National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 118 out of 10,493

Result pages: prev   19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217   next


VAERS ID: 1991892 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Medium


VAERS ID: 1991893 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Additional Details: pt experienced lighthead, flushing and mild sweating symptoms, had pt lay down on floor and elevate legs, took blood pressure (was 112/80, osat 99 HR 75). pt started feeling better, had drink water and retook blood pressure ( 126/70, osat 99 HR 71), pt called wife who came to pick him up, pt declined calling 911, had nurse practicioner take blood glucose at pt request was (117)


VAERS ID: 1991894 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted shortly after receiving Pfizer booster today. She was alert after 1-2 minutes. Her mother was with her and stated she faints after every immunization she receives due to needle phobia. Patient stayed longer than 15 mins and was fine. She was advised to drink lots of water today and to take it easy


VAERS ID: 1991896 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 3 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Additional Details: pt brought over by pharmacist to clinic- vitals 88/52 HR 80 glucose and fluids given- pt placed in supine position- improved with interventions-


VAERS ID: 1991898 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Pt given flu shot and Moderna booster in L arm. She moved chairs so I could provide same thing to her dad: as I was providing his flu shot she said she felt lightheaded; When i finished his shot dad noticed she looked wobbly and her eyes were rolling around. I held her shoulders and asked if her dad could help me lay her down and keep her legs elevated. She lost consciousness briefly but opened her eyes pretty quickly when her mom asked her if she was ok (she replied YES);ems came & assessedher


VAERS ID: 1991909 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zofran and multi vitamin
Current Illness:
Preexisting Conditions:
Allergies: Soy, chickpea, beans
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, extremely sore arm, chills, nausea, dizziness


VAERS ID: 1992041 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ685AA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Haemorrhage, Hyperacusis, Pallor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient was given the Pfizer covid-19 vaccine in his left arm. He switched seats and I gave him his flu vaccine in his right arm. He started bleeding so I removed the bandage and held pressure with a cotton ball. The bleeding stopped and there was a welt and the patient started to feel lightheaded and like he was going to black out. Patient appeared pale and out of it. Called 911 and patient put head between knees and drank water. Laid on the floor with feet elevated. Vital signs assessed. Patient reported vision better but echoing still in ears mildly. Condition improved before arrival of EMS.


VAERS ID: 1992045 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

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

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA 5-11 year COVID vaccine administered to a 4 year old patient. No adverse effects known at this time.


VAERS ID: 1992048 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-12-29
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: #ADHD #OSA smoker
Allergies:
Diagnostic Lab Data: COVID + 12/29/21
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1992054 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu like symptoms, body aches, headache, chills. 51 years old. Dose 1-Feb. 23, 2021. Dose 2-March 30, 2021. Moderna COVID-19 vac
Other Medications: Atorvastatin 40mg Lansoprazole 40mg Vitamin D
Current Illness:
Preexisting Conditions: Severe sleep apnea GURD
Allergies: Provigil Sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, headache from early morning day after booster until late evening. Approximately 12 hours.


VAERS ID: 1992057 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling, Facial paralysis, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol 300 once daily Took ibuprofen 400 at 11:30 AM the day after vaccination (12/29), and Benadryl at the onset of numbness (12:30 PM on 12/29)
Current Illness: NA
Preexisting Conditions: gout
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Itchy and swollen right eye, swollen right cheek right side corner of mouth seemed droopy, but may have been the swelling right side of chin swollen


VAERS ID: 1992059 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-12-29
   Days after vaccination:300
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Computerised tomogram thorax normal, Cough, General physical health deterioration, Hypoxia, Laboratory test abnormal, Malaise, Systemic inflammatory response syndrome
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient also received 3rd dose COVID Vaccine Moderna Lot# 050E21A 9/19/2021
CDC Split Type:

Write-up: chronic adrenal insufficiency, acromegaly and gigantism, chronic diastolic heart failure, previous CABG, remote history of PE, chronic dyspnea, type 2 diabetes, and history of stroke. He presents with symptoms, signs, and test results concerning for acute infection due to COVID-19 with systemic inflammatory response syndrome probably due to viral infection. He does have cough and is mildly hypoxic at rest intermittently raising concern for pneumonia, but no radiographic infiltrates were evident on chest CT performed yesterday. In addition to risk of pneumonia with hypoxic respiratory failure, he is also at risk for acute on chronic adrenal insufficiency, acute heart disease, and recurrence of venous thromboembolism, and he has had severe acute functional decline with generalized weakness and disequilibrium, so hospitalization is considered medically necessary.


VAERS ID: 1992067 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 1 RA / IM

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

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

Write-up: Nurse asked how old he was, he said 12. Grandma who has custody did not correct. He turns 12 in 2 weeks. He was given a full dose instead of a pediatric dose. When he comes back for his second he will be 12 and will receive a full dose. He had no reaction while waiting his 15 minutes.


