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

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



Case Details (Reverse Sorted by Onset Date)

This is page 118 out of 3,524

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VAERS ID: 1376589 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-19
Onset:2021-05-21
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Chronic lymphocytic leukaemia
SMQs:, Haematological malignant tumours (narrow)

Life Threatening? Yes
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: high blood pressure pills
Current Illness:
Preexisting Conditions: high blood pressure
Allergies: n/a
Diagnostic Lab Data: He now has abnormal blood and has been back 3 times for blood draws. The current diagnosis is CLL. Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood and bone marrow ? the spongy tissue inside bones where blood cells are made
CDC Split Type:

Write-up: None stated.


VAERS ID: 1376596 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Psoriasis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: At the time was not taking any medications. Taking Vitamin D 2000IU daily.
Current Illness: Plaque Psoriasis
Preexisting Conditions: Plaque psoriasis
Allergies: Wheat, pollens
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hives after initial dose 3 days after being administered. Provider, believed it was not related and advised pt to get her second vaccine. After 2nd dose pt had a response mildly the same day and it progressed over the next week. Hives were far more severe than after initial vaccination affecting the periorbital tissue, arms, abdomen, and legs. Exacerbated pt''s plaque psoriasis. Pt was prescribed a topical clobetasol 0.05% BID. pt to follow-up next week. No changes to respiration or irritation or oropharynx.


VAERS ID: 1376986 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Flushing, Hyperhidrosis, Hyperventilation
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hyperventilation-Mild, Systemic: Weakness-Mild


VAERS ID: 1377124 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-16
Onset:2021-05-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 05/16/21 - vaccine administration 05/21/21 - small rash on inside right knee around 5pm; by 9pm, rash all over body. Administered 1 Benadry tablet at 9:30pm. 05/22/21 - rash progressed; called pediatrician; administered 1 Zyrtek tablet. 05/23/21 - rash appeared to start subsiding. Child reported some numbness in fingers and toes. Administered 1 Zyrtek tablet. 05/24/21 - rash subsided significantly. Swollen fingers and toes. Administered topical itch cream. 05/25/21 - fully resolved.


VAERS ID: 1377660 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site mass, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Within 48 hrs developed a large mass on arm at injection site. Extremely painful, very warm to touch.


VAERS ID: 1377813 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-03-16
Onset:2021-05-21
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Lung opacity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Duoneb neb, Albuterol neb, Ayr nasal spray, Risperdal, Klonopin, Neurontin, Ferrous sulfate, Lopressor, Ultram, MVI, Imdur, Synthroid, Anoro Ellipta inhaler, Remeron, Aricept, Fibercon, Xarelto, Protonix, Dilantin, Miralax, Flonase nasal sp
Current Illness: Unknown
Preexisting Conditions: COPD, HTN, Hypothyroidism, OA, dementia, anxiety, depression, Schizoaffective disorder, H/O pulmonary embolism, chronic constipation, neurogenic bladder, diverticulosis of colon
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to PCP on 05/21/21 from group home with C/O cough, dyspnea, fever, and chills with known exposure to COVID-19. Rapid test in office was positive for COVID-19. Chest Xray showed ground-glass opacities consistent with COVID pneumonia. Patient admitted to the hospital on 05/21/21


VAERS ID: 1377836 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-24
Onset:2021-05-21
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort, Vitamin D, Zocor, Ocuvite, Reglan, Buspar, Eliquis, Ayr nasal spray, Claritin, Nexium, Remeron, Ferrous sulfate, Miralax, albuterol inhaler
Current Illness: unknown
Preexisting Conditions: HTN, Atrial fibrillation, H/O ischemic stroke, macular degeneration, intellectual disability, H/O pancreatitis, malignant breast cancer
Allergies: Tuberculin test
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to PCP from group home residency on 05/21/21 with C/O cough, dyspnea, fever, chills, and body aches. Known exposure to COVID-19. Rapid test in PCP office was positive for COVID-19. Chest Xray showed pneumonia. Patient admitted to hospital on 05/21/21


VAERS ID: 1378772 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT#EW0171 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT#EW0185 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acoustic stimulation tests, Physical examination, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 06/04/2021 , Hearing Test and Drs'' exam .
CDC Split Type:

Write-up: Ringing in the ears. Tinnitus


VAERS ID: 1378815 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood test, Chest pain, Lymphadenopathy, Paranasal sinus discomfort, Pharyngeal swelling, Swelling, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins; mag, a, d, and biotin
Current Illness: None
Preexisting Conditions: None
Allergies: Known allergies penicillin, predizone, Zofran, niacin, pheneghan
Diagnostic Lab Data: Did get blood work drawn on 6/7/2021 at medical office unsure if testing for this signs of enlarged liver
CDC Split Type:

Write-up: Anaphylaxis sharp pain left side by chest swelling in nape of neck by thyroid extreme sinus pressure between eyes tongue swelled glands under ears swelled throat swelled. Epi pen given by HCP in pharmacy


VAERS ID: 1379526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C214 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (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: Lexapro Multi vitami
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash at injection site 1 week after vaccine received. Rash about 3 inches in diameter, warm to the touch, slightly itchy.


VAERS ID: 1380675 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210608543

Write-up: SICK REALLY BAD; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 21-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-MAY-2021, the subject experienced sick really bad. The action taken with covid-19 vaccine was not applicable. The patient recovered from sick really bad on 31-MAY-2021. This report was non-serious. This report was associated with product quality complaint: 90000181659.


VAERS ID: 1381057 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-05-21
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; LISINOPRIL; FEXOFENADINE; METFORMIN; SPIRONOLACTONE; RITUXIMAB
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic granulomatosis; Allergic rhinitis; Diabetes mellitus; Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: Rapid pcr; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021581230

Write-up: : Pt received both doses of the pfizer covid vaccine; 23Feb2021 and 22Mar2021 (lot EN6207) and diagnosed with covid on 21May2021; Diagnosed with covid on 21May2021; This is a spontaneous report from a contactable other healthcare profession (HCP). A 64-year-old male patient at the age of 64 years old received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 intramuscular on 23Feb2021 (Lot Number: EN6200) as 1st dose, single, dose 2 via an unspecified route of administration on 22Mar2021 (Lot number: EN6207) as 2nd dose, single for covid-19 immunisation. Medical history included diabetes mellitus (DM), hypertension (HTN), Granulomatosis, rhinitis allergic. Concomitant medications within 2 weeks of vaccination included amlodipine; lisinopril; fexofenadine; metformin; spironolactone; rituximab. The patient previously took allopurinol and experienced drug hypersensitivity (Known allergie-Allopurinol). Patient received both doses of the Pfizer covid vaccine; 23Feb2021 and 22Mar2021 (lot EN6207) and diagnosed with covid on 21May2021. the adverse event result in Doctor or other healthcare professional office/clinic visit. Prior to vaccination, the patient was not diagnosed with COVID-19, Since the vaccination, the patient been undergoing lab tests and procedures which included Rapid PCR: positive on 21May2021 (Nasal Swab). No treatment received for the events. Outcome of the events was unknown. It was reported as non-Seriousness. Seriousness criteria of Results in death, Life threatening, Caused/prolonged hospitalization, Disabling/Incapacitating, Congenital anomaly/birth defect were all no. Information on Lot/Batch number was available. Additional information has been requested.; Sender''s Comments: The efficacy of a vaccine varies from one patient to another and can be affected by different factors; however, there is reasonable possibility that the reported events Vaccination failure and COVID-19 are related to BNT162B2.


