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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 118 out of 6,867

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VAERS ID: 1583077 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-02
Onset:2021-08-17
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Lethargy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALLOPURINOL, ATORVASTATIN, AMLODIPINE, POTASSIUM CITRATE, TRAMADOL, GLIMEPIRIDE, METFORMIN
Current Illness:
Preexisting Conditions: CHOLECYSTECTOMY, DM, HTN, SLEEP APNEA
Allergies: AMPICILLIN, PENICILLIN
Diagnostic Lab Data: POSITIVE COVID-19 PCR 08/17/2021 @ 2330
CDC Split Type:

Write-up: arrived from home by EMS. Pt tested COVID+ on 8/13, c/o weakness and lethargy, intermittent SOB. Denies n/v/d, abd pain


VAERS ID: 1583084 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Palpitations, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), 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: None
Current Illness: None
Preexisting Conditions: Bad teeth
Allergies: Gogi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weak knees shaky. Racing heart. No treatment, stayed at pharmacy for about an hour until it subsided. Wasn''t anxious but thought it was similar in behavior to anxiety .


VAERS ID: 1583099 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, chills, muscle pain, headache, insomnia, fatigue


VAERS ID: 1583117 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Flank pain, Headache, Nausea, Pain, Pyrexia, Tenderness, Tinnitus, Tunnel vision
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: High grade fever consistent for 36 hours ranging from 100.7F to 103.5F despite alternation of acetaminophen and ibuprofen every 3 hours. 103.5 fever registered 27 hours after vaccine. Severe body aches, right axilla tenderness, nausea, diarrhea, multiple episodes of tunnel vision and tinnitus. Bilateral flank pain for 24 hours and severe headache.


VAERS ID: 1583138 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Headache, Heart rate abnormal, Hypertension, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rapid heart beat, soreness, headache, dizzyness, hangover feeling, high blood pressure.


VAERS ID: 1583141 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Oropharyngeal pain, Rash, Respiratory tract congestion, Rhinorrhoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1st day after vaccination had runny nose and sore throat and congestion 2nd day after vaccination (today) has as rash and hives all over her face and neck and arm. She is also SOB and gasping on and off.


VAERS ID: 1583154 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 stated lt arm began to be numb after injection.


VAERS ID: 1583168 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Limb discomfort
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 stated his lt arm felt heavy.


VAERS ID: 1583335 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Injection site pain, Pain, Rash, Rash erythematous, Skin warm
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: arm pain night after injection. Fatigue, aches, pain, headache, shortness of breath on day after. Neck and chest hot to the touch. Bright red rash across chest and stomach on second day. Rash is hot to the touch and surrounding skin that isn''t red is cool to the touch. Alternate chills and sweating.


VAERS ID: 1583361 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Myalgia, Tremor, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco, acyclovir, robaxin
Current Illness: no
Preexisting Conditions: asthma, back pain, PCOS
Allergies: opioids, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports that 2 days after receiving the both doses of the Pfizer Covid-19 vaccination she developed myalgia, fatigue & tremor in both hands.


VAERS ID: 1583363 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Muscle spasms, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, synthroid, sertraline, sometimes sublinox
Current Illness: None
Preexisting Conditions: Celiac Anemic Hypothyroid Hashimotos
Allergies: Celiac
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea Sore arm, not at injection site just overall Cramps Tired


VAERS ID: 1583392 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Face injury, Fall, Hyperhidrosis, Skin laceration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received J&J covid vaccine after completing consent and Prevaccination Checklist for COVID-19 vaccines. Patient was walked waiting room to sit for 15 minutes after injection. Patient reported to front desk staff she felt dizzy, staff instructed patient to sit in chair and take deep breathes. Patient sat down in chair and then had syncopal episode, witnessed by other patients in waiting room. Patient fell forward out of chair and hit face on floor causing laceration above left eyebrow. Patient was transferred to exam room where she continued to be lightheaded diaphoretic for approximately 15 minutes. Patient was slowly moved to sitting position, given orange juice to drink and laceration was treated. Patient was walked to vehicle approximately 30 minutes after syncopal episode and reported no further symptoms.


VAERS ID: 1583582 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypopnoea, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), 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: Zinc, B complex, vitamin C
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever, convulsions, shallow breathing