VAERS ID: 1992074 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ3594 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient developed bilateral hand tingling. Diaphoretic approximately 11 minutes after the dose. Ice pack to the back of the neck, water/apple juice and saltines provided. Vital signs taken: BP 116/79 HR 71 Patient stated that he had not eaten all day; only had a large coffee prior to the vaccine dose. Patient also stated that he had not slept the night before. Patient refused to lie on the stretcher. He sat for an additional 10 minutes then stated he was feeling better, tingling resolved and he was ready to leave.


VAERS ID: 1992080 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-12-29
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient vaccinated 4/28/2021, 4/7/2021. Hospitalized COVID positive 12/29/21.


VAERS ID: 1992085 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-12-29
   Days after vaccination:334
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

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

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

Write-up: Fully vaccinated, not boosted. COVID breakthrough infection with inpatient hospital admit.


VAERS ID: 1992090 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Lethargy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus?fever, chills, sore arm
Other Medications: Glycopyrolate, Fluoxetine, Lorazepam , Fertile Aid, CoQ-10
Current Illness:
Preexisting Conditions:
Allergies: Ceclor, Bactrum
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Chills, Headache (worst symptom), fatigue, lethargy , sore arm


VAERS ID: 1992101 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-12-29
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Malaise
SMQs:

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

Write-up: Employee complained of not feeling well.


VAERS ID: 1992103 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-12-29
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Employee complained of not feeling well. T--101


VAERS ID: 1992110 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-12-29
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR + 12/29/21
CDC Split Type:

Write-up: Admitted to hospital with breakthrough COVID 12/29/21


VAERS ID: 1992116 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-15
Onset:2021-12-29
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Vaccinated dates: 11/15/2021, 3/19/2021, 2/19/2021. Hospitalized with symptomatic COVID 12/29/21.


VAERS ID: 1992117 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 4 RA / IM

Administered by: Private       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:

Write-up: We had a patient come in today for their appointment to receive a Moderna booster. The patient was vaccinated and felt fine after their waiting period. When we went enter their vaccination into the state registry, we saw that she had received a Moderna booster dose 9 days ago at one of our other locations. The immunizer did not notice anything unusual about the patients CDC card. We called the patient and they only had 3 doses on her CDC card (her primary Moderna series and the booster dose she received on 12/29), however, it was reported that the patient went to one of our other locations on 12/20 and the patient received a vaccination. Upon checking our EMR, they received a flu shot and a Moderna booster dose on 12/20. It was reported that the patient felt fine while we were on the phone with them and we advised they contact their PCP if any adverse events occur.


VAERS ID: 1992124 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-12-29
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: positive covid


VAERS ID: 1992125 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-12-29
   Days after vaccination:321
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: covid


VAERS ID: 1992130 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Birth control - tri-sprintec Womens one a day multi vitamin Vitafusion Power C vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up around 1 a.m. with my entire body shaking uncontrollably and a terrible headache. The shaking went on for nearly and hour while the severe headache lasted well into the next day.


VAERS ID: 1992131 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-21
Onset:2021-12-29
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: covid


VAERS ID: 1992136 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-09
Onset:2021-12-29
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

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

Write-up: covid


VAERS ID: 1992140 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily , Liberax , ( for IBS) Crestor, vitamin D with calcium And Zinc.
Current Illness: None
Preexisting Conditions: IBS
Allergies: I have had bad allergies to generic Liberax in the pass I ended in hospital. No doctor was able to tell what ingredient affected me .
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy above throat and swelling of tongue, I called pharmacist she advised to take Benadryl. 16 hours later still feel itchy waiting for doctor to return my call.


VAERS ID: 1992144 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 3 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? 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 under the age requirement to receive booster (15 years old), but was accidently given the booster dose for Pfizer. It had been 6 months since the patient received their second dose, given on 06-06-21


VAERS ID: 1992146 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-21
Onset:2021-12-29
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 12/29/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1992153 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-12-29
   Days after vaccination:328
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 12/29/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1992158 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LL / IM

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

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

Write-up: After administering Pfizer COVID-19 vaccine on 12/29/2021, it was discovered that 1.8mL of diluent was added to the 5-11 year dose vial instead of 1.3mL as required. Per CDC guidelines and pharmacy, it was recommended that this dose be administered again with the proper amount of diluent added. Patient came back to office and was given correct dosage. Monitored for 15 minutes continuously with no reaction and was discharged.


VAERS ID: 1992166 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-12-29
   Days after vaccination:316
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 12/28/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1992167 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

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

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

Write-up: A pediatric dose of the vaccine was administered instead of a 12 year old and up dose.