VAERS ID: 1381079 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Facial paralysis, Head discomfort, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (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: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021582088

Write-up: right sided facial droop; blurred vision; head pressure; This is a spontaneous report from a contactable healthcare professional. A 48-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), intramuscular, administered in the left arm on 21May2021 14:45 (02:45 PM) (Batch/Lot Number: EW0171) (at age of 48-years-old) as 1st dose, single dose for COVID-19 immunization. Facility where the most recent COVID-19 vaccine was administered was reported as "Other". The patient''s medical history included COVID-19 from an unknown date and unknown if ongoing. The patient was diagnosed with COVID-19 prior to vaccination. The patient had no known allergies. The patient did not have any other vaccines within 4 weeks prior to the COVID vaccine. There were no concomitant medications. The patient did not receive any other medications within 2 weeks of vaccination. On 21May2021 14:45 (02:45 PM), the patient experienced right sided facial droop, blurred vision, and head pressure. It was unknown if the patient has been tested for COVID-19 prior to vaccination. Therapeutic measures were taken as a result of the events which included vitals (as reported). The outcome of the events was recovered on an unspecified date.; Sender''s Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of event right sided facial paralysis, blurred vision, and head discomfort cannot be totally excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1381102 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021583524

Write-up: Myocarditis/pericarditis; Myocarditis/pericarditis; This is a spontaneous report from a contactable physician. A 18-year-old male patient received bnt162b2 (BNT162B2 PFIZER-BIONTECH COVID-19 VACCINE), dose 2 intramuscular, administered in Arm Left on 18May2021 (at the age of 18-year-old) as 2nd dose, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Arm Left on an unspecified date for COVID-19 Immunization. The patient experienced myocarditis/pericarditis on 21May2021 17:30. The adverse event result in emergency room/department or urgent care. The patient received treatment for the adverse event included anti-inflammatory medication. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. The outcome of the events was unknown. No follow up attempts are possible; Information about lot/batch number cannot be obtained.; Sender''s Comments: Based on available information, a possible contributory role of BNT162B2 vaccine can not be excluded for the reported events of myocarditis/pericarditis due to temporal relationship. Case will be re-assessed upon the additional information provided. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1381669 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-05-21
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19


VAERS ID: 1381713 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood test, Chest X-ray, Chest pain, Computerised tomogram thorax abnormal, Cough, Echocardiogram, Electrocardiogram, Fibrin D dimer increased, Musculoskeletal discomfort, Pain, Painful respiration, Pulmonary pain, Pulmonary thrombosis, Pyrexia, Ultrasound Doppler normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dietary supplements (list available upon request)
Current Illness: No
Preexisting Conditions: No
Allergies: Food allergies (list available upon request)
Diagnostic Lab Data: Chest x-ray to rule out various issues, then blood test leading to a D-dimer of 3000 (normal 50-100), leading to chest Cat Scan resulting in clots in chest and lungs. Heart ultrasound (EKG) conducted to rule out clots related heart decease. Also ultrasound of veins and legs, and no clots found in these areas.
CDC Split Type:

Write-up: Internal and persistent sharp/stabbing pain in left side around lungs/mid-back/thoracic area. Discomfort felt in thoracic area of back when taking short shallow breaths, and when taking deep breaths caused sharp pains in the same thoracic area of the back. Dry cough (no mucous), no blood. Occasional low grade temperatures. Pain unbearable while laying on back and side (less so while sitting, standing, or walking). Pain became so bad while driving and entering/exiting a vehicle, and 12 days of duration, decided to go to Urgent Care, which led to a recommendation to go to ER.


VAERS ID: 1381734 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Decreased appetite, Fatigue, Headache, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Was in the middle of a course of cephalexin for a staph infection, stopped after 2.5 days because of adverse event that did not end with stopping the antibiotic.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue Shooting pain in legs Joint pain Weakness Headache Loss of appetite


VAERS ID: 1381787 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein normal, Electrocardiogram normal, Fatigue, Laboratory test normal, Lymphadenopathy, Pain in extremity, Pyrexia, Red blood cell sedimentation rate increased, Red blood cell sedimentation rate normal, SARS-CoV-2 antibody test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: intermittent asthma, heart murmur, hypercholesterolemia
Allergies:
Diagnostic Lab Data: 5/26/21: ESR: 22, COVID IGG NEG, CHEM negative except for slightly low chloride, normal CRP 6/3/21: EKG normal, ESR normal, CRP normal
CDC Split Type:

Write-up: right axillary lymphadenopathy, fever for 7 days (low grade), fatigue, lower leg pain


VAERS ID: 1381934 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-13
Onset:2021-05-21
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin Vitamin d
Current Illness: No illness None
Preexisting Conditions: None.
Allergies: Lactose intolerance
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Hearing loss significant


VAERS ID: 1382154 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: 5:20 Pt had syncope episode. Taken to Observation area via w/c to lay down. BP 80/52 P62 R20 5:35 BP 90/62 P 60 R 16 No nausea. skin warm & dry. 6:05 Sitting up drinking juice. 6:35 Pt left with parents w/o assistance.


VAERS ID: 1382157 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Hypertensive crisis
SMQs:, Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Pt states has hx of anaphylactictic reactions to meds & c/o feeling dizzy after 30 minutes in waiting area. Transferred by w/c to oberservation area to cot. BP 200/80 P64 R16. When pt started experiencing sever headache when she laid down. BP 220/80 Pt was in severe hypertension crisis. 7:45pm EMS called 8:12pm Transferred to EMS. BP 210/100


VAERS ID: 1382359 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: Several hours after 2nd dose, I developed a rash across upper arms and chest/back


VAERS ID: 1382451 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspiration, Balance disorder, Blood test, Computerised tomogram normal, Magnetic resonance imaging head normal, Magnetic resonance imaging neck, Neurological symptom, SARS-CoV-2 antibody test positive
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Probiotics, Vitamins & Zertek
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Scan, MRi BraIn & neck and many blood tests
CDC Split Type:

Write-up: The day after shot Covid like symptoms. The nest morning Stroke like symptoms required hospitalization for two weeks. I was wobbly and could not drink water without asperating. Symptoms still persist today..Extensive testing showed no stroke occured. Prior to shot, I was tested for antibodies from a Covid infection 7 months ago. The antibodies where still very strong. I gave in to peer pressure and got the shot with my doctors approval.


VAERS ID: 1382510 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-01
Onset:2021-05-21
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alfuzosin 10 mg Tablet Extended Release 24 hr Directions: 0.5 tablet oral twice a day (Active) amLODIPine 5 mg Tablet Directions: 1 tablet oral twice a day (Active) atorvastatin 40 mg Tablet Directions: 1 tablet oral daily (Active) ne
Current Illness: BPH, hyperlipidemia, hypertension
Preexisting Conditions: Same as above
Allergies: Sulfa Medications
Diagnostic Lab Data: COVID-19 PCR Pos on 5/21/2021 and here, at Medical Center PCR ++ on 5/30/2021
CDC Split Type:

Write-up: Patient tested positive for COVID 19 on 5/21/2021, then admitted to Medical Center on 5/30/2021 with worsening dyspnea, cough and fevers. Remains admitted as of 6/8/2021. Had received Pfizer vaccination at the Vaccination Center Dose #1 in February 2021 Dose #2 on 3/17/2021


VAERS ID: 1382630 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Patient received the Moderna vaccine. Patient informed staff after vaccine that she had previously received the Pfizer COVID-19 vaccination #1 in series. She had assumed any manufacture was acceptable for #2 in series. No reaction noted


VAERS ID: 1382675 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Dyspnoea, Fatigue, Heart rate irregular, Injection site bruising, Injection site pain, Limb discomfort, Loss of personal independence in daily activities, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious diarrhoea (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: multi-vitamins, calcium, vitamins D and C
Current Illness: none
Preexisting Conditions: none
Allergies: Doxycycline, and Percoset
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Heavy bruising and moderate soreness at injection site 2 hours after vaccination. One bout of Diarrhea 3 hours after vaccination. Chills started 11 hours after vaccination and continued for 8 hours. Treated with 2 Bayer aspirin every 4 hours. Full body aches (Included head, eyes, back, arms, legs, and general all over body muscle ache) started 11 hours after vaccination and continued for 19 hours. Treated with heat and massage pad, and 2 Advil every 4 hours, but discomfort was not relieved. Occasional: irregular heartbeats. Constant: limbs felt strangely heavy, quickly tired on ordinary short walks, felt out of breath, weak, no energy. Ongoing 2-14 days after vaccination. No treatment received.