VAERS ID: 1583589 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Blood pressure increased, Dizziness, Fatigue, Nausea, Palpitations, Presyncope, Somnolence, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: APPROXING TWO MINUTES AFTER GIVING THE MODERNA VACCINE INTO THE LEFT ARM IM, PATIENT STARTED TO COMPLAIN OF HER HEART STARTING TO RACE AND FEEL LIKE IT WAS GOING TO POUND OUT OF HER CHEST. I ADVISED PT TO CONTROL HER BREATHING WITH SLOW DEEP BREATHS, SO IT DOESNT TURN INTO ANYTHING ELSE. TOOK BP AT 9:57AM WITH 152/111 HR OF 85 PT WAS SITTING. STILL ABLE TO UNDERSTAND AND TALK WITH ME AND KNOW WHAT IS GOING ON. BP AGAIN AT 10:02 AM 129/107 HR 82, PT SAID FEELING A LITTLE BETTER, I ASKED IF SHE WOULD LIKE SOMETHING TO DRINK, SHE SAID SHE HAD A TEA WITH HER HUSBAND. PT ABLE TO TAKE 2 SMALL SIPS AND THEN FELT LIKE SHE WAS GOING TO VOMIT. ASKED PT AGAIN TO CONTROL BREATHING WITH SLOW DEEP BREATHS, PT WAS ABLE TO STILL DO THIS. ASKED PT IF SHE FELT OK ENOUGH TO STAND TO TAKE BP, SHE SAID SHE THOUGHT SO, I ADVISED IF SHE FELT LIKE SHE NEEDED TO SIT DOWN THE CHAIR WAS RIGHT NEXT TO HER. PT STOOD AGAINST WALL, TOOK BP WITH AUTOMATED CUFF, BP 148/102 HR 85 STANDING. PT SAID SHE WAS EXTREMLY DIZZY AND LIGHT HEADED AND FELT LIKE SHE WAS GOING TO PASS OUT. I HELPED HER TO THE CHAIR. ONCE IN THE CHAIR, PHARMACIST CAME IN TO CHECK ON PT AND PT STATED TO HER THAT SHE WAS JUST VERY TIRED AND WAS GOING TO GO TO SLEEP AND STARTED TO NOD OFF, I CONTINUED TO TALK TO HER AND SHE WOULD STILL REPLY TO VERBAL COMMANDS BUT DIDNT LIKE TO OPEN HER EYES. CHECKED BLOOD GLUCOSE AT 10:15 AND WAS 117. PT CONTINUED TO NOT RESPOND TO VERBAL STIMULI. PT CONTINUED TO DECLINE AND WAS UNABLE TO RESPOND, GAVE EPI INTO LEFT THIGH AT 10:20AM. TRANSFERRED CARE TO FIRE AND AMBULANCE SERVICE


VAERS ID: 1583592 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Immunodeficiency, Injection site erythema, Injection site swelling, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira lyrica sumatriptan metoprolol A few others
Current Illness: Crohns Migraines
Preexisting Conditions: Crohns Migrains
Allergies: Infliximab Iodine dye contrast opiods
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is immunocompromised due to being on Humira for Crohns. Patient got her 3rd Pfizer Covid vaccination on Monday at 11am at the pharmacy. At 4am the following morning patient states arm started to hurt and she developed painful red swelling the size of a quarter on Tuesday. Patient was seen on Wednesday at 230ish with swelling and well defined ertyehma on left arm at injection site measuring 5cm x 6cm. Patient concerned for infection, provider and collaborating physican concerned for allergic reaction. Treated for both with Keflex 50mg QID x 10 days and Prednisone 40mg Daily x 5 days. Patient told to follow up with PCP asap and ER if symptoms worsen.


VAERS ID: 1583615 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest pain, Pain, Paraesthesia, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Synthroid, Vienva, Fluoxetine
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: Levaquin, Avelox
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, tacycardia, body aches, skin tingling all over body, anxiety


VAERS ID: 1583620 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications in the 48 hour time frame before vaccination
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Seasonal Allergies; Animal Dander and Saliva; No food or medicine allergies known
Diagnostic Lab Data: None yet, if prolonged over 3 days, will seek out dermatologist, or upon review of this form upon submittal if contacted.
CDC Split Type:

Write-up: Itchy Rash, All over body, started on wrists and top of hands both sides; now on arms, stomach, thighs, face, and back.


VAERS ID: 1583831 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Large swollen lymph node above shoulder blade


VAERS ID: 1583834 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine, atorvastatin, ezetimibe, farxiga, hydrochlorothiazide, losartan, metoprolol ER
Current Illness: none
Preexisting Conditions: diabetes, high blood pressure, high cholesterol, allergic rhinitis
Allergies: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received her 2nd dose of Moderna COVID vaccine on 8/17/2021 at around 11AM. The patient called us the following day on 8/18/2021 to let us know she was having arm pain and swelling. The patient stated that the symptoms were not immediate and began on the evening of 8/17/2021. We asked the patient if she had tried anything to help her with side effects. The patient said that she had not taken or tried anything at the time of her phone call. We counseled the patient to use a cold compress, ice packs, and/or analgesic medications to help her with the pain and swelling. The patient did not mention needing to seek any additional medical attention.


VAERS ID: 1583997 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Malaise, Peripheral coldness, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none per patient
Current Illness: none per patient
Preexisting Conditions: none per patient
Allergies: none per patient
Diagnostic Lab Data: None that we are aware of at this time.
CDC Split Type:

Write-up: Patient was give her 1st Moderna shot on 7/20/21 with no issues or side effects. On 8/17/21 she received her 2nd Moderna shot @ 6:00pm. She is a healthy young female with no known allergies, health conditions, and not on any medications or OTC supplements. After the Second dose I advised patient to sit for 15 minutes in our waiting area to be monitored and what to look out for in case of a reaction. Around 6:10 pm her friend signaled to me that the patient was not feeling well. I immediately went out to check on her. She stated that she could see black/dark color in her eyes, was having hearing loss, syncope, felt ice cold internally, but was hot and clammy outside to the touch. I sat her down and called 911 for EMT to come evaluate her. She was feeling much better about 10 minutes after this @ about 6:20-6:30 pm. EMT and fire department evaluated patient and we all advised her to stay with family for the night to be monitored. She did not go to the ER. They felt she was ok to go home and rest. 8/18/21


VAERS ID: 1584003 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Itchy Rash on both feet the night of being vaccinated; a single painful welt on right arm crevice next day. That is so far (24 hours since being vaccinated).