VAERS ID: 1992169 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-12-29
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

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

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

Write-up: Patient vaccinated against and then tested positive for COVID19


VAERS ID: 1992177 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-12-29
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated against and then tested positive for COVID19


VAERS ID: 1992183 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-12-29
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Blood sodium increased, Blood test, Blood thyroid stimulating hormone normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram spine, Electrocardiogram, Exposure to SARS-CoV-2, Fall, Head injury, Hypernatraemia, Hypoxia, Lung opacity, Oxygen saturation decreased, SARS-CoV-2 test positive, Skin abrasion, Troponin normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), 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), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Home Medications 1. Aricept 10 mg oral tablet : 1 tab(s) orally once a day (at bedtime) 2. carbidopa-levodopa 50 mg-200 mg oral tablet, extended release : orally 3 times a day 3. levothyroxine 125 mcg (0.125 mg) oral tablet : 1 tab(
Current Illness: unknown
Preexisting Conditions: dementia hypothyroidism GERD
Allergies: none known
Diagnostic Lab Data: Patient seen upon arrival to emerge department. Vitals are reviewed and noted for hypoxia, he is 86% on room air. He is placed on 4 L nasal cannula with an oxygen saturation of 93 to 94%. He does not appear to be in any acute distress. He does also have an abrasion to his forehead from the fall yesterday. He is not on any blood thinners. Patient will have an IV established, blood work performed, EKG, chest x-ray as well as a CT head and C-spine given his fall yesterday. He is also given Decadron 10 mg IV for his hypoxia, and will have a rapid Covid test performed. Did discuss given his hypoxia and progressive weakness with frequent falls, I recommended admission, and daughter at bedside and patient are agreeable to this. He will also be updated on his tetanus. Patient''s rapid Covid test is positive. Chest x-ray shows bilateral opacities, left greater than right. Patient will be given Rocephin 1 g IV and azithromycin 500 mg. Abs are reviewed, negative troponin. Sodium evaded at 150. TSH within normal limits. CT C-spine shows no acute fracture. CT head shows no acute findings. Admitting diagnosis Acute hypoxic respiratory failure Covid pneumonia Hypernatremia Frequent falls History of dementia
CDC Split Type:

Write-up: Patient is an 89-year-old male with history of dementia, hypothyroidism and GERD presenting to the emergency department with his daughter For low oxygen saturation. Daughter states patient lives alone and she brought him up here in hopes to place him in a facility, which she states she has been trying to work on. She states ever since December 13 he has had more frequent falls and progressive weakness. She states he fell yesterday and hit his head on the bathtub. He is not on blood thinners. She also noted today while he was eating breakfast his oxygen was 79%. Patient denies any feeling of shortness of breath, denies chest pain. He states the reason he fell yesterday was because he slipped. He has been vaccinated against Covid. He denies abdominal pain, nausea, vomiting or diarrhea. Daughter does note they had a family Christmas party on December 18, and a couple days later they were notified someone at the party was diagnosed with Covid.


VAERS ID: 1992184 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Nexium, Sucralfate
Current Illness: Gastritis, Gastric Ulcera
Preexisting Conditions:
Allergies: Peanut and Nuts Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA He had Injection site swelling the same day of the vaccine. He had mild fever for 36 hrs days since the day of the vaccine. The most bothering side effect has been the swollen lymph nodes in the left arm (injection site). It has been two days since the vaccine day and it is still swollen and painful.


VAERS ID: 1992187 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

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

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

Write-up: After administering dose of 5-11 year Pfizer COVID-19 vaccine, it was discovered that the vaccine was mixed with 1.8mL of diluent instead of 1.3mL of diluent. According to CDC guidelines, the dose should be repeated immediately in this scenario. Confirmed with pharmacy and they agreed with CDC guidelines. Staff from Pharmacy spoke with Pfizer and they stated they do not give treatment recommendations but they would follow CDC guidelines. She stated we can give the mother the option to administer another dose of the vaccine or to wait 3 weeks and draw antibody titers to see if he has antibodies. Mother chose to have another dose administered since they were in the office already. Second dose administered in different leg from first administration and patient was watched continuously for 15 minutes with no reaction, discharged home.


