the lower legs and cramping in the lower legs on 5/14 (22 days after first COVID vaccine and 6 days before her 2nd vaccine). Had dizziness on 5/13, one day before second vaccine. The day after the second vaccine, she had nausea, myalgias, dizziness, fevers to 102 F, chills, and headaches. She has had persistent dizziness since then.
Preexisting Conditions:
Allergies: Gluten, adhesive tape/silicon
Diagnostic Lab Data: elevated CRP. Otherwise normal CBC, BMP, tick panel, connective tissue panel.
CDC Split Type:

Write-up: Developed a red popular rash over the lower legs and cramping in the lower legs on 5/14 (22 days after first COVID vaccine and 6 days before her 2nd vaccine). Had dizziness on 5/13, one day before second vaccine. The day after the second vaccine, she had nausea, myalgias, dizziness, fevers to 102 F, chills, and headaches. She has had persistent dizziness since then.


VAERS ID: 1351656 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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

Write-up: A large welted rash like spot covering majority of upper arm.


VAERS ID: 1351867 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-21
Onset:2021-05-21
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: alegra, Eliquis, Fluticasone propionate nasal spray, asmanex
Current Illness:
Preexisting Conditions: Long Hauler Covid 19, asthma, allergies
Allergies: Septra, oxycontin, hay fever, nickel
Diagnostic Lab Data: I was told based on the look of the rash that I had shingles 5/24/21 and that this was happening to people that had the pfizer covid vaccine
CDC Split Type:

Write-up: may 18th I notice small bumps on my upper right ribcage under my arm. three days later the bumps had grown in size and hurt went to doctors office and was told I have shingles. I have been given oral meds for shingles.


VAERS ID: 1351875 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NDC#59676-0580- / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Impaired driving ability, Impaired work ability, Loss of personal independence in daily activities, Mobility decreased, Pain, Pain in extremity
SMQs:, Dementia (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The soreness experienced continued for a week to the day of the shot and on the 8th day until the present became increasingly unbearable. I''m unable to dress myself because the pain in my left arm is excruciating. I can''t raise my arm for more than a foot from my side. I''ve taken ibuprofen and am using ice compresses, but it doesn''t help enough. So far I''ve missed 3 days of work. I cannot dress myself, so I know I can''t drive. Please advise. I also massage the sore area to keep my arm from stiffening up.


VAERS ID: 1351892 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Brain natriuretic peptide increased, C-reactive protein increased, Chest discomfort, Chills, Echocardiogram normal, Electrocardiogram T wave abnormal, Fatigue, Feeling hot, Hypotension, Nausea, Pyrexia, Troponin
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Imuran, prednisone, Plaquenil, famotidine, Vitamin D
Current Illness: None
Preexisting Conditions: Lupus
Allergies: None
Diagnostic Lab Data: Troponin 0.064, CRP 17, BNP 303, ECG with t-wave changes, normal ECHO
CDC Split Type:

Write-up: On 5/19 she got her first Covid Vacc (Pfizer). The following day she had mild fatigue and chills, but it did not interfere with activity. Then 5/21 PM she noted a discomfort in her chest. By yesterday she had marked chills, felt burning hot, c/o a mild ST and mild nausea and abd pain. Her chest discomfort (poorly characterized in location) worsened and she was brought to ER with concerns that she had another effusion. At the hospital, she had 24 hours of fever and hypotension.


VAERS ID: 1352164 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed mood, Hypoaesthesia, Migraine
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (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: Phentermine, but I didn?t take any 15 hours prior as suggested by pre-vaccine suggestions
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: None, honestly waiting for the second and whatever happens to come with that one!
CDC Split Type:

Write-up: Complete left side face and arm numbness along with a now three day migraine! Extremely unhappy this is what comes along with being forced to have something forced on me in order to work!


VAERS ID: 1352539 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Fatigue, Hot flush, Hypotension, Incoherent, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 50mg daily Clonazepam 1mg daily Omeprazole 40mg BID Multivitamin daily
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data: None available.
CDC Split Type:

Write-up: Pt. Had glucose level drops. Down into 60''s with no previous issue with hypoglycemia, pale skin in face. Severe fatigue, low blood pressure readings of 112/60 and 110/90. Hot flashes and nausea. Non-coherent with glassy eyes with no awareness. Fluctuations in symptoms and slept for Three days in and out. Pt. Took approx. Three days to feel back to himself.