VAERS ID: 1584006 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-08-17
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Laboratory test abnormal, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

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

Write-up: Symptoms of running nose, cough and sneezing on 8/16/2021. Tested on 8/17/2021; with positive results.


VAERS ID: 1584014 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Fatigue, Headache, Limb discomfort, Muscular weakness, Nausea, Pain, Pain in extremity, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins, minerals, probiotics
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa
Diagnostic Lab Data: None, tricare/military did not refer those tests unless I am short of breath, leg swelling, or chest pain. They told to call back if those symptoms present and they would treat.
CDC Split Type:

Write-up: Mild headache around 10:00 am the day after vaccination (17th). Headache continued to worsen until 6:00pm when it became unbearable and moved to my eyes. Around 3:00pm lower back pain and leg pain began. It was hard to move my legs due to feeling heavy, weak, and sore. Symptoms all seemed to worsen around 6:00pm. Called tricare nurse line for recommendations around this time. On both feet my third and fourth toe became numb shortly after this. I was extremely fatigued but could not sleep due to nausea. I self treated at home with an epsom salt bath and arnica. Nurse could not recommend a pain medication. I was able to sleep until 4:00am the next morning (18th). Headache persisted until the morning of the 18th. Currently, the headache and body pains have subsided. I am still tired today on the 18th.


VAERS ID: 1584197 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01076 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidentally given a non-diluted dose of 0.3ml. She did feel faint before 15 minutes of waiting. Staff gave patient water.


VAERS ID: 1584199 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-12
Onset:2021-08-17
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

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

Write-up: fully vaccinated, tested positive for COVID 19


VAERS ID: 1584213 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-08-17
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 8/17/21. EE with symptoms of HA, sore throat, and stuffy nose. Tested positive for Covid 19 on 8/17/21. He''s still symptomatic with a stuffy nose. Remains isolated and will do antibody testing.


VAERS ID: 1584225 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Hypoaesthesia, Injection site reaction, Limb discomfort, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topamax, tylenol, ibuprofen
Current Illness:
Preexisting Conditions: Migraines, asthma
Allergies: Keflex, clotrimazole, latex, adhesive, nitrates in hot dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme heaviness in arm that was injected. Also experienced numbness and tingling throughout entire arm and hand. Other hand and feet were also tingly. Blurry vision occurred and extreme diarrhea


VAERS ID: 1586326 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PF2154 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blindness, Dizziness, Heart rate increased, Interchange of vaccine products, Oxygen saturation decreased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Respiratory failure (broad), Medication errors (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Day before allergy medicine and allergy testing at allergist.
Current Illness:
Preexisting Conditions:
Allergies: Food allergy: Pineapple, Ginger
Diagnostic Lab Data: None
CDC Split Type:

Write-up: During the 30 minute waiting period after receiving the shot, I started feeling dizzy like I was going to faint. I called over a nurse and shortly after lost my vision. I was still conscious. The nurses put an oxometer on me. My oxygen level dropped and heartrate went up. I am not sure how long it lasted. My vision came back and I was still dizzy. I sat in the observation area for 1.5 hours. Drinking water and trying to recover. My vitals went back to normal. I am reporting this because I recieved a Johnson. After consulting with my Panama doctor, decided to get a Pfizer booster not available here).


VAERS ID: 1586341 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1586343 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Ear pain, Headache, Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Headache-Medium, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: Pt also experienced boday aches and ear pain. As of afternoon on 8-18-21, she was beginning to feel better but still had symptoms present.


VAERS ID: 1586363 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypertension-Severe, Additional Details: Patient''s first BP reading was 175/118 HR 87 and 5 minutes later second reading was 147/98 HR 69. Her dizziness resolved.


VAERS ID: 1586369 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM

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

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

Write-up: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium


VAERS ID: 1586518 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Headache, Immediate post-injection reaction, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Chills: Cold, shivering, 12 hour duration Headache: Pain in my head, 24 hours duration Fatigue: Excessive tiredness, 36 hours duration Pain at injection site: immediate, 48 hour duration


VAERS ID: 1586524 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Other Medications: multivitamin with iron, creatine, beta-alanine, vegan omega, ashwagandha, zinc
Current Illness: none
Preexisting Conditions: none
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: body aches, and felt feverish about 8-9 hours after vaccine. symptoms went away throughout the night. next day woke up with a headache that went away throughout the day.


VAERS ID: 1586531 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Heart rate increased, Injection site pain, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same as above #2 02/18/2021
Other Medications: Baclofen 10mg, Bupropion 150mg, Toviaz 4mg. Digestive enzymes, nettles, milk thistle, probiotic, k27, turmeric, vits c&e
Current Illness:
Preexisting Conditions: MS, CLL
Allergies: Oxybutinin, trospium cl, myrbetriq, sulfa, nickel on skin, bandages adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, Chills, tiredness, joint pain, weakness, fast heartbeat


VAERS ID: 1586533 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Muscle spasms, Paraesthesia oral
SMQs:, Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptives
Current Illness: None
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data: ED evaluation on 8/18/21
CDC Split Type:

Write-up: Pt developed facial spasms, tingling in her lips and right sided facial droop. She cannot close her right eye. She was diagnosed with Bell''s Palsy


VAERS ID: 1586578 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: None
Current Illness: None
Preexisting Conditions: Arthritis in Spine
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Small bumps on both legs, but cheeks, and arms at injection sight that are red and itchy. Looks as though they are ant bites.