VAERS ID: 1992188 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-12-29
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Appetite disorder, Arthralgia, Asthenia, Back pain, Chest X-ray, Chest discomfort, Chest pain, Condition aggravated, Cough, Dehydration, Depression, Dizziness, Dyspnoea, Fatigue, Fibrin D dimer increased, Headache, Laboratory test, Nausea, Neck pain, Renal impairment, SARS-CoV-2 test, Urine analysis, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Home Medications: Current Home Medications 1. amiodarone 200 mg oral tablet : 1 tab(s) orally once a day 2. atorvastatin 20 mg oral tablet : 1 tab(s) orally once a day 3. colchicine 0.6 mg oral tablet : 1 tab(s) orally once a day 4. Coreg
Current Illness: unknown
Preexisting Conditions: history of CAD, CHF, sleep apnea, oxygen dependance, cardiac arrythmia, MI, pacemaker, AICD
Allergies: no known allergies
Diagnostic Lab Data: 3:22 PM patient appears dehydrated and will have an IV established and given a fluid bolus while we obtain some baseline abdominal and cardiac labs including Covid testing, chest x-ray and urinalysis. He will be given Decadron. Patient will have blood cultures and lactic acid as well. He will require admission. 4:22 PM patient remains alert and appropriate. Continues to oxygenate okay. He will be admitted for further care and treatment. 5:12 PM Case discussed with RPG who agreed to admit the patient for further care and treatment. Patient is critical and his condition is very guarded at this time. Patient does have elevated D-dimer however his impaired kidney function prevents any further evaluation with CTA at this time
CDC Split Type:

Write-up: Patient is a 76-year-old male with a history of coronary artery disease, prior MI, congestive heart failure with prior CABG and AICD placement. Patient is also oxygen dependent COPD and suffers from depression. He presents to the emergency room by EMS complaining of increasing generalized weakness, cough and shortness of breath over the last 4 to 5 days. He does state that several family members at home had for similar symptoms. He thought it was just a cold but it seems to be getting worse. Patient was vaccinated for Covid however it was approximately 8 months ago and he has not received a booster. Comfort to the anterior chest with coughing and deep inspiration. He was noted to have pulse oxygenation of 78% when EMS arrived at the house. Patient was 88% in the emergency room on 5 L nasal cannula. Associated Symptoms: appetite changes, back pain, chest pain, cough, depression, dizziness, fatigue, headache, joint pain, nausea, neck pain, shortness of breath, weakness, wheezing


VAERS ID: 1992189 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Hypoaesthesia, Interchange of vaccine products, Paraesthesia, Swelling, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza vaccine 2019 age 41 - Experienced shortness of breath and chest tightness.
Other Medications: None
Current Illness: No illnesses
Preexisting Conditions: No
Allergies: Sulfa Flu Vaccine
Diagnostic Lab Data: No lab or tests performed
CDC Split Type:

Write-up: Received moderna booster shot (Had J&J on 8/2021) on 12/28/21 approximately at 10:45am. At 7:00am woke up to numbness and tingling. Swelling started approximately at 2-3:00pm. Went to ER. Was seen by ER MD. He felt this was a reaction to the vaccine. Notified facility to let them know events. Was given IV Benadryl at ER about 5:30 PM and was sent home.


VAERS ID: 1992196 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 3 LA / IM

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

Write-up: Vaccine administered as a booster to 15yr old.


VAERS ID: 1992211 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Confusional state, Crying, Disorientation, Electrocardiogram normal, Fatigue, Foaming at mouth, Loss of consciousness, Musculoskeletal stiffness, Pallor, Seizure, Seizure like phenomena, Syncope
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), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC generic Zyrtec daily
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Arrived at Hospital approx 515PM on 12/29/2021. Blood test and EKG was performed. MD stated all looked normal. Diagnosed with a seaizure and syncopal episode following vaccination
CDC Split Type:

Write-up: Patient had seizure like activity 5 minutes after vaccine was injected. Turned pale white, body stiffened, convulsed, foamed at mouth, regained consciousness 2 times in and out before finally coming all the way back to consciousness. Patient woke up tearful and confused. Was disoriented and very tired/ weak for about 2 hours after injection.


VAERS ID: 1992212 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-12-29
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR + 12/29/21
CDC Split Type:

Write-up: Breakthrough COVID infection with admission to hospital 12/29/21


VAERS ID: 1992214 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-12-29
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Dyspnoea, Hypoxia, Malaise, Pneumonia, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Advanced COPD, Acute CHF, CKD (chronic kidney disease), Hypertension, Prediabetes
Allergies: ACE-1 (angiotensin converting enzyme inhibitors)
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: CHIEF COMPLAINT: patient BIBA with C/O increased SOB starting about a week ago. patient states he has not felt well since discharge from hospital with diagnosis of pneumonia in november. patient was 82% on RA. HISTORY OF PRESENT ILLNESS: 83 yo male with PMH of GERD/CVA/CHFCOPD/CKD/HTN/HLD and other medical issues as below came to ED due to c/o progressively worsening SOB and productive cough for 1 week. No cp/dizziness/palpitations/fever/chills. He had recent admission for PNA. He was hypoxic in ED. Chest xray was negative. He is covid positive. He got in steroids and remdesevir.