VAERS ID: 1382678 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Circumoral swelling, Hyperhidrosis, Loss of consciousness, Pallor, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pediatric multivitamin Proair rescue inhaler
Current Illness:
Preexisting Conditions:
Allergies: Cat Dander Tree nut Peanut Walnut
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine dose around 13:20. At approx. 13:25 patient began to audibly wheeze, became pale, diaphoretic, and had mild circumoral swelling. Patient received 0.3 mg epinephrine via EpiPen at 13:26, and 911 was called. Patient lost consciousness at 13:27 and pt was lowered to floor from chair to prevent a fall. Patient immediately regained consciousness. Patient was transferred to a chair and vitals were obtained at 1330. BP 112/60, HR 86, SPO2 96% on rom air. Mild wheezes bilaterally over anterior bronchi, all other breath sounds clear throughout. EMS arrived, patient was still slightly pale and was transported to ED. Upon leaving, patient was AOx4, ambulatory, and without respiratory distress. Per ER note, patient was given Benadryl and solumedrol by EMS. At the ER, patient received NS bolus 1L, and Benadryl 25 mg orally. Patient was medically cleared by ED MD to go home at 17:58 pm on 5/21/21


VAERS ID: 1383403 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Michigan  
Vaccinated:2020-12-18
Onset:2021-05-21
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELU142 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ataxia, Central nervous system lesion, Cerebellar stroke, Computerised tomogram, Echocardiogram, Magnetic resonance imaging
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol 25mg daily Zocor 20mg daily Enalapril 30mg daily Metformin XR 500 2x daily
Current Illness: None
Preexisting Conditions: Hypertension Hypercholesterolemia
Allergies: Bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: On May 21st 2021 I suffered a cerebellar left hemisphere stroke resulting in a taxia on my left side. After repeated CAT scans MRIs echocardiograms including t e e there is no explanation for where the 40 to 50 lesions came from in my cerebellum.


VAERS ID: 1384569 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-12
Onset:2021-05-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592670

Write-up: rash on stomach, hand, face and neck; This is a spontaneous report from a contactable consumer (patient). A 16-year-old male patient received the first dose of BNT162B2 (Pfizer-BioNTech COVID-19 vaccine, Lot Number: Ew0171), via an unspecified route of administration, administered in the left arm on 12May2021 at 17:15 as a single dose for COVID-19 immunization. The patient had no medical history. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient''s concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other medication within 2 weeks of vaccination. Since the vaccination, the patient has not been tested for COVID-19. On 21May2021, the patient developed rash on stomach, hand, face and neck. The patient received Benadryl and cortizone-10 as treatment for the event. The outcome of the event was not recovered. The event was reported as non-serious.


VAERS ID: 1384570 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity
SMQs:, Angioedema (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592672

Write-up: Allergic reaction; This is a spontaneous report from a non-contactable consumer. A 12-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE lot/batch number and expiration date not reported) intramuscular on 20May2021 as 1st dose, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced allergic reaction on 21May2021. Went to the ER the next day. Put on allergy meds. Taken back to the hospital the night of the 23May2021 to an unknown date. Event did not result in death, was not life-threatening, was not disabling/incapacitating and did not cause congenital anomaly/birth defect. Therapeutic measures were taken as a result of the event which included Allergy medications. Outcome of the event was not recovered. Information on the lot/batch number has been requested.


VAERS ID: 1384571 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ETHINYLESTRADIOL;NORETHISTERONE ACETATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Endometriosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592678

Write-up: Hives over 90% of body; swollen face; difficulty breathing; This is a spontaneous report from a contactable consumer (reported for herself). A 29-year-old female patient received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine), dose 2 via an unspecified route of administration, administered in the left arm, at age 29 years, on 21May2021 18:00 (Batch/Lot Number: EW0186) as 2ND DOSE, SINGLE DOSE for COVID-19 immunisation. Medical history included endometriosis from an unknown date and unknown if ongoing. Patient had no known allergies. Patient was not pregnant at the time of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medication included ethinylestradiol;norethisterone acetate taken for an unspecified indication, start and stop date were not reported, received within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient historically took first dose of BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine, lot number: EW0179) at age 29 years on 30Apr2021 05:00 PM on the left arm for COVID-19 immunisation. On 21May2021 at 21:00, the patient experienced hives over 90% of body, swollen face and difficulty breathing. Patient was hospitalized in May2021 for 1 day. Patient was treated with dexamethasone 12mg for the events. Since the vaccination, the patient has not been tested for COVID-19. Facility where the most recent COVID-19 vaccine was administered was other. The outcome of the events was recovering.


VAERS ID: 1384603 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Arthralgia, Asthenia, Back pain, Chest discomfort, Dizziness, Dyspnoea, Gait disturbance, Hypoaesthesia, Pain in extremity, Paraesthesia, Paralysis, Pharyngeal swelling, Pruritus, Spinal pain, Swelling face, Swollen tongue, Throat irritation, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma (Diagnosed as a toddler. Had RSV as a baby); Constipation chronic (Diagnosed about a year ago.); Seasonal allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Grass allergy; Pollen allergy; Shellfish allergy (4-5 years old); Sickness (4-5 years old); Vomiting
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021593677

Write-up: Anaphylactic reaction; left cheek started swelling; looking woozy; throat and tongue started swelling; throat and tongue started swelling; having a hard time breathing; from the neck down, she had a temporary paralysis and she could not move./she could not feel anything from the waist down.; whole body was shaking; numbness and tingling all over.; numbness and tingling all over.; extreme pain in her back; When they would touch her hips, toes, spine, ankles, and knees she would complain of extreme pain, like joint pain.; When they would touch her hips, toes, spine, ankles, and knees she would complain of extreme pain, like joint pain.; When they would touch her hips, toes, spine, ankles, and knees she would complain of extreme pain, like joint pain.; very weak; chest was tight.; cannot walk without assistance; itching all over and in her throat; itching all over and in her throat; This is a spontaneous report from a contactable consumer (parent). A 13-years-old female patient received first dose of bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, 0.3 ML), at the age of 13-years-old , via an unspecified route of administration, administered in Arm Right on 21May2021 11:55 (Lot Number: EW0179; Expiration Date: Aug2021) as 0.3 ML SINGLE for covid-19 immunisation. Medical history included ongoing asthma, Diagnosed as a toddler. Had RSV as a baby. ongoing seasonal allergy, To like grass and pollen. ongoing constipation, Diagnosed about a year ago. allergic to shellfish because she gets sick. She said that it happened when her daughter was 4-5 years old. Whenever she has contrast for a MRI she throws it up. The patient''s concomitant medications were not reported. The patient previously took Azithromycin and Amoxicillin and were allergic. The patient experienced anaphylactic reaction on 21May2021 with outcome of recovering, left cheek started swelling on 21May2021 with outcome of unknown, looking woozy on 21May2021 with outcome of unknown, throat and tongue started swelling on 21May2021 with outcome of unknown, having a hard time breathing on 21May2021 with outcome of unknown, from the neck down, she had a temporary paralysis and she could not move./she could not feel anything from the waist down on 21May2021 with outcome of unknown, whole body was shaking on 21May2021 with outcome of unknown, numbness and tingling all over on 21May2021 with outcome of unknown, extreme pain in her back on 21May2021 with outcome of unknown , when they would touch her hips, toes, spine, ankles, and knees she would complain of extreme pain, like joint pain on 21May2021 with outcome of unknown, very weak on 21May2021 with outcome of unknown , chest was tight on 21May2021 with outcome of unknown , cannot walk without assistance on 21May2021 with outcome of unknown , itching all over and in her throat on 21May2021 with outcome of unknown. Patient was in hospital from 21May2021 to 23May2021. AE(s) require a visit to Emergency Room. No AE(s) following prior vaccinations. No Family Medical History Relevant to AE(s). No Relevant Tests. Clinical courses as follows: It was reported they wanted her to wait for 30 minutes after her daughter received the vaccine. She said that after about 20 minutes, her daughter said that it felt like someone punched her in the face and her left cheek started swelling. She said that her husband said that their daughter started looking woozy and her eyes were closing. The staff laid her down on a mat on the floor. Then her daughter''s throat and tongue started swelling and she was having a hard time breathing. Then her daughter complained that from the neck down, she had a temporary paralysis and she could not move. Her daughter asked if she asked if she was going to die. The nurse gave her an EpiPen and called a ambulance. Her whole body was shaking, probably from the EpiPen, like almost convulsing. She said that they got her onto the ambulance and her daughter was having trouble breathing. They gave her another dose of an EpiPen in the ambulance. They also gave her daughter a steroid and some Benadryl through an IV. Her daughter was rushed to the ER, having a hard time breathing and complaining she could not feel anything from the waist down. Caller said that her daughter was also complaining of numbness and tingling all over. She also started to complain about extreme pain in her back. When they would touch her hips, toes, spine, ankles, and knees she would complain of extreme pain, like joint pain. Her daughter had numbness from waist down. If they touched her foot she could not feel it. Her daughter was admitted to the hospital and got released yesterday 23May2021. She is still experiencing pain and numbness. The numbness is from the waist down and the tingling was up and down her arms. She said that her daughter was very weak and could not feed herself. They had to give her several albuterol breathing treatments in the hospital because her chest was tight. She was not wheezing, but they could tell it was constricted and treated her with Albuterol. She said that her daughter still cannot walk without assistance this morning. She was treated with Motrin, Benadryl and Atarax, and Prednisone in the hospital. The caller said that her daughter also complained about itching all over and in her throat. The caller said that her daughter did not have a rash though.