VAERS ID: 1586597 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal sensation in eye, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Eye pain, Fatigue, Feeling cold, Headache, Myalgia, Pain in extremity, Pyrexia, Respiratory tract congestion, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: Extreme vertigo, loss of appetite, fever up to 103 for whole month of July
Preexisting Conditions: Anemia
Allergies: Cephalosporins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after receiving vaccination had sore arm and slight fever and headache and assumed just feeling side effects of vaccine. By day 1 after vaccine, fever more persistent and developed a cough and congestion, chills and high fever at night, day 2 sore arm virtually gone but coughing, fever, chills, headache, and now wheezing persisted. Now is day 3 and fever is worsening, eyes warm and hurt to move, headache and congestion affecting whole head, wheezing, coughing, loss of appetite, diarrhea, fatigue, muscle aches all over body despite soreness from vaccine gone, and shortness of breathe.


VAERS ID: 1586611 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash vesicular
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: unknown
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none listed
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: The patient''s daughter contacted me to let me know her Mother developed a rash on her left arm on 08/17/21. She described it as non-itchy but does have blisters. She stated the rash was on the upper portion of her arm as well as a small amount on the lower part of the arm. I advised I would completed this report and that they should contact her doctor for medical advice.


VAERS ID: 1586638 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine
Current Illness:
Preexisting Conditions: Lupus
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, chills, headache, fever, back pain the next day. Vomiting, headache, severe back pain day 3


VAERS ID: 1586642 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-08-17
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: hospitalized 8/17/21


VAERS ID: 1586646 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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: Finesteride, Flomax, Loratizine
Current Illness: None
Preexisting Conditions: Chronic Lymphacitic Leukemia (since Dec. 2013 diagnosed) and seen by a oncologist since 2013 every 6 to 8 months but no medication have had to take for it.
Allergies: None
Diagnostic Lab Data: NOT APPLICABLE
CDC Split Type:

Write-up: This is my 3rd dose as I have a weakened immune system. This is the first time I had noticable pain under my left arm for the past 48 hours.


VAERS ID: 1586657 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-08-17
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Blood thyroid stimulating hormone, Chest discomfort, Electrocardiogram abnormal, Full blood count, Metabolic function test, Palpitations, Sinus tachycardia
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none to date
Diagnostic Lab Data: 1) Electrocardiogram - arrhythmia - sinus tachycardia with AV dissociation and accelerated junctional rhythm 2) bloodwork (CBC, Metabolic profile and TSH) - no significant findings; all within normal reference range 3) Echocardiogram - performed once palpitations were diminished; no structural or flow changes noted.
CDC Split Type:

Write-up: began experience heart palpitations during majority of day and night; heaviness in chest.


VAERS ID: 1586659 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Oropharyngeal pain, Sensation of foreign body, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: unknown
CDC Split Type:

Write-up: scratchy, sore throat, feels like lump in throat


VAERS ID: 1586665 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-06
Onset:2021-08-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: Neurontin, buprenorphine, Robaxin, Tylenol, Naproxen, Multivitamins-Fish oil, potassium, Magnesium, Zinc, Vitamin D3
Current Illness:
Preexisting Conditions: Fibromyalgia, migraines, mild asthma
Allergies: Phentermine, Topamax, Zoloft
Diagnostic Lab Data:
CDC Split Type:

Write-up: Warmth, hardness, pain and itching for 2 days after shot but it then resolved, 10 days later on 8/17 the injection site became red, warm, hard and itchy


VAERS ID: 1586731 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-08-17
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK LA / IM

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

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

Write-up: Tested positive for COVID-19 after being fully vaccinated.


VAERS ID: 1586746 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-08-17
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK LA / IM

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

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

Write-up: Tested positive for Covid-19 after being fully vaccinated.


VAERS ID: 1586773 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: The patient was vaccinated with the second dose of COVID-19 Pfizer before 21 days. The patient arrives at the facilities of Vaccination Center, patient tells the staff that she has an appointment for her second dose, they register it as walk-ins and the vaccine is administered, later the staff realized that the first dose was administered 15 days before


VAERS ID: 1586797 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Englarged lymph nodes in left armpit. Pain, swelling. Treatment - warm compress, no doctor''s visits. Onset 8/17/2021 late in evening, has not subsided presently.


VAERS ID: 1586798 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Pt received 0.3ml of undiluted Pfizer vaccine. Error was not discovered until after the dose had been administered. Patient contacted regarding dosing error and was made aware of possible symptoms to monitor for. No reaction reported by patient.


VAERS ID: 1586801 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hypotension, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, rosuvastatin, hydrochlorothiazide, segluromet, losartan, metoprolol succinate er, paroxetine,
Current Illness: none
Preexisting Conditions: Diabetes mellitus, Hypertension, Hypercholesterolemia
Allergies: None known, prior anaphylaxis but cause unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial swelling, tongue swelling, trouble breathing, hypotension began approximately 24 hours after vaccine administration. Pt was treated in emergency department.