VAERS ID: 1992215 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 - / IM

Administered by: Public       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient should have received 30 mcg dose of Pfizer BioNTech vaccine. 10 mcg dose of Pfizer BioNTech was administered. Patient and guardians were immediately informed of the administration error. Clinician and Operations Chief educated patient and guardians that re-administration was not indicated, per CDC guidelines.


VAERS ID: 1992224 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site pain, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Childhood BCG vaccine scar redness and pain. Muscle/arm pain under the BCG vaccine scar about half an inch far from the covid vaccine. No pain at the moderna booster vaccine site after 1 day of vaccination. No treatment.


VAERS ID: 1992233 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Effexor, birth control, vitamin c, multivitamin
Current Illness: NA
Preexisting Conditions: Migraines, anxiety and depression
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brain fog the next day. Lasted 24 hours.


VAERS ID: 1992236 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-12-29
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna 3/3 and 3/31. Positive on 12/27


VAERS ID: 1992253 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Periorbital swelling, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Left eyelid puffy and sensitive following Pfizer booster shot 8 months after receiving Johnson and Johnson dose


VAERS ID: 1992262 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-12-29
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Bronchitis, COVID-19, Chest pain, Cough, Diarrhoea, Dyspnoea, Influenza virus test, Musculoskeletal chest pain, Pain, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM2, HTN, Cardiomyopathy, GERD
Allergies: NKA
Diagnostic Lab Data: Covid-19 test positive. Covid Flu PCR 12/29/2021.
CDC Split Type:

Write-up: 49-year-old female with past medical history of diabetes mellitus type 2, hypertension, gastroesophageal reflux disease, and cardiomyopathy leading to cardiomegaly and has not resolved per patient presented for approximately 1 week of cough, shortness of breath and now chest and rib pain. Patient reports that symptoms started on Friday and when she reported to the ED she was being treated for bronchitis. Patient states the shortness of breath and cough did not resolve with over the counter medications and that is what prompted her in. She states the chest pain feels more like rib pain due to consistent coughing and that is when she feels it. She endorses fevers, body aches, diarrhea and weakness.


VAERS ID: 1992268 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ear swelling, Oropharyngeal discomfort, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Adverse: Hives, facial swelling, ear swelling, throat discomfort


VAERS ID: 1992270 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 4 RA / IM

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

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

Write-up: PATIENT WAS GIVEN A SECOND BOOSTER, WHICH IS NOT INDICATED AT THIS TIME.


VAERS ID: 1992276 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-12-29
   Days after vaccination:306
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: stage 3 kidney disease, peripheral vascular disease, prediabetes, panlobular emphysema
Allergies: unknown
Diagnostic Lab Data: SARS-CoV-2 DETECTED USING PCR TEST ON 12-29-21
CDC Split Type:

Write-up: PATIENT HOSPITALIZED ON 12-29-21 FOR COVID-19


VAERS ID: 1992283 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Covid 19 dose 2
Other Medications: Sprintec birth control
Current Illness: N/a
Preexisting Conditions: Heart murmur
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Fever was 99.8 when I woke up then. Spike to 100.9. Dropped to 98.6 then back up at 99.9 . Body chills Body aches Weak Nauseous Headache Took Tylenol every six hours which was 4times of a dose of 2pills . Drank lots of fluids. And rested all day . Next day body aches temp was 99.4


VAERS ID: 1992289 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Swollen under left arm in armpit, slightly painful, pain radiates outward from swollen site


VAERS ID: 1992294 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-12-29
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR + 12/29/21
CDC Split Type:

Write-up: COVID PCR + 12/29/21 and admitted to hospital 12/29/21


VAERS ID: 1992318 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / SYR

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

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

Write-up: Swollen lymph nodes in armpit- size of a softball.


VAERS ID: 1992326 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm sometimes with flu shot over the years. Sore arm not as bad with 1st does of covid
Other Medications: None
Current Illness: None
Preexisting Conditions: No
Allergies: Antibiotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm with injection, raised bump 2 inches across, very sore spot in underarm, tired, fever for 12 hours. Took 2 Tylenol extra strength at 2pm and again at 10:30pm.


VAERS ID: 1992328 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL007 / 1 LA / IM

Administered by: Private       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: Tylenol
Current Illness: Ear infection 11/2021
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient given undiluted vaccine.


VAERS ID: 1992329 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Injection site rash, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash at injection site, Body aches, chills, dizzy, nausea & low grade fever. These symptoms started at 2am on 12/29/2021 and ended at 4:40 am then reoccurred on 12/30/2021 in evening for a couple hours and then disappeared.


VAERS ID: 1992332 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-14
Onset:2021-12-29
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, Malaise, Vaccine breakthrough infection
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Fully vaccinated, not eligible for booster. COVID symptomatic breakthrough infection with inpatient hospital stay. 35 w pregnant. Not in labor and baby showing no distress.