VAERS ID: 1384695 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-04
Onset:2021-05-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021637136

Write-up: Deep vein thrombosis from groin to knee; This is a spontaneous report from a contactable consumer (patient). This 58-years-old male patient received the second single dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) in left arm, on 04May2021 at 14:00 (lot EW0171), at the age of 58 years, for COVID-19 immunization. The first dose of BNT162B2 vaccine was administered on 09Apr2021 at 15:00 (at 58 years of age), lot: EP7533, in left arm. Medical history included COVID-19. Past drug history included allergy to lamotrigine (LAMITRIL). The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Concomitant medications were not reported. On 21May2021 the patient deep vein thrombosis from groin to knee. The event required ER visit, Doctor or other healthcare professional office/clinic visit, hospitalization for 6 days and was reported as serious also as life-threatening condition. Treatment received included removed blood clot and blood thinners administration. The event was resolving at the time of report. Since the vaccination, the patient had not been tested for COVID-19.


VAERS ID: 1385067 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Unknown  
Location: Vermont  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207221A / UNK LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Dyskinesia, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: After getting Johnson & Johnson Covid Vaccine Patient Within 10 minutes exhibited SX of seizures (jerking) & Vomiting. Breathing - NormaL Called 911 & Pt. was taken by ambulance


VAERS ID: 1385289 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Blood test, Cardiac stress test, Chest pain, Computerised tomogram head, Computerised tomogram thorax, Contusion, Dizziness, Dysgeusia, Dyspnoea, Electrocardiogram, Fatigue, Feeling abnormal, Headache, Limb mass, Myocardial infarction, Pain in extremity, Pain in jaw, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydromorphone, flexeril, gabapentin, proAir, servent diskus, vit D, vit B, multi vit, hawthorn, red yeast rice, coQ10
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: Stress test 6/14 Ct scan head/chest, EKG, ultra sound, blood test 6/2 Blood work 5/24
CDC Split Type:

Write-up: 5/21/21 10:00pm shortness breath, chest pain, shoulder pain, jaw pain, metallic taste, fatigue ?mini heart attack? symptoms 5/26-5/27 trouble breathing, fatigue, light headed 5/29 pain in left arm 5/30 night - second ?mini heart attack? symptoms General fatigue, hard to breath, overall feeling bad 6/2 - bruise on arm and lump Extreme headache, fatigue, chest pain, arm pain Emergency room visit = blood clots


VAERS ID: 1385395 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abortion spontaneous, Blood test, Dizziness, Exposure during pregnancy, Syncope, Ultrasound antenatal screen abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplements I was taking were prenatal vitamin and vitamin d and DHS supplements.
Current Illness: None
Preexisting Conditions: None
Allergies: I am allergy to Sulfa antibiotic.
Diagnostic Lab Data: The did blood work and a ultra sound.
CDC Split Type: vsafe

Write-up: I was having light headeness and fainting. I also was having abdominal pain.I end up having a miscarriage at 8 weeks.


VAERS ID: 1385433 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Rash, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My husband has red patches (about the size of dimes) - essentially a rash, on his neck and on his stomach since 2 days after his second dose. He has not received any treatment. The day after his 2nd dose he was in bed all day with muscle aches, fatigue, headache, etc. that resolved within 24 hours.


VAERS ID: 1385467 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Stomach cramps and diarrhea


VAERS ID: 1385478 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Pain
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad)

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

Write-up: Patient states that she started to have shoulder pain the next day and later noticed some weakness. Has had continued pain over her deltoid since especially by the end of the day and with repeated use of arm but has improved to at least 75%. Weakness has resolved.


VAERS ID: 1386063 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Chest X-ray, Fibrin D dimer, Full blood count, Metabolic function test, Pulmonary embolism, Troponin I, Urine analysis
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone, toprimate, chlorthalidone
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies: Demoral
Diagnostic Lab Data: Chest X-ray, urinalysis, CBC, cmp, troponin 1, D-Dimer, CT angiogram,
CDC Split Type:

Write-up: Acute pulmonary embolism 6/3/2021 at 9:24am prescribed eliquis 10mg, potassium 60 meq, magnesium 2g, morphine 4mg


VAERS ID: 1386070 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM

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

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

Write-up: The patient''s wife called today to ask about the second shot and reported an itchy rash all over stomach and some on arms and legs. The patient''s wife also states he has a rash on his back, but that and practitioner said it looks more fungal and not related to the rash on his stomach, arms and legs.


VAERS ID: 1386135 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Delirium, Injection site cellulitis, Loss of consciousness, Malaise, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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? No
Previous Vaccinations:
Other Medications: Wellbutrin Topamax Vyvance IVIG (discontinued 6 wks prior to v
Current Illness:
Preexisting Conditions: CIDP, Cutaneous Lupus, Asthma
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hrs after initial dose of Moderna vaccine, I QUITE SUDDENLY, felt EXTREMELY ill. I immedently drove home and literally passed out in my front hallway. whwn I came to my senses, I realized that I, obviously had a nigh fever-103.4! Phoned my friend (live alone0 since I was somewhat DELILIOUS -we went to Hospital ER. I was "treated and released". 48 hours later I was (Sunday afternoon). I was forced to go to an Urgent Care facility, as the injection site had developed cellulitis. i was given a 10 day regimine of Ceftin (broad spectfum antibiotic) to combat the infection. NO ONE SHOULD HAVE A VACCINE AT THIS FACILITY! I HAD TO INSIST THAT THE ADMINISTRATOR OF THE VACCINE "WIPE DOWN/DECOMMI


VAERS ID: 1386339 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1988, age 21, Typhoid immunization -- similar reaction; no issues on subsequent typhoid shots
Other Medications: Vitamin D, Flonase, magnesium, albuterol
Current Illness: none
Preexisting Conditions: asthma, allergies
Allergies: watermelon
Diagnostic Lab Data:
CDC Split Type:

Write-up: 101 fever, chills, body ache, headache, fatigue. Treated with bufferin. Incapacitating for about 24 hrs... Fever broke after that and severity of symptoms decreased over the next 24 hrs. Day 3 back to 90% of normal.


VAERS ID: 1386826 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-05-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Head discomfort, Tinnitus, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I am told I had an allergic reaction to the pertussis vaccine as a young child
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fullness in head feeling, lack of balance, room spinning, slight ringing in ear. Symptoms were moderate to slightly severe. Lasted approximately 1.5 weeks in full force 24-7. Starting to finally taper off now, but still have somewhat heavy head feeling. Lack of balance has not been an issue the past 3 days.


VAERS ID: 1387218 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / N/A LA / SYR

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

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: Vitamin D
Current Illness: None
Preexisting Conditions: Iron deficiency anemia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pityriasis across chest; went away without treatment in about 10 days. It wasn''t itchy or painful.


VAERS ID: 1387724 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Migraine, Nausea, Pain, Pyrexia, Vaccination site pain, Vaccination site pruritus, Vaccination site rash
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fruit allergy; House dust allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021599762

Write-up: rash formed under injection site with burning/itching; rash formed under injection site with burning/itching; rash formed under injection site with burning/itching; dizziness; nausea; migraine; fever; chills; body aches; This is a spontaneous report from a contactable consumer (patient). A 46-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration on 21May2021 10:00 (at the age of 46-year-old) (Batch/Lot Number: EW0182) as 2ND DOSE, SINGLE DOSE for covid-19 immunisation. The patient was not diagnosed with COVID-19 prior to vaccination and has not been tested for COVID-19 since the vaccination. The patient did not receive any other vaccines within four weeks prior to COVID vaccine. The patient was not pregnant at the time of vaccination. Medical history included known allergies to Septra, Cipro, Erthamycin, Lexipro, protonix, strawberries and house dust. The patient had no other medical history. Concomitant medications included ethinylestradiol, norgestimate (ORTHO TRI-CYCLEN) and multivitamin. Historical vaccine includes first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, lot number: EW0123) on 30Apr2021 at 10:00 AM (at the age of 46-year-old) for COVID-19 immunisation. On 21May2021, the patient experienced fever, chills, and body aches 8 hours after 2nd shot. On 23May2021 at 10:00 AM, the patient experienced rash formed under injection site with burning/itching, dizziness, nausea, and migraine began 48 hours after the injection. The events required doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of all events which included Benadryl, Tylenol, and ice. The patient was recovering from all events. Follow-up attempts are needed. Further information is expected.