VAERS ID: 1352986 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544416

Write-up: EXPIRED VACCINE ADMINISTRATION; THE PREFILLED SYRINGE WAS OUT OF THE 2 HOUR FRAME BY 15 MINUTES; This spontaneous report received from a health care professional concerned a 49 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-MAY-2021, the subject experienced expired vaccine administration. On 21-MAY-2021, the subject experienced the prefilled syringe was out of the 2 hour frame by 15 minutes. The action taken with covid-19 vaccine was not applicable. The outcome of the expired vaccine administration and the prefilled syringe was out of the 2 hour frame by 15 minutes was not reported. This report was non-serious.


VAERS ID: 1352990 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Delaware  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient refused to give details regarding allergies, drug abuse or illicit drug usage, alcohol consumption, smoking and lab details.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544638

Write-up: FEVER; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient refused to give details regarding allergies, drug abuse or illicit drug usage, alcohol consumption, smoking and lab details. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on MAY-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 21-MAY-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The outcome of fever was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment comment not required as per standard procedure as the case assessed as non-serious


VAERS ID: 1353010 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Fatigue, Headache, Injection site bruising, Injection site erythema, Injection site nodule, Injection site pain, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL; ROSUVASTATIN; AMBIEN
Current Illness: Asthmatic; Blood pressure high; High cholesterol
Preexisting Conditions: Comments: Patient had no known drug allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: Body temperature; Result Unstructured Data: 102.3 F
CDC Split Type: USJNJFOC20210547008

Write-up: BRUISING AROUND THE INJECTION SITE AREA; KNOT (BUMP) AROUND INJECTION SITE; INJECTION SITE SORENESS; REDNESS AROUND INJECTION SITE; FATIGUE; BODY ACHES; FEVER; HEADACHE; CHILLS; This spontaneous report received from a patient concerned a 54 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included asthmatic, high blood pressure, and high cholesterol, and other pre-existing medical conditions included patient had no known drug allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1808986, and expiry: UNKNOWN) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. Concomitant medications included lisinopril for high blood pressure, rosuvastatin for high cholesterol, and zolpidem tartrate for sleep. On 21-MAY-2021, the subject experienced body aches. On 21-MAY-2021, the subject experienced chills. On 21-MAY-2021, the subject experienced fever. On 21-MAY-2021, the subject experienced headache. On 21-MAY-2021, the subject experienced fatigue. Laboratory data included: Body temperature (NR: not provided) 102.3 F. On 22-MAY-2021, the subject experienced bruising around the injection site area. On 22-MAY-2021, the subject experienced knot (bump) around injection site. On 22-MAY-2021, the subject experienced injection site soreness. On 22-MAY-2021, the subject experienced redness around injection site. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fever, body aches, headache, bruising around the injection site area, knot (bump) around injection site, redness around injection site, fatigue, chills, and injection site soreness. This report was non-serious.


VAERS ID: 1353029 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210547939

Write-up: WHOLE VIAL ADMINISTERED TO PATIENT; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) 2.5 ml, administered on 21-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-MAY-2021, the subject experienced whole vial administered to subject. The action taken with covid-19 vaccine was not applicable. The outcome of whole vial administered to patient was not reported. This report was non-serious.


VAERS ID: 1353034 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Illness, Injection site pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210548236

Write-up: LIGHTHEADEDNESS; SICK; PAIN IN ARM; TIREDNESS; INJECTION SITE PAIN/ INJECTION SITE TENDERNESS; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 21-MAY-2021, the subject experienced lightheadedness. On 21-MAY-2021, the subject experienced sick. On 21-MAY-2021, the subject experienced pain in arm. On 21-MAY-2021, the subject experienced tiredness. On 21-MAY-2021, the subject experienced injection site pain/ injection site tenderness. The action taken with covid-19 vaccine was not applicable. The patient recovered from lightheadedness, sick, pain in arm, tiredness, and injection site pain/ injection site tenderness on 23-MAY-2021. This report was non-serious.


VAERS ID: 1353040 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Decreased appetite, Dizziness, Headache, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210548994

Write-up: LIGHT HEADEDNESS; SORE THROAT; CHEST HEAVINESS; APPETITE LOST; CHILLS; FEVER; HEADACHE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-MAY-2021, the subject experienced appetite lost. On 21-MAY-2021, the subject experienced chills. On 21-MAY-2021, the subject experienced fever. On 21-MAY-2021, the subject experienced headache. On 23-MAY-2021, the subject experienced chest heaviness. On 25-MAY-2021, the subject experienced light headedness. On 25-MAY-2021, the subject experienced sore throat. The action taken with covid-19 vaccine was not applicable. The patient recovered from chills, fever, and headache on 23-MAY-2021, and had not recovered from light headedness, sore throat, chest heaviness, and appetite lost. This report was non-serious.


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