VAERS ID: 1992335 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL007 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect route of product administration, No adverse event, Product preparation issue
SMQs:, Drug abuse and dependence (broad), 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: None
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine given from undiluted vial. No adverse outcomes noted. asked parents to watch for any signs or symptoms and report to clinic immediately.


VAERS ID: 1992339 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL007 / 2 LA / IM

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

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

Write-up: Child was given vaccine from an undiluted vial. No adverse affects at this time. Parents notified to monitor for any sign or symptoms of reaction and call clinic immediately.


VAERS ID: 1992344 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 5D753 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: no adverse event. due to mix up with multiple people waiting for different vaccines pt received a shingrix vaccine she was not intended to get. she did receive the moderna booster she came in for after receiving the shingrix. the physician was notified (called her office twice) and we are awaiting a follow up call to determine if pt has received the shingrix series before or if the provider would like her to receive the second vaccine if this was her first. (the patient does not think she has ever received the shingrix vaccine) i phoned the patient today to follow up and she states she only has normal arm soreness from vaccination.


VAERS ID: 1992350 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-12-29
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / UNK - / -

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

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

Write-up: covid symptoms and positive test


VAERS ID: 1992363 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA L039F21A / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 12-6-21 got the Pfizer booster. Then got Moderna booster (0.25 mL) on 12-29 in error
Current Illness: 12-6-21 got the Pfizer booster. Then got Moderna booster (0.25 mL) on 12-29 in error
Preexisting Conditions: 12-6-21 got the Pfizer booster. Then got Moderna booster (0.25 mL) on 12-29 in error
Allergies:
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Pt wanted a flu shot, but instead sas administered Moderna Covid shot (0.25mL) on 12-29. He got the Pfizer booster on 12-6-21


VAERS ID: 1992376 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA -13F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Feeling of body temperature change, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: All covid vaccinations with same response
Other Medications: none
Current Illness: none
Preexisting Conditions: back issues
Allergies: Erythromycin, Nubain, demerol
Diagnostic Lab Data: none
CDC Split Type:

Write-up: sore arm, hot and cold flashes followed by low grade temp up to 100.3 F, chills, nausea and weakness x 36 hours


VAERS ID: 1992380 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 1 LA / IM

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

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

Write-up: Pt received Regeneron mab on 12/17 and presented for vaccination on 12/29, it was mistakenly administered.


VAERS ID: 1992389 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

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

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

Write-up: Father requested Pfizer booster for pt. VAR form was completed by patient''s father; he wrote down DOB and the age of 16 yeas old. When counseling prior to administration, Rph noted the age of 16 years written on VAR form and proceeded with vaccination; Rph realized that pt was only 15 years old during batching of the record. Pt is not experiencing any adverse reactions. Family is not upset. Report submitted since Pfizer booster is currently only authorized for ages 16 years and up.


VAERS ID: 1992396 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028821A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Chills, Pain
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Raised blood sugar to over 350 the night of 12/29 body ache and chills


VAERS ID: 1992398 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Heart rate increased, Hypoaesthesia, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Left arm numbness/weakness, nausea, fatigue, rapid heart rate. Symptoms resolved over night


VAERS ID: 1992430 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Dysphonia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient experienced chest pain, shortness of breath within 5 minutes of vaccine receipt, which resolved but was followed by dysphonia


VAERS ID: 1992443 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Shakiness-Mild


VAERS ID: 1992462 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-12-29
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, Road traffic accident, SARS-CoV-2 test
SMQs:, Accidents and injuries (narrow), Arthritis (broad), COVID-19 (broad)

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

Write-up: Patient came to ED for neck pain from a recent but previous MVA. Patient was tested for COVID while in ED. Not sure why except high incidence in community at this time.


VAERS ID: 1992472 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

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

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

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


VAERS ID: 1992483 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-23
Onset:2021-12-29
   Days after vaccination:340
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Hospitalized 12/29/21 2nd covid vaccine 2/13/21, pfizer. Lote and location unknown 3rd pfizer covid vaccine 9/29/21, FF8841, IM L arm


VAERS ID: 1992490 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ778AB / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Extrasystoles, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Dehydration (broad), Hypokalaemia (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: aripiprazole, bupropion, b-12
Current Illness: cold
Preexisting Conditions: none
Allergies: gluten allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Heart beating faster and not a regular rhythm. Felt like missing beats, and gradually slowing. Shortness of breath upon minimal exertion. Took diltiazem and ingested soy milk to increase Mg+2 and K+. As of time report being submitted, symptoms are residing but not completely gone.