VAERS ID: 1387726 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Diarrhoea, Diarrhoea haemorrhagic, Influenza like illness, Malaise, Pain
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gastric hemorrhage; Gastritis; Hemorrhoidal bleeding; Pregnant
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021600214

Write-up: bloody diarrhea; felt awful; heavy flu-like symptoms; stomachache; loose stool; weakness; achiness; This is a spontaneous report from a contactable physician (patient). A 65-year-old female patient received the second dose of bnt162b2 (BNT162B2, Solution for injection, lot number: EW0179), dose 2 via an unspecified route of administration, administered in the right deltoid, on 20May2021 10:30 (received at 65-years-old) as 2ND DOSE, SINGLE for COVID-19 immunization. The patient did not receive any other vaccines within the four weeks prior to receiving BNT162B2. The patient stated the only relevant medical history she has is that 10 or 20 years ago she had taken a steroid drug and had gastritis where there was a little blood in her intestinal tract and then when she was pregnant she had a hemorrhoid where there was a little blood, but never really had any other intestinal problems. Concomitant medications were unspecified; the patient stated she has some chronic medical conditions and takes medication for them, but they do not interact with the vaccine and there is nothing that affects her immune system. The patient previously received the rubella vaccine when she was about 25-years-old and had an intense reaction; her knees swelled up like a balloon and she was incapacitated for a week. The patient previously received the first dose of BNT162B2 (BNT162B2, lot number: EW0175), administered in Right arm deltoid muscle on 29Apr2021 at 10:30 for COVID-19 immunization at the age of 65-years-old. The patient experienced bloody diarrhea (diarrhoea haemorrhagic) (medically significant) on an unspecified date, felt awful (malaise) (medically significant) on an unspecified date, weakness (asthenia) (medically significant) on 21May2021, achiness (pain) (medically significant) on 21May2021, heavy flu-like symptoms (influenza like illness) (medically significant) on an unspecified date, stomachache (abdominal pain upper) (non-serious) on an unspecified date, loose stool (diarrhoea) (non-serious) on 24May2021. After the second dose, and it has been 5 days now since getting the second dose, the patient had diarrhea and now is having bloody diarrhea and wants to know if this has been reported. The diarrhea is now bright red blood. The patient stated that yesterday (24May2021), she started with the stomach ache and loose stool or diarrhea. Today (25Ma2021), she had a bout of, moderate amount of, bright red bloody diarrhea. The patient further stated this had improved but now she is losing blood so because of that is has worsened. She stated it was not serious until today and then all of a sudden, she had a moderate bright red amount of diarrhea which she has never had, and it is medically significant. She stated that yesterday she had a lot of diarrhea in terms of volume and the volume has gotten better today but now it is bright red which is concerning. She initially mentioned that about 6 hours after the second dose she started feeling like she had a bad case of the flu and felt really bad for like 3 days and that was letting up. Clarified that starting 21May2021, for the first 2 days after the second dose of the Covid 19 Vaccine: Patient further described as very heavy flu-like symptoms; severe achiness; weakness; just felt awful but events are much better now, now she has light symptoms which are improving. She would say it was medically significant but now it is barely insignificant. The adverse events did not require a visit to the emergency room or physician office. The patient did not receive any corrective treatment for the adverse events. Outcome of the events was recovering.; Sender''s Comments: Based on available information, a possible contributory role of the subject product, BNT162B2 vaccine, cannot be excluded for the bloody diarrhea and the other reported events due to temporal relationship. There is limited information provided in this report. Additional information is needed to better assess the case, including complete medical history, diagnostics including stool cultures and colonoscopy, counteractive treatment measures and concomitant medications. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1387730 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-14
Onset:2021-05-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAIR; MOBID; BUSPIRONE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Fever; Lactose intolerant; Ulcer
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021600313

Write-up: Running a fever since the 2nd vaccine on 14May2021. My entire body is itching all over. I want to the doctor and emergency room. Nothing helps including oral steroids, Tylenol and Benadryl.; Running a fever since the 2nd vaccine on 14May2021. My entire body is itching all over. I want to the doctor and emergency room. Nothing helps including oral steroids, Tylenol and Benadryl.; This is a spontaneous report from a contactable consumer. A 74-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 2 via an unspecified route of administration, administered in Arm Right on 14May2021 12:15 (Batch/Lot Number: Unknown) as 2ND DOSE, SINGLE for covid-19 immunisation. Medical history included Asthma, hay fever, ulcers, lactose intolerant. Concomitant medications included montelukast sodium (SINGULAIR); cisapride (MOBID); buspirone (BUSPIRONE); taken for unspecified indications, start and stop dates were not reported. The patient previously took aspirin for hypersensitivity, visceral for hypersensitivity, cafergot comp for hypersensitivity. Prior the vaccination the patient was not diagnosed with COVID-19. The patient received first dose of BNT162B2 on 25Feb2021 at 10:30 AM in right arm for COVID-19 immunization. Running a fever since the 2nd vaccine on 14May2021. My entire body is itching all over. I went to the doctor and emergency room. Nothing helps including oral steroids, Tylenol and Benadryl. The patient received treatment for the events: Benadryl, Tylenol, oral steroids, cortisone cream. The outcome of the events was not recovered. Follow-up attempts needed. Additional information has been requested.


VAERS ID: 1387812 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Malaise, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021650162

Write-up: extreme malaise; neck pain; having very bizarre symptoms; extreme fatigue; fever for a week; This is a spontaneous report from a contactable consumer or other non hcp (patient herself). A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number, NDC number and expiry date were not provided), via an unspecified route of administration on 16May2021 as 2ND DOSE, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously took first dose of historical vaccine, bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) on an unspecified date for COVID-19 immunization. It was reported as patient wanted to know if there is a test to see if her reaction is related to the second shot of the Pfizer COVID-19 vaccine. She said that her doctors are basically running every blood test to see if it is a reaction to the vaccine. She said that she had a fever for a week, extreme malaise, and neck pain. Her last shot of the Pfizer COVID-19 vaccine is on 16May2021 and her fever did not start until 21May2021. She also mentioned that she had a delayed reaction to the vaccine (a month later) and this was not verified to caller as she disconnected before clarifying. She also said that her reaction was delayed. She said that it happened a month later. It was reported as she seems to behaving very bizarre symptoms that her doctor is also having a hard time diagnosing. She would like to report this or see if there are any similar symptoms being reported by others with these adverse effects with the Pfizer Covid vaccine. She seems to have had a delayed reaction, if she is having one to the shot. Later provides bizarre symptoms as extreme fatigue and fever for a week. No further details provided. Investigation assessment was not provided. Reporter seriousness for the events was unspecified. The outcome of events was unknown. No follow-up attempts are possible. information about lot/batch number cannot be obtained.


VAERS ID: 1388054 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient started breaking out with minor rash on May 21 on our way to vacation four days after her Covid Shot. Her mother and I thought it may be the sheets she slept on in the motel or maybe something she ate. She was treated with Bendryl pill and cream. the next few days at or destination the rash got worse and worse itching was incredible and a bad headache. On Tuesday evening Patient started swelling on her feet and hands her feet were somewhat blue We got extremely concerned and called our Health Care Provider nurse Line. With everything we provided to her relating to Patients symptoms she felt like calling 911 immediately would e best for her. The Island we were staying on is very small and the hospital was 2 miles away my daughter just took her. The attending physician treated her for a severe case of hives She said that it was due to an unknown origin. Patient just received her 2nd Pfizer Covid shot on June 7 and on June 8 started breaking out with hives we now know the shot was the culprit. Hope this is helpful information


VAERS ID: 1388077 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Hypotension, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing taken
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: CAT SCAN
CDC Split Type:

Write-up: WITHIN TWO MINUTES OF GETTING OFF THE CHAIR I STARTED HAKING AND PASSED OUT. COULDN''T BREATH NEEDED AN OXGEN MASK. MY BLOOD PRESSUE DROP VERY LOW.