VAERS ID: 1586803 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna # 2 in February 2021-- one day of nausea and fatigue
Other Medications: mycophenolate 1500 mg daily, Losartan, Rosuvastatin, Sertraline Metoprolol, Bupropion, Ezetimide
Current Illness: none
Preexisting Conditions: AZOOR (auto-immune retinal disease)
Allergies: Sulfonamides
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Extreme fatigue and lethargy, nausea and body aches and headache began gradually 3-4 hours after the shot and got worse by evening and all next day. 48 hours after the shot, somewhat better, but still anorexic and headache.


VAERS ID: 1586811 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT AVAILABLE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received 0.3ml of undiluted Pfizer vaccine. Error was not discovered until after the dose had been administered. Patient contacted regarding dosing error and was made aware of possible symptoms to monitor for. Patient complained of arm soreness at the injection site.


VAERS ID: 1586831 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Nausea, Oropharyngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Omeprazole, sertralin
Current Illness: none
Preexisting Conditions: asthma
Allergies: Allergic to sulfa drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nausea, Dizziness, sore throat, fever and chills


VAERS ID: 1586868 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-08-17
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

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

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

Write-up: positive covid test


VAERS ID: 1586899 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: depomedral 40 Monday, 2 Benadryl, azyl Tuesday prior to injection, after injection 15 min another Benadryl and another 30 minutes epipen, later in evening 2 prednisone . next day 8-18 2 prednisone. today 8-19 1 pred
Current Illness: endocrine/ pancreatic cancer. multiple allergies
Preexisting Conditions: multiply allergies
Allergies: iodine fish, yellow dye, nuts, wasp stings
Diagnostic Lab Data: none released to leave
CDC Split Type:

Write-up: Anaphylactic reaction. 15 minutes started to itch. 30 minutes later itch inside face throat getting thick. by this time 3 Benadryl and an EpiPen. Later evening 2 prednisone. next day 2 prednisone from continued itching. one today. all administered by patience. patience was calm due to prior life events


VAERS ID: 1586910 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamine
Current Illness:
Preexisting Conditions:
Allergies: Gluten intolerance, lactose intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Monthly period came 6 days earlier than normal. Period is extremely heavy than normal and more painful and extremely thick.


VAERS ID: 1586944 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

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

Write-up: Reports a bump the size of marble between eyebrows with pain to touch that appeared the next day after receiving the vaccine. Patient had fever and tiredness the following day. On 08/19/2021 patient reports body aches.


VAERS ID: 1586952 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-02
Onset:2021-08-17
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase decreased, Anion gap, Aspartate aminotransferase increased, Basophil count decreased, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine decreased, Blood glucose normal, Blood lactic acid decreased, Blood osmolarity, Blood potassium normal, Blood sodium normal, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Carbon dioxide normal, Eosinophil count decreased, Eosinophil percentage decreased, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Immature granulocyte count, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count decreased, Monocyte percentage, Neutrophil count decreased, Neutrophil percentage increased, Nucleated red cells, Platelet count normal, Procalcitonin, Protein total decreased, Red blood cell count decreased, Red cell distribution width increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Agranulocytosis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, carvedilol, enalapril
Current Illness: HTN, Hyperlipidemia, CAD, previous DVT
Preexisting Conditions: acute pulmonary embolism
Allergies: NKA
Diagnostic Lab Data: GLUCOSE 139BUN 30CREAT 0.9MDRD GFR 82NA 136K 4.4CL 103CALCIUM 8.0ALK PHOS 87CO2 26.6AST 137ALT 196AST/ALT 0.7TL PROT 6.2ALBUMIN 2.2TBILI 0.4OSMO 280.4ANION GP 10.8BUN/CRE 33.3LACTATE 1.60 PTT 119.4 WBC 18.9RBC 4.60HGB 13.9HCT 39.8MCV 86.5MCH 30.2MCHC 34.9RDW 14.6RDWSD 46.7PLT 339MPV 10.1AUTONEU% 87.6AUTOLYM% 6.2AUTOMON% 4.0AUTOEOS% 0.1AUTOBAS% 0.2AUTONEU# 16.6AUTOLYM# 1.2AUTOMON# 0.8AUTOBAS# 0.0AUTOEOS# 0.0NRBC% 0.0NRBC 0.0HGB/HCT 2.9IG# 0.36IG% 1.9 PROCALC 0.71 LACTATE 2.80
CDC Split Type:

Write-up: Patient hospitalize after being fully vaccinated:


VAERS ID: 1586986 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit H, B12, D3, Lexapro, Daily Vitamin, Calcium, Letrozole
Current Illness: Breast Cancer - in remission
Preexisting Conditions: Sciatica
Allergies: Mold, Flonase
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme shaking and cold for approxiamtley 30 minutes


VAERS ID: 1587077 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nervousness
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), 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: Systemic: Dizziness / Lightheadness-Severe, Additional Details: The pt passed out for few minutes after recieving the vaccine, He indicated he was very lightheaded and nervous.