VAERS ID: 1992501 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 4 LA / IM

Administered by: Public       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:

Write-up: Client was given booster dose of Pfizer on 12/29/2021. Client has already received 3 doses of Pfizer and last dose of Pfizer was given on 08/27/2021. Booster dose administered on 12/29/2021 was administered too early according to protocol. Supervisor spoke to the client on 12/29/2021 and client was made aware of this error.


VAERS ID: 1992502 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-26
Onset:2021-12-29
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Caesarean section, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillin.
Diagnostic Lab Data: CT Scan of child on 12/28/2021.
CDC Split Type:

Write-up: Was vaccinated (first shot) at 30 weeks pregnant. Delivered via c-section at 38 weeks on 9/15/2021. Child has since been diagnosed with sagittal synostosis (likely present at birth) and will require surgery.


VAERS ID: 1992503 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-12-29
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV on Triumeq, ETOH abuse, smoker, schizophrenia, HTN, asthma
Allergies:
Diagnostic Lab Data: COVID + 12/29/21
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1992531 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: the vaccination was not supposed to have been given as the patient is 14 years old


VAERS ID: 1992536 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-15
Onset:2021-12-29
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Blood gases abnormal, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Cough, Diarrhoea, Dizziness, Dyspnoea, Exposure to SARS-CoV-2, Full blood count normal, Haematochezia, Hypoxia, Intestinal obstruction, Lung disorder, Melaena, Metabolic function test normal, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: ADMISSION: 12292021: 57-year-old male with a history of stage IV colon cancer status post resection in 2013, liver cancer who presented to the emergency department with shortness of breath, cough, dizziness and weakness for the last 2 days. He reports also having a low-grade fever along with this. He has had some nausea and abdominal discomfort and diarrhea but this is actually been going on for several months now. Does report some intermittent bloody stools and melena as well. He reports he has not really been followed for his colon cancer as at 1 point he was on hospice for 2 years and then came off of hospice and has not really followed since that time. He is vaccinated and received his booster on 12/15/2021 He lives at the facility and has exposures there. Workup in the emergency department reveals relatively normal CBC and BMP. His COVID swab is positive. His ABG shows hypoxia and he has required 2 L of supplemental oxygen as well. Chest x-ray does show some areas of bilateral airspace disease. CT abdomen pelvis shows possible esophagitis along with postoperative findings and some fluid-filled bowel loops suggesting possible enteritis. Given his hypoxia he has been admitted. PATIENT IS CURRENTLY AN INPATIENT.


VAERS ID: 1992537 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3303680 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Lymphadenopathy
SMQs:, 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-Hctz for treatment of High Blood Pressure 20-12.5 MG daily
Current Illness: None
Preexisting Conditions: High Bood Pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On Tuesday, 12/28/21, I received my Pfizer booster shot in my left arm at Urgent Care. The next day, I noticed a swollen lymph node in my left underarm pit as a reaction to the shot. I called the Urgent Care , and spoke to someone who took the information down and said that a doctor would return my call but he/she never responded. Today, I noticed redness around where the shot was administered and sent an e-mail to the urgent care informing them of my adverse reaction to the booster shot. As of yet, I have not received a response.


VAERS ID: 1992550 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3859 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash macular
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: Same reaction, more severe, to second dose of Pfizer vaccine in April 2021
Other Medications: Sinovastatin 40 mg, famotidine 40 mg, metformin 1000 mg, centrum silver for women 50+, omega a plus, cranberry 4200 mg, levothyroxine .88 mg, calcium & d3 1200 mg, vitamin e 400 iu, vitamin c complex 1000 mg, hydroxychloroquine 400 mg
Current Illness: Mild cold symptoms one month prior
Preexisting Conditions: Rheumatoid arthritis, osteoporosis, osteoarthritis, hypoactive thyroid disorder, diabetes type 2
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching on both arms two days after injection, red splotches on both arms three days after injection, this reaction is not as severe as the previous vaccine which lasted several weeks (did not report)


VAERS ID: 1992552 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-20
Onset:2021-12-29
   Days after vaccination:343
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, Lisinopril, Voltarin Gel, Cymbalta, Seroquel, Zoloft, Protonix, Senna, Synthroid, Prednisone,
Current Illness:
Preexisting Conditions: OA, RA, Hypothyroidism, Vertigo, GERD, Depression, Chronic neck/back pain w/sciatica
Allergies: Oxycodone, Penicillins, Fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID (+) 12/29/21


VAERS ID: 1992562 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-24
Onset:2021-12-29
   Days after vaccination:339
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK LA / IM

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

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

Write-up: Hospitalized 12/29/21 2nd Pfizer covid vaccine 2/14/21, EL9267 LOT, IM L arm 3rd Pfizer covid vaccine 8/30/21, FD8448 LOT, IM R arm


VAERS ID: 1992566 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Aches, chills, nausea, vomiting,pain at injection site