VAERS ID: 1388385 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-05-21
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Lymphadenitis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I88.0 - Nonspecific mesenteric lymphadenitis abdominal pain


VAERS ID: 1388396 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Exposure during pregnancy, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap vaccine - I developed pneumonia after taking the vaccine when I was pregnant with my second child
Other Medications: Prenatal vitamins
Current Illness:
Preexisting Conditions: ADHD
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: At night, I was nauseous, I had, chills muscle aches, and developed a fever. In the morning, I had a 101 temp and then I took Tylenol. I also threw up chicken soup . I called my doctor after hours that Saturday but I spoke to a nurse. They told me to stay hydrated. I drank ginger ale and ate crackers. By Sunday morning, I started to feel better. By Monday, I felt 100% well. Estimated date of delivery is November 6th, 2021. I was super tired the first trimester and the second trimester, I''ve been feeling great. I''ve been getting a lot of stuff done around the house. But it is hard to squat sometimes. I had a checkup May 24th and the doctor said that the baby was doing fine.


VAERS ID: 1388466 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-08
Onset:2021-05-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Impaired work ability, Pyrexia, Respiratory tract congestion, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I was fine up until the 5/21. As I was leaving work, I got a horrible headache. I had a fever, coughing, congestion, wheezing, irritated throat--it felt like I had COVID. My lasted from 5/21-5/23. It never got over 100, but I never get fevers. I had a tele-med visit on 5/24 and she had me take antibiotics for a week, but they didn''t work. On the 5/28, I spoke with her again and she wanted to see me again in a week. On 6/1, she had me take another round of antibiotics that helped a little, so I was able to return to work part-time. I got a Rocephen injection on 6/7 and that finally helped. I was then able to return to work full time. Currently, I am still experiencing some throat irritation and coughing, but I''m much better. I''m taking some cough medicine that she prescribed as needed.


VAERS ID: 1388469 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER EW0185 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Womens multivitamin, allegra allery, probiotic
Current Illness: NA
Preexisting Conditions: NA
Allergies: Aspirin, iodine, nuts, shellfish
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Extreme chills, sweats, headache, exhaustion, and fever of 100.8 for 23 hours


VAERS ID: 1388492 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Altered state of consciousness, Blood creatine phosphokinase normal, Blood creatinine increased, Blood lactic acid, Colitis, Computerised tomogram abdomen abnormal, Leukocytosis, Pancreatitis, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Celebrex 200 mg po daily Oxycodone 10 mg po every 6 hours Pregablin 50 mg po twice daily Temazepam 30 mg po prn qHS Cyclobenzaprine 10 mg po prn three times daily Denavir 1% topical apply every 2 hours Flonase 50 mcg 2 sprays twice daily L
Current Illness:
Preexisting Conditions: Hypertension Hyperlipidemia Chronic pain
Allergies: Penicillin
Diagnostic Lab Data: white blood cell count 34,970 Creatinine 1.6 Lactic acid 1 CK 101 CT scan of the abdomen revealed pan colitis. Repeat CT scan again revealed pancolitis with pancreatic inflammation
CDC Split Type:

Write-up: In the days following the vaccine, patient developed decreasing responsiveness and presented to the hospital 4 days after vaccination with leukocytosis acute renal failure


VAERS ID: 1388834 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, 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: cetirizine 10mg , Flonase allergy relief 50mcg
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received Moderna vaccine for his first dose of Covid vaccine instead of Pfizer.


VAERS ID: 1388847 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-05-21
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG - 20 May Chest XRay - 20 May CT - 20 May EKG - 10 Jun
CDC Split Type:

Write-up: Intense Chest Pain / Difficulty Breathing / Pericarditis Diagnosed in ER


VAERS ID: 1388888 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Computerised tomogram head, Dizziness, Dysarthria, Facial paralysis, Feeling abnormal, Hemiplegia, Laboratory test, Loss of consciousness, Magnetic resonance imaging, Neurological symptom, Urinary incontinence
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), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Lisinopril, Aspirin, REquip
Current Illness: NONE
Preexisting Conditions: HTN, Hyperlipidemia, prediabetes, smoker, COPD, restless legs
Allergies: NONE
Diagnostic Lab Data: Basic labs, Head CT and MRI pending
CDC Split Type:

Write-up: Within 2 hours of 1st Pfizer COVID injection pt had sudden onset left-sided paralysis with facial droop and slurred speech and then brief loss of consciousness with loss of bowel and bladder function. This happened on 5/21/2021. His wife is here giving the history. Him and his wife have the first Covid injection by Pfizer on 5/21/2021 at 3:30 PM at pharmacy. Within 2 hours they were back home sitting on the porch relaxing and he had the sudden onset of stroke like symptoms as noted above. EMS was called. Apparently by the time EMS arrived he had recovered to baseline and they advised him he did not have to go to the hospital for evaluation if he did not want to apparently. Since that time he has had no further stroke like symptoms but has continued to feel a bit foggy in the head with a slight dizziness.


VAERS ID: 1388922 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D23C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Fatigue, Pyrexia, Stress
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Fever after flu shot in 2019.
Other Medications: N/A
Current Illness: Nasal inflammation.
Preexisting Conditions: Seborrheic dermatitis.
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The day after the vaccine, I started feeling tired in the afternoon, and was bedridden for at least four hours with a fever less than 100 degrees. During this time, I had mild sharp pain in the heart twice, each lasting about 5-10 seconds. The fever was gone after I took Tylenol, but the heart pain is still quite stressful to think about even today.


VAERS ID: 1388966 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Presented to the ED after 2nd covid vaccine. 5 minutes after the administration patient developed throat fullness, she was administered one dose of an epi pen and symptoms were somewhat relieved. After first dose she broke out in hives a week after, which resolved.


VAERS ID: 1389066 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-21
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Endotracheal intubation, Psychogenic seizure, Seizure
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: patient has history of seizures, presented with a seizure to ED, she was nonverbal, diagnosed with unspecified convulsions and pseudoseizures. Patient was intubated. diagnosed with seizures and acute respiratory failure.


VAERS ID: 1389145 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: No illness ever
Preexisting Conditions: Since my 2nd shot I have chest pain, it?s still going on, I feel like the pain is in heart and left side of neck. Please advise if If this is serious complications of shot
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Check and neck pain, I feel like my heart is going to explode


VAERS ID: 1389192 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: esomeprazole 20mg daily, allergy nose spray fluticasone prn, Pepcid prn, birth control pills daily, multivitamin daily, vitamin D daily.
Current Illness: Two months prior had sinus infection which progressed to bronchitis. Took 5 weeks to get better.
Preexisting Conditions: Sees GI doctor regularly. Has Barrett''s. Also has anxiety.
Allergies: Sulfa allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 6 hours after 1st shot, pt woke up with irritated GI tract. Felt like severe stomach ache from reflux. Had diarrhea for 3 days. GI tract irritation and stomach pain persisted for the 3 days. Did not take anything for symptoms.


VAERS ID: 1389272 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: 17 year old patient presented to clinic with parent for first Covid vaccine, patient was administered Moderna instead of Phizer. Parent was notified and no additional adverse signs and symptoms reported by parent.


VAERS ID: 1389338 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Fatigue, Hyperhidrosis, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin, Vit. B, Vit. D, ASA (81mg), omega 3, pro-biotic
Current Illness: None
Preexisting Conditions: None
Allergies: Lidocaine, marcaine, carbocaine, Demerol,scallops, peppers
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tightness in chest, sweats, chills, nausea, vomiting, SOB, fatigue


VAERS ID: 1389350 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: After receiving the COVID-19 vaccine the patient was waiting in the store after the shot and was walking around. He had gotten dizzy while walking in an aisle, and lost his balance and fell.


VAERS ID: 1389546 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Discouragement, Dysstasia, Full blood count, Gait inability, Metabolic function test, Mobility decreased, Urine analysis
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica / Allopurinol / Ativan / Cardura / Cymbalta / Ferrous sulfate / Fish oil capsule / Floranex / Lexapro / Lopressor / Melatonin / Norvasc / Oxybutynin / Oxycodone / Protonix / Senexon-S / Ventolin / Vitamin D3 /
Current Illness: Covid
Preexisting Conditions: Spondylolisthesis / spinal stenosis / acquired absence right knee / hyperlipidemia / foot drop, left foot / anxiety disorder / primary osteoarthritis, right elbow / low back pain / chronic kidney disease / GERD /
Allergies: Dilaudid
Diagnostic Lab Data: CBC, CMP and urinalysis on 6/2/2021.
CDC Split Type:

Write-up: Received 2nd vaccination on Wednesday, May 19 2021 and symptoms started May 21, 2021 when being discharged from Nursing Home. Could barely get in vehicle and once home, needed to be pushed in wheelchair due to extreme weakness. Could not stand or walk for the next three days. Have since slowly regained some strength, but feels at least 70% of strength was lost and had to start over with physical therapy. Very upset and discouraged.