VAERS ID: 1587101 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Fatigue, Influenza like illness, Mobility decreased, Pain in extremity, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: All vaccines I have passed out except when I was a baby.
Other Medications: Lexapro, np thyroid, multivitamin, probiotic, d3, b12, iron
Current Illness: No
Preexisting Conditions: I have a history of having seizures with needles.
Allergies: Not that I know of
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainted for 10 seconds after the shot, then got chills and started shaking and teeth chattering. That is normal to me when getting shots. But I shook for 30 min straight and on and off the rest of the day. That part isn?t normal. I had flu like symptoms which the pharmacist said could happen. I slept all day the next day. Today, my arm still hurts but I can move it. I?m feeling really tired weak still but not like yesterday. My appetite is coming back too.


VAERS ID: 1587110 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chills, Pyrexia, Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 12 hours after injection, Pt spiked a high fever, chills and vomiting. By 9:00am he collapsed and had two seizures. He was administered Tylenol and Ibuprofen


VAERS ID: 1587131 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, Bisoprolol/HCTZ, Amlodipine Besylate, Zyrtec, Lovazaa, Vitamin C, D, and zinc.
Current Illness: None
Preexisting Conditions: High Blood Pressure, Obstructive Sleep Apnea
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Beginning at approximately 08:00 on 17 August, my heart rate began to climb from my normal resting heart rate of 56 bpm. By 19:00, my resting heart rate was exceeding 105 bpm. My resting heart rate remained above 105 bpm until around 01:36 18 August, when it began to decline. My resting heart rate was back to normal by around 13:36 18 August. The highest resting heart rate observed was 128 bpm for several minutes while laying in bed.


VAERS ID: 1587154 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Joint pain for 24 hours


VAERS ID: 1587178 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-08-17
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abscess drainage, Abscess neck, Adenoidal hypertrophy, Pain, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV, IV drug abuse with heroin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 28-year-old male with a history of HIV, IV drug abuse with heroin as his drug of choice who presents to the emergency room with a neck abscess. He states that he has injected IV drugs into his neck but it has been over a month. In the emergency room it was initially felt he needed to be seen by ENT but they said a general surgeon can drain the abscess. Dr was consulted by the ED. was done of the neck that showed the following: 2.7 x 2.8 x 3.9 cm multiloculated abscess within the right paramedian anterior neck, centered at the level of the thyroid cartilage.2. Mild prominence of the adenoidal soft tissues, which may be reactive or may be secondary to 8/18/2021 tested positive. This is a 28-year-old male with a history of HIV, IV drug abuse with heroin as his drug of choice who presents to the emergency room with a neck abscess. He states that he has injected IV drugs into his neck but it has been over a month. In the emergency room it was initially felt he needed to be seen by ENT but they said a general surgeon can drain the abscess. Dr was consulted by the ED. was done of the neck that showed the following: 2.7 x 2.8 x 3.9 cm multiloculated abscess within the right paramedian anterior neck, centered at the level of the thyroid cartilage.2. Mild prominence of the adenoidal soft tissues, which may be reactive or may be secondary to pharyngitis. Patient denies any fever, chills or dysphagia. He does states that it is 8/10 in intensity with throbbing pain.


VAERS ID: 1587193 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-15
Onset:2021-08-17
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: none known
Allergies: unknown
Diagnostic Lab Data: PCR + for Covid 8/17/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines on approximate dates of 2/15 and 3/15/2021 at Bergen Pines Hospital Public Clinic in Paramus NJ. Tested asymptomatic Covid on 8/17/2021. Reported as case of breakthrough Covid illness. Client had contact with positive person several days before she tested positive.


VAERS ID: 1587214 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac monitoring abnormal, Condition aggravated, Palpitations, Urine output
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After Moderna covid vaccine March 3, 2021 age 71, I had afib incidence lasting three hours
Other Medications: bosutinib, apixaban, pulmicort, enalapril, diltiazem, allegra, tirosint, vitamin D
Current Illness:
Preexisting Conditions: chronic myeloid leukemia (inactive), diabetes, high blood pressure, mild pulmonary hypertension, afib rarely
Allergies: sulfa drugs, cephalosporin, musinex, synthroid
Diagnostic Lab Data: My Afib was confirmed by my blood pressure monitor and Kardia device.
CDC Split Type:

Write-up: Three days after moderna vaccine, I had Afib starting when I was sleeping and lasting thee hours. My pulse was 169. I woke up with racing heartbeat and unusually urine output.


VAERS ID: 1587231 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 RA / IM

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

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

Write-up: none. Patient lied, she had been fully vaccinated elsewhere with moderna on 02/28/2021 and 04/04/2021 and chose to get a third shot of Moderna before it was approved to


VAERS ID: 1587245 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Pt did not experience any adverse event out of the normal (i.e. sore arm, feeling tired). Pt is under the age of 18. Currently Moderna is only supposed to be used at 18 years old or older.


VAERS ID: 1587266 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-07
Onset:2021-08-17
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / -

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

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

Write-up: Tested positive for Covid-19.