VAERS ID: 1992589 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-12-29
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presented with cough and weakness. Patient ended up being positive for COVID and fully vaccinated, no booster


VAERS ID: 1992592 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, COVID-19, Intensive care, Obstructive airways disorder, SARS-CoV-2 test positive, Stridor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid positive test on admission found incidentally 12/29/21
CDC Split Type:

Write-up: Pt presented for her third Pfizer vaccine. Almost immediately after vaccination, pt c/o Wheezing. On assessment, pt had audible stridor, could not speak a sentence. Pt treated with albuterol and epi-pen. Due to concern for airway, rapid response called and pt taken to the ER. Patient is currently in ICU


VAERS ID: 1992598 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Dyspnoea, Fatigue, Feeling of body temperature change, Loss of consciousness, Pain, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Shortness of breath Turning blue and passing out extreme fatigue Feeling of throat closing Extreme hot and cold Extreme soreness


VAERS ID: 1992610 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C Zinc Vitamin D
Current Illness: No
Preexisting Conditions: No
Allergies: Cantaloupe Honeydew Raw Almonds Bananas Avocado Propolis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, enlarged throat, swollen tongue


VAERS ID: 1992637 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-13
Onset:2021-12-29
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Oedema mucosal, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Anemia, eczema
Allergies: No known allergies
Diagnostic Lab Data: 12/29/21 COVID Result IPOC Detected Abnormal
CDC Split Type:

Write-up: 12/29/21 presenting today for Headache (1 day) and Cough (1 day) Physical Exam Constitutional: General: She is not in acute distress. Appearance: She is well-developed. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Nose: Mucosal edema, congestion and rhinorrhea present. Neck: Trachea: No tracheal deviation. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. No murmur heard. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing or rales. Musculoskeletal: Cervical back: Normal 12/29/21 Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Findings: No rash. Neurological: Mental Status: She is alert and oriented to person, place, and time.


VAERS ID: 1992639 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HT 8030 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Body temperature increased, Chills
SMQs:, Neuroleptic malignant 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: Covid19/Pfizer
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, temperature, inflammation of axilla.


VAERS ID: 1992651 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-12-29
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 300 mg Oral Tab cholecalciferol (VITAMIN D) 1,000 unit Oral Cap cholecalciferol (VITAMIN D3) 400 unit oral Tab metFORMIN (GLUCOPHAGE) 500 mg oral tablet warfarin (COUMADIN) 5 mg oral tablet
Current Illness:
Preexisting Conditions: Atrial fibrillation Arthritis CVA Diabetes, type II Degenerative joint disease, left hip Gout Hypertension Prostate enlargement S/p hip replacement, left Primary osteoarthritis of left hip Stroke Statin intolerance Umbilical hernia Hyperlipidemia
Allergies: Ciprofloxacin Gemfibrozil Levaquin [Levofloxacin] Lipitor [Atorvastatin] Macrobid [Nitrofurantoin Monohyd/M-Cryst] Pravastatin Simvastatin Sulfa (Sulfonamide Antibiotics) Tricor [Fenofibrate Micronized]
Diagnostic Lab Data: POSITIVE COVID TEST 12/29/2021
CDC Split Type:

Write-up: WEAKNESS


VAERS ID: 1992652 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site reaction, Rash erythematous
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 known
Current Illness: None known
Preexisting Conditions: tremors
Allergies: Peanuts, other nuts, Celebrex
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Patient has red rash on arm below injection site that is itching. Patient is going to try cool compress and an oral antihistamine. She may also try a topical hydrocortisone cream. Patient will follow up with her primary care provider if these do not start to resolve rash.


VAERS ID: 1992659 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

Administered by: Pharmacy       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 15 mg daily
Current Illness: Myalgia Rheumatica
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported taking prednisone 15 mg daily for past 2 weeks and next 4 weeks. Did not report immunocompromised. Gave 0.5 ml for 3rd Moderna shot. After review, patient is considered immunocompromised if 20 mg daily .


VAERS ID: 1992660 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-12-29
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Paraplegic. Anemia. Leukocytosis. TBI from MVA.
Allergies: Neomycin.
Diagnostic Lab Data: Covid-19 PCR positive on 12/29/21, negative on 12/22/21.
CDC Split Type:

Write-up: Infected with SARS-CoV-2 despite receiving the Moderna vaccine series with booster. Dates of vaccination 4/5/21, 5/5/21, 12/6/21.


VAERS ID: 1992665 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-29
Onset:2021-12-29
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Surgery
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized heart rhythm issue post operatively.


VAERS ID: 1992672 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-06
Onset:2021-12-29
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Infection, Nephrolithiasis
SMQs:

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

Write-up: Hospitalized with infected kidney stone.


Result pages: prev   19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=118&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166