VAERS ID: 1389568 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bells Palsy


VAERS ID: 1389752 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-03-18
Onset:2021-05-21
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac disorder, Chest pain, Dyspepsia, Echocardiogram abnormal
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 7.5 mg daily
Current Illness: N/A
Preexisting Conditions: hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient has primary essential hypertension. Patient undergoes an annual echocardiogram to monitor for ventricular hypertrophy. Prior to this years ECHO, all results have been normal. This year there was an incidental finding of a small amount of fluid around her AV node. ECHO was performed on 5/21/21. She is to have a repeat ECHO on June 11 to monitor for changes. Patient did endorse stabbing like chest pain a couple of weeks ago, but dismissed it as heartburn. Her first Pfizer Covid shot was 3/18/21 and her second Pfizer Covid shot was 4/7/21. Same lot# for both vaccines.


VAERS ID: 1390377 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-05
Onset:2021-05-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 2280 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ny
Current Illness: No
Preexisting Conditions: No
Allergies: Ny
Diagnostic Lab Data: Hart reading is more than 225bpm
CDC Split Type:

Write-up: Heart problem


VAERS ID: 1390928 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-05-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH RW0186 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TEGRETOL; WELLBUTRIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bipolar disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021607643

Write-up: large clotting discharge with period; period came earlier than usual and very heavy/clots are still present; This is a spontaneous report received from a contactable consumer (patient). A 48-year-old female patient received the second dose of BNT162B2 (lot number: Rw0186), via an unspecified route of administration in arm left on 13May2021 15:00 at single dose for COVID-19 immunisation. Medical history included no just bipolar. Concomitant medications included carbamazepine (TEGRETOL) for bipolar, and bupropion hydrochloride (WELLBUTRIN) for bipolar over 25 years daily with no unusual side effects. Patient previously received the first dose of BNT162B2 (lot: Ee0186) in arm left on 22Apr2021 15:00 for COVID-19 immunisation and experienced period came earlier than usual and very heavy. On 21May2021 13:00, the patient experienced large clotting discharge with period. This had never happened before and period had never been this heavy or early. Then it stopped but a few days later clots were still present. Looked it up and others had reported uterine lining shedding and heavy bleeding. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Outcome of the events was unknown.


VAERS ID: 1390942 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling, Oral pruritus, Peripheral swelling, SARS-CoV-2 test, Sneezing, Swelling, Throat tightness, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? No
Previous Vaccinations:
Other Medications: SINGULAIR; ALLEGRA D; BENADRYL; CELEXA [CITALOPRAM HYDROBROMIDE]; VASCEPA; SYMBICORT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy; Arthrodesis; Asthma; Cholesterol; Fruit allergy; Heart valve disorders; Sulfonamide allergy; Triglycerides; Ulcer
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 Nasal Swab; Test Result: Negative ; Test Date: 202104; Test Name: COVID-19 Nasal Swab; Test Result: Negative ; Test Date: 202104; Test Name: COVID-19 Nasal Swab; Test Result: Negative ; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:unknown results; Comments: after vaccination
CDC Split Type: USPFIZER INC2021609864

Write-up: swollen arm; 2 days later hives under chin on left side/ hives on left cheek/ hives on her left trunk, face, and arm; throat started to close; mouth started to itch; swollen itchy eyes; swollen itchy eyes; sneezing; swollen lump in shoulder immediately; This is a spontaneous report from a contactable consumer (the patient). A 54-year-old female received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, lot number EW0167), via an unspecified route of administration in the left arm on 21May2021 17:00 (at the age of 54-years-old) as a single dose for COVID-19 immunization. The patient''s medical history included: asthma, allergies, leaky heart valve, fusion feet, cholesterol, triglycerides, ulcers, and allergy to sulfa and bananas. The patient had a negative COVID-19 nasal swab in Jan2021, and twice in Apr2021. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient was not pregnant at the time of vaccination. Concomitant medications included: montelukast sodium (SINGULAIR), fexofenadine hydrochloride/ pseudoephedrine hydrochloride (ALLEGRA D), diphenhydramine hydrochloride (BENADRYL), citalopram hydrobromide (CELEXA), eicosapentaenoic acid ethyl ester (VASCEPA), budesonide/ formoterol fumarate (SYMBICORT), all taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 21May2021 19:00, within 2 hours of vaccination, the patient experienced swollen itchy eyes, mouth started to itch, sneezing, throat started to close; swollen lump in shoulder immediately. Two days later (23May2021), hives under chin on left side. The next day (unspecified date) she got hives on left cheek, then a few days later (unspecified date), hives on her left trunk. It was also reported she had hives on left side of trunk, face, and arm, and had a swollen arm. For treatment, the patient took 3 BENADRYL and 20 mg of prednisone. The outcome of the events was recovering. Since the vaccination, the patient has been tested for COVID-19 on an unspecified date (unknown results).


VAERS ID: 1390960 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-01
Onset:2021-05-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Carotid artery dissection, Computerised tomogram neck, SARS-CoV-2 test, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LISINOPRIL; AMLODIPINE BESILATE; LIS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: CT of neck; Result Unstructured Data: Test Result:small carotid dissection in neck artery; Test Date: 20210521; Test Name: Nasal Swab Covid test; Result Unstructured Data: Test Result:Unknown
CDC Split Type: USPFIZER INC2021613242

Write-up: mini stroke (TIA); small carotid dissection in neck artery; This is a spontaneous report from a non-contactable consumer (patient). A 63-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration administered on arm left on 01May2021 10:30 (Batch/Lot number was not reported) as 1ST DOSE, SINGLE for COVID-19 immunization. Medical history included hypertension. The patient had no known allergies. Concomitant medications included lisinopril (LISINOPRIL), amlodipine besilate (AMLODIPINE BESILATE) and lactulose (LIS) all taken for an unspecified indications and therapy dates. On 21May2021 (also reported as 2 weeks after 1st vaccine), the patient went to the emergency room department with a mini stroke (TIA). CT of neck on that same day of 21May2021 showed a small carotid dissection in neck artery. The patient also had nasal swab COVID test on that day with unknown results. It was reported that TIA possibly caused by dissection being blocked for a short time. The patient went 3 days in hospital (since May2021) running test. It was stated that the events resulted to doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. The patient had prescriptions (unspecified medications) and follow up care as treatment. The patient recovered from the events in May2021. The patient then received the 2nd dose of PFIZER-BIONTECH COVID-19 VACCINE on 26May2021 16:45 ((Batch/Lot number was not reported) on the left arm. No follow-up attempts are possible; Information about lot/batch number cannot be obtained.


VAERS ID: 1390995 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-30
Onset:2021-05-21
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021634086

Write-up: Bells Palsy; This is a spontaneous report from a contactable consumer (patient). A 30-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: EW0171, expiration date not reported), via an unspecified route of administration, administered in Left arm on 30Apr2021 14:00 (at the age of 30-years-old) as 2nd dose, single dose for covid-19 immunisation. Medical history was reported as none and the patient had no known allergies. The patient did not receive other medications in two weeks of vaccination. The patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: ER8732) via an unspecified route of administration, administered in Left arm on 09Apr2021 14:00 as 1st dose, single dose for covid-19 immunisation. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination. The patient has not been tested for COVID-19 since the vaccination. On 21May2021 at 16:00, the patient experienced Bell''s palsy and was treated with Antiviral / steroid prescription. The adverse event resulted in emergency room/department or urgent care. The reporter assessed event as non-serious with no seriousness criteria of resulting in death, Life threatening, Caused or prolonged hospitalization, Disabling or Incapacitating, Congenital anomaly or birth defect. The outcome of the events was recovering.


VAERS ID: 1391724 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-20
Onset:2021-05-21
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Cardiac disorder, Electrocardiogram ambulatory
SMQs:

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: Yes I was taking medication.
Current Illness: No other illnesses.
Preexisting Conditions: No chronic or long-standing health conditions.
Allergies: No allergies.
Diagnostic Lab Data: No medical test or lab results.
CDC Split Type: vsafe

Write-up: I had a heart scare attack and it was months after the shot however I feel that it relevant to the vaccine. I had to wear a Holter monitor for 24hrs.