VAERS ID: 1587284 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-03-26
Onset:2021-08-17
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Dyspnoea, Headache, Pain, Respiratory tract infection, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Covid 19 positive at referral hospital 8/18/2021
CDC Split Type:

Write-up: Complaiing of cough, congestion, diarrhea, headache, shortness of breath, body aches


VAERS ID: 1587288 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FC3181 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benlysta Methotrexate Velafaxine Busperone Pilocarpine 800mg ibuprofen Cyclobenzaprine Oxycodone 5mg OTC: Vita. D, stool softeners, melatonin, folic acid, miralax
Current Illness: None
Preexisting Conditions: Lupus Sjrogens Arthritis Constipation Torn rotator cuff, both shoulders Bipolar
Allergies: Cymbal ya Cheap metals on skin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: So far: 8/17/2021. Same day as third vaccine shot- Bad Headache a couple hours after shot. Ok w Tylenol then ok for a few hours and come back. 8/18/2021. Day after, pain at injection site. Fatigue 8/19/2021. Fatigue, pain at injection site.


VAERS ID: 1587297 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-08-17
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/19 COVID PCR positive
CDC Split Type:

Write-up: COVID-19 positive $g14 days post vaccine series.


VAERS ID: 1587305 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Dysgeusia, Fatigue, Headache, Injection site pain, Injection site swelling, Nausea, Pruritus, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Metallic taste in mouth, headache, fatigue, nausea, stomach cramps, explosive diarrhea, fever, injection site pain, injection site swelling,Red circular itchy welts/ rash.


VAERS ID: 1587316 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3101 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site swelling, Injection site warmth, Lymphadenopathy, Ultrasound scan normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, hydrocortisone, vitamin d3, amlodipine, estradiol-norethindrone acet. omeprazole
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ultrasound of left arm for blood clot-negative
CDC Split Type:

Write-up: severe swelling of lymph nodes in left armpit and chest on left side near collarbone infection at injection site (left arm) severe swelling, redness, bruising and fever of the injection site


VAERS ID: 1587324 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 300mg per day Lynparza 400 mg per day vytorin 10/40 once per day xgeva shot every 3 months
Current Illness: none
Preexisting Conditions: metastatic breast cancer
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: fever 100.5, chills, extreme fatigue lasted two days


VAERS ID: 1587325 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: norvasc irbesartan triamterene
Current Illness: none
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: He is having extreme fatigue as well as a swollen left axillary lymph node and occasion moderate headaches pain level 5-6/10


VAERS ID: 1587326 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Eye swelling, Headache, Lip swelling, Pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Hydroxyzine HCL
Current Illness:
Preexisting Conditions: History of blood clot in lung
Allergies: Wellbutrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports itching began "a couple hours after I got the shot." Started on hands and legs eventually moving to feet, face and lips. Took a shower once she got home from work and itching continued. Eyes and lips became swollen from the itching. Patient took prescribed hydroxyzine HLC 50mg that evening and went to sleep. Reports she woke in the middle of the night with chills, low grade fever, body aches and headache. The following day, itching had resolved. Reports she still had body aches and headache. Took ibuprofen for discomfort. Patient did not seek outside medical treatment with PCP, urgent care or ER.


VAERS ID: 1587327 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA 0880211 / UNK RA / SYR

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

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

Write-up: Fever, arm very swollen


VAERS ID: 1587345 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine was unnoticeable given to the 17 years old patient


VAERS ID: 1587381 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

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

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

Write-up: Client came on 7//23/21 and received dose #1 of Moderna. Client returned on 8/17/21. Clerical staff registered client and wrote that she was due for Pfizer #2. Client did not have vaccine card and was poor historian. Nurse did not confirm utilizing history. Client received Pfizer on 8/17/21. Medical director notified and because CDC sees the 2 MRNA vaccines as essentially interchangeable, he was not concerned. VM left for client to discuss.


VAERS ID: 1587391 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Patient came in for Pfizer COVID19 vaccination on 08/17/2021; Mother filled out paperwork stating patient was age 12. Paperwork was filled out false and patient was only 10 years of age. This is below the approved age for the EUA. Called mother to notify her we would not be able to complete the second dose due to the unapproved age; mother reported no adverse effects for her child as a result of the vaccination.


VAERS ID: 1587396 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Muscle spasms, Pregnancy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Normal pregnancy conditions and outcomes (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: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense upper back pain and spasm on side of body where I received shot. It?s been about two full days and my back pain has only intensified. I also ran a low fever the night after vaccination. Currently pregnant 14 weeks, previously 2 miscarriages.


VAERS ID: 1587397 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-08-17
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PARoxetine (PAXIL) 40 mg tablet Take 1 tablet (40 mg) by mouth 1 time per day metoprolol succinate (TOPROL XL) 25 mg SR tablet (24 hr) Take 1 tablet (25 mg) by mouth 1 time per day levothyroxine 75 mcg tablet TAKE 2 TABLETS ONCE A DAY FOR 1
Current Illness: none
Preexisting Conditions: HTN (hypertension) Primary hyperparathyroidism (HCC) Vitamin D deficiency Postsurgical hypothyroidism Goiter Osteopenia
Allergies: Acrylate Copolymer Potassium Dichromate
Diagnostic Lab Data: positive covid PCR 8/19/21
CDC Split Type:

Write-up: patient tested positive for covid 8/19/21


VAERS ID: 1587422 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-23
Onset:2021-08-17
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

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

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

Write-up: Positive COVID case mild symptoms, will be getting infusion this weekend.


VAERS ID: 1587459 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral embolism, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, arterial (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? No
Previous Vaccinations:
Other Medications: loratadine and cetirizine
Current Illness: non
Preexisting Conditions: fibermyalgia and arthritis
Allergies: pantoprazole, latex, codeine, benadryl, NSAIDS
Diagnostic Lab Data: scan at the hospital
CDC Split Type:

Write-up: 24 hours after the shot, patient had a blood clot in her foot. she went to a walk in clinic and was then sent to the hospital to get her foot scanned. patient was released and told to monitor for any additional symptoms


VAERS ID: 1587480 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysuria, Pollakiuria, Urine analysis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1. Urinary lab
CDC Split Type:

Write-up: Day One 1. Within 2 hours of taking shot, I started having pain when urinating and felt like I had to urinate all the time, but no release 2. Am only able to urinate a few droplets at a time Day Two 1. Still struggled urinating Day Three 3. Went to see urgent care and was given antibiotic, still waiting to see outcome


VAERS ID: 1588535 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cystitis, Extra dose administered, Kidney infection
SMQs:, Medication errors (narrow)

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

Write-up: Rec''d 3 doses since Feb 2021. All 3 times got bladder/kidney infection(s). Had to take strong antibiotics 3 times & am on daily low dose antibiotic to keep infections down/cleared. Grateful for the vaccine(s) but thought needed to report the infections.


VAERS ID: 1588538 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: none
CDC Split Type:

Write-up: The patient woke up early in the morning a day after the vaccination with severe itching and rash. She came to my office today as rash is persistent and itchy. She denies breathing difficulty. On examination, she has fine urticarial rash on face, trunk and arms but not on legs. She is advised to take Claritin 10 mg once a day for itching and to take Benadryl 50 mg every 4-6 hours as needed.


VAERS ID: 1588570 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-08-17
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: break thru covid case


VAERS ID: 1588576 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-03
Onset:2021-08-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: break thru covid case


VAERS ID: 1588730 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthropod bite, Blister, Body temperature increased, Condition aggravated, Diarrhoea, Migraine, Musculoskeletal stiffness, Pain, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Januvia, metformin, synthroid, atovarstatin, glipizide, duloxetine, AREDs with multivitamin
Current Illness: None 1 month prior
Preexisting Conditions: Diabetes, hypothyroidism
Allergies: none I am aware of
Diagnostic Lab Data: Note - had possible Covid in June 2021. Tested negative but son was positive. I was told to treat as if I had Covid. I had a severe headache with fever for 5 days.
CDC Split Type:

Write-up: 1st immediate was migraine due to stress of not wanting vaccine but my employer requiring it as condition of employment. Had not had a migraine since the death of my children''s father. -4 hours later had a temp of 100.3F. 4 hours later had fever blisters forming above and below my lips. 12 hours later all mosquito bites on my body turned from dime size bumps to 3 inch hives - began to take benadryl; 12 hours later body aches were beginning - began to take ibuprofen 12 hours later a stiff neck was starting 24 hours later the diarhea started. = started imodium 24 hours later blisters began forming inside my nose 48 hours later - just starting to feel better. Still taking benadryl, ibuprofen and imodium


VAERS ID: 1588745 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Heart rate decreased, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient indicated that he fainted/passed-out in front of the ice cream freezers. He bumped his head/face when he fell. he came to, and reported to the pharmacy. The nurse and TLC and the pharmacist sat him down, checked his pulse, blood pressure, O2 saturation, and got him a bottle of water. He was very pale, and his pulse was low.


VAERS ID: 1588746 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SC

Administered by: Public       Purchased by: ?
Symptoms: Injection site reaction, Pain
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: Nexplanon.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Constant throbbing above my left elbow on my arm. The pain has not stopped for days, and neither does the throbbing.


VAERS ID: 1589064 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chills, Cough, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: levemir insulin pregabalin actos furosemide valsartan
Current Illness: n/a
Preexisting Conditions: diabetes stage 3 renal failure stage 3 cancer patient (surgery and radiation)
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: severe chills, fever, severe aches, joint pain - hacking cough, chest tightness


VAERS ID: 1590932 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

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


VAERS ID: 1590934 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-06
Onset:2021-08-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe


VAERS ID: 1590939 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Hypotension-Medium, Additional Details: Patient experienced syncope and fell face down onto the floor at the rx dept area. After vaccinating, i advised patient to have a seat on the chair for 15 minutes, but after 5 minutes, patient stood up and moved to the pick up line in the rx dept. and at that time, he fell face down onto the floor. I had him to ly down with both legs elevated for 30 minutes and he was back to nor mal. I asked and he stated he didn''t have any cut on the lips or any broken teeth. patient is on Chlotharlidone 25mg


VAERS ID: 1590980 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-08-17
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81mg PO qday clopidogrel 75mg qday Cortef 5mg PO bid insulin aspart 100 units/mL per scale SQ QIDAC bedtime isosorbide mononitrate 30mg PO qAM lexapro 10mg PO qday lipitor 40mg PO at bedtime lisinopril 10mg PO qday meclizine 25mg PR
Current Illness:
Preexisting Conditions: anemia anxiety arthritis bipolar blood clot diabetes mellitus GERD high blood pressure hypercholesterolemia osteoporosis shortness of breath on exertion stroke thyroid disease
Allergies: divalproex sodium penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted with breakthrough case of COVID on 8/18/2021


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