VAERS ID: 1391955 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 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: Already received a Janssen, should not have received a Pfizer dose.


VAERS ID: 1392064 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Joint range of motion decreased, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Arm pain originating in the deltoid region spanning down length of arm. Patient reports limited range of motion, pain, weakness, and tingling in fingertips.


VAERS ID: 1336801 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure check from paramedics: normal
CDC Split Type:

Write-up: The Janssen vaccine was administered to this patient & after the patient went to sit on a chair by rx waiting area for his 15 min waiting period. A few min later he lost consciousness for a split second & collapsed onto the floor. He hit the side of his head very hard and stayed laying on floor (conscious, breathing, and responsive). The Rph, had pharmacy tech call 911 and went to care for customer. Customer was advised to stay laying down with arm over head, remove mask, & was fanned with air. He agreed to aid & informed Rph his ear/ head hurt from the strike to floor. Paramedics came * checked his blood pressure an vitals which were normal. He did not go into amublance.


VAERS ID: 1341342 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amylase, C-reactive protein, Cholecystitis acute, Full blood count, Hepatic enzyme, Laboratory test, Ultrasound abdomen
SMQs:, Infectious biliary disorders (narrow), Gallbladder related disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work (ultra sensitive C-reactive protein), complete hemogram, liver enzymes, amylase, etc. Abdominal ultrasound
CDC Split Type:

Write-up: Acute acalculous cholecystitis


VAERS ID: 1332423 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

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

Write-up: Red, raised circular area around injection has been growing since a few hours following injection. It is itchy, and painful to touch, and warmer than the rest of my arm.


VAERS ID: 1332657 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dehydration, Sleep disorder
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, specifically to counteract any pain and swelling.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Woke up sometime around 18 Hrs post vaccination (2nd Dose). Extreme chills, dehydration, and skin tempreture (Internal showed normal at 97.9)


VAERS ID: 1333176 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt was sitting in post-vaccinating area after a covid shot. Suddenly he felt his heart racing, started hearing noises, feeling dizziness, and he passed out briefly.


VAERS ID: 1333186 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6318 / 1 LA / IM

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

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

Write-up: Patient may have been given 0.2ml instead of 0.3ml of Pfizer COVID19 vaccine based on an error that the technician made when drawing the vaccine up into the syringe. The patient was contacted and made aware. Based on the CDC and clinical guidelines, re-administration is not recommended since they received $g 50% of the dose.


VAERS ID: 1333198 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient had chest tightness and trouble breathing 15 minutes after receiving vaccine


VAERS ID: 1333204 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: 46770575463

Write-up: Patient got 1st shot at a Health department 2nd shot at a Pharmacy ( from the request of insurance agent sent patient to pharmacy to get second shot ) 3rd shot at a Health Department (Patient went with 1st dose card ) Patient called the Pharmacy to schedule Moderna Shot, informed can''t do it and need to contact Prescriber, Patient is mentally challaned


VAERS ID: 1333206 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

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

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

Write-up: Patient may have been given 0.2ml instead of 0.3ml of Pfizer COVID19 vaccine based on an error that the technician made when drawing the vaccine up into the syringe. The patient was contacted and made aware. Based on the CDC and clinical guidelines, re-administration is not recommended since they received $g 50% of the dose.


VAERS ID: 1333214 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type: CA134B1001

Write-up: RN administered the Moderna vaccine earlier than the 4-day grace period for the vaccine. Patient tolerated the vaccine administration and left in stable condition.


VAERS ID: 1333219 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Condition aggravated, Feeling cold, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: Patient reports with all vaccines
Other Medications: None
Current Illness: None
Preexisting Conditions: Congenital Hearing Disorder
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Initially after first dose of Janssen Covid vaccine patient was initially on guerney but states he felt fine and was then assisted to a chair. Four minutes after vaccine, patient was sitting in chair and was observed to slump in chair and was then assisted to the floor. Patient had syncopal episode. Immediately ammonia was placed under his nose and patient aroused. Patient is cool and clammy. Cold ice pack applied to back of head and neck. Vital signs taken pulse 80, respirations 20, blood pressure 126/79, and 02 sat 100%. Patient is alert and oriented x4 and states "this always happens." Oxygen applied at 4 liters per minute via simple mask. Patient assisted slowly to a sitting position. Tolerated well. Patient assisted to gurney by Nurses. Vital signs rechecked, blood pressure is 132/65, pulse 69, 02 sat is 99% on room air. Patient transferred to nurse treatment room via gurney in stable condition with nurse assistance. Report given to Nurse.


VAERS ID: 1333225 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Swollen lymph nodes in left armpit. Very tender and painful


VAERS ID: 1333228 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling hot, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: patient experienced shortness of breath, sweating, and feeling warm after waiting for observation for 12 minutes. Patient stood up and symptoms started and resolved after another 10-15 minutes of sitting


VAERS ID: 1333230 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Head discomfort, Hypoacusis, Injection site pain, Pain in extremity, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin gummies
Current Illness:
Preexisting Conditions:
Allergies: Latex, environmental allergies, tomatoes, avocado, animals
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 minutes after I received my vaccine I got really dizzy and then couldn?t breathe. My head got super heavy and I couldn?t hear well. I was about to pass out. They laid me on the ground for awhile and when I felt better I noticed my arms hurt. I had broken out in hives all over them. Pharmacist gave me Benadryl and in about 10 minutes I felt better. While I was receiving the shot it hurt really bad and usually shots don?t bother me.


VAERS ID: 1333241 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RL / -

Administered by: Other       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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT REQUESTED TO VACCINATE TO RIGHT THIGH INSTEAD OF ARM D/T MEDICAL CONCERN OF HIGH RISK OF BILAT LYMPHADEMIA. VACCINE WAS GIVEN IN RIGHT THIGH AS REQUESTED.


VAERS ID: 1333250 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: 3rd Moderna Vaccine 1st dose given at one location, 2nd dose given at a Pharmacy and 3rd dose given through location from first dose. Unaware that 2nd dose was given. Patient''s brother unaware that 2nd dose was given at the Pharmacy for he is the caregiver. Spoke with pharmacist regarding 2nd dose and he stated that the patient was brought via transportation provided by insurance.


VAERS ID: 1333265 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site pain, Pyrexia, Rash, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), 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: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The adverse event began with a sudden rash on the face, arms, neck, ears, chest and back, accompanied by a mild headache, dizziness, aching at the injection site, and a sub-dermal "burning" sensation in the skin and upper extremities. There was no rash that presented below the waist. The rash was accompanied by a low-grade fever of 99 to 100 Fahrenheit and lasted for over an hour from the time the adverse event presented. Once the low-grade fever dissipated, the rash symptoms and low-grade fever dissipated as well.


VAERS ID: 1333267 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Pt started complaining of being dizzy and dry mouth about 10 minutes after vaccination. Denies SOB/ difficulty breathing, increased HR, chest pain. No rash or hives. Patient vitals: HR 84, Resp 18, B/P 160/70, O2 94%, BG 191. Patient specified dizzy when her legs are crossed. Expressed she has not eaten since 6 AM and was sitting in the sun for 1 hour prior to arriving for vaccine. After drinking 2 bottles of water , and resting, patient denied EMS services. PT released.


VAERS ID: 1333271 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate decreased, Hypoaesthesia, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: N/a
Current Illness: na
Preexisting Conditions: na
Allergies: Na
Diagnostic Lab Data: low heart rate. oxygen was normal within range
CDC Split Type:

Write-up: patient experiencing difficuly breathing, numbness in arms, nausea, shakiness ,light headed


VAERS ID: 1333286 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Vitamin D, Vitamin C, Vitamin B & Zinc
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaginal bleeding 72 hours after injection


VAERS ID: 1333291 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, 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? No
Previous Vaccinations:
Other Medications: Dyazide L. Thyroxine Albuoral
Current Illness: MS Asthma Kidney Disease RBB LAB Ostio Arthritis Fibromyalgin
Preexisting Conditions:
Allergies: Ultram Asmatic reaction to Quorn- Micro Protein
Diagnostic Lab Data:
CDC Split Type:

Write-up: 97% pulse 145/78 93 regular


VAERS ID: 1333295 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Very strong menstrual bleeding starting the following day


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