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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 119 out of 6,867

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VAERS ID: 1591139 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-08-17
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incomplete course of vaccination
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? 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 - only documented to have received 1 dose of Pfizer vaccine.


VAERS ID: 1591144 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-08-17
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: hospitalized 8/17/21 COVID positive


VAERS ID: 1591146 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspepsia, Headache, Malaise, Myalgia, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Recently completed chemotherapy and radiation for breast cancer-herceptin and perjeta finished end of June 2021. Radiation completed Feb 2021. This was my 3rd-booster dose of Pfizer
Preexisting Conditions: Breast cancer-completed treatment June 2021. Nothing else.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: As with my second shot I had high fever (103.7), myalgias and headache starting about 12 hours after the shot and lasting 24 hours. 24 hours after the shot-I noticed what I thought was severe heartburn (I do not have heartburn normally-only during my first pregnancy 11 years ago). I tried Tums-which didn?t work-it was night so propped myself on pillows-and only found comfort by leaning forward and sleeping upright. I was otherwise febrile and not feeling good so forgot about it. Then my sister had the 3rs Pfizer shot and called me the night after she did saying she had awful heartburn-and wondering if I?d had this side effect. We decided to report it, since it was two of us. The symptom lasted maybes 8-10 hours and then completely resolved.


VAERS ID: 1591150 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-07
Onset:2021-08-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: hospitalized 8/17/21, COVID positive, only 1 dose Pfizer


VAERS ID: 1591180 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Infliximab, Hydroxychloroquine , Emgality VitaminD3, Magnesium Oxide, Fish Oil, Riboflavin , Acyclivir, Integrative Vitamin B, Claritin, Gabapentin
Current Illness: Migraines, Herpes Simplex
Preexisting Conditions: Chronic multi-systemic Sarcidosis-lungs, liver, spleen, bones,skin Herpes Simplex Migraines
Allergies: Penicillin, adhesives, Tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After an hour of my Infliximab treatment I began to have difficulty breathing, started itching and became light- headed. In 10 years I had never had a reaction to my Infliximab. Treatment was stopped and begun again after symptoms cleared in about 10 minutes . Symptoms then returned. Treatment wAs again stopped and Benadryl was given as was IV steroids. When symptoms cleared treatment was again started and completed. I weigh 135 lbs and receive 500 ml of Inflximab every 5 weeks.


VAERS ID: 1591209 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: CASE IS SYMPTOMATIC WITH FEVER, COUGH, HEAD ACHE AND RUNNING NOSE, TESTED ON 8/17/202.


VAERS ID: 1591216 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Puerto Rico  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Injection site erythema, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient indicates not taking any medications.
Current Illness: Patient does not report having any conditions.
Preexisting Conditions: Patient does report any chronic conditions.
Allergies: Patient indicates no allergies to medications, food or other products.
Diagnostic Lab Data: Event is reported to Doctor and orders 25mg tb from BENADRYL and it''s given at 11:13am. Additional 30 minutes in observation. Patient reports feeling better and improvement is noticeable in eruption area, redness decreases.
CDC Split Type:

Write-up: 23 year old female patient vaccinated at 10:55 am. with first dose PFIZER vaccine, while waiting for 15 minutes of observation. Patient presents localized skin eruption of approximately 1cm on upper left arm. Vitals are taken by paramedic DXT (79) patient reports no having breakfast.


VAERS ID: 1591248 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-05
Onset:2021-08-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol #3, allopurinol, norvasc, bumex, keflex, synthroid, toprol XL, nystatin powder, mycolog cream
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated against COVID-19 and presented to the ED where he was diagnosed with COVID infection leading to hospitalization


VAERS ID: 1591282 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
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 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: headache, chills for one day, myalgia and pain at IM injection site x 2 days
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pain at injection site, myalgia, feverish/chills, headache for 2 days, 3rd day nausea


VAERS ID: 1591292 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-07
Onset:2021-08-17
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, No adverse event, 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: Patient did not have reaction to vaccine but tested positive for COVID on 08/17/2021


VAERS ID: 1591325 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-11
Onset:2021-08-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Mobility decreased, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: mitral valve prolapse
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vertigo and Vomiting that was so extreme I could not get out of bed. Lasted for about 5-6 hours. Afterwards had a dull headache that has persisted for 3 days.


VAERS ID: 1591330 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
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 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Depressed level of consciousness, Disorientation, Oxygen saturation decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), 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: Lamictal
Current Illness:
Preexisting Conditions: Patient reports a history of seizures
Allergies: Codeine
Diagnostic Lab Data: Paramedics assessed the patient by taking her blood pressure, testing her sugar level, and patient was given oxygen for a few minutes due to a low pulse ox. Pulse ox returned to normal on room air before patient went home.
CDC Split Type:

Write-up: Patient seemed disoriented and semiconscious. Husband reported she had a history of seizures. Patient was breathing and had a pulse. 911 was called, and paramedics arrived at the scene where they evaluated the patient. Patient refused to be taken to the hospital, and husband proceeded to take her home. Followed up with patient the following day, and they were contacting patient''s neurologist to report what happened.


VAERS ID: 1591376 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Dizziness and lightheaded


VAERS ID: 1591377 (history)  
Form: Version 2.0  
Age: 19.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Diarrhoea, Fatigue, Headache, Influenza virus test, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

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

Write-up: pt presents with c/o fever, chills, body aches, headache, sore throat, loss of smell/taste, cough, diarrhea and fatigue since tuesday


VAERS ID: 1591387 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-08-17
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Electrocardiogram, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: NONE
Allergies: N/A
Diagnostic Lab Data: EKC, blood work, chest X-ray
CDC Split Type:

Write-up: On and off heart palpitations for 2-3 weeks leading up 14-16 hours of heart palpitations on 8/17/2021-8/17/2021. No previous history of heart palpitations prior to vaccine.


VAERS ID: 1591417 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
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 FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Flushing, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: anemia requiring monthly blood transfusions
Preexisting Conditions: anemia requiring monthly blood transfusions
Allergies: none
Diagnostic Lab Data: I called emergency number, paramedics came out, checked blood pressure and and blood glucose, all within normal limits
CDC Split Type:

Write-up: patient''s left arm became numb and her left arm became flushed and so did her neck and face area within a minute of receiving the vaccine


VAERS ID: 1591426 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-08-17
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK RA / SYR

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: COVID 19 positive


VAERS ID: 1591429 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
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 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: Patient less than 18 years old


VAERS ID: 1591439 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
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 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Medications: Biktarvy 1tab PO daily gabapentin 800mg PO QAM and Q Lunch, 1600mg QHS Septra DS 1 tab PO daily topiramate 100mg PO QAM and 150mg PO QHS
Current Illness:
Preexisting Conditions: PMH significant for HIV/AIDS, Thrombocytopenia, seizures (alcohol withdrawal), normocytic anemia, and alcohol abuse, liver dysfunction.
Allergies: Pt w/ a hx of pollen allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 mins post vaccination pt c/o dizziness and periorbital area swelling. Vitals: @10:50 BP 140/92, HR 74, O2SAT 99% -- $g @10:56 140/94, 83, 100% -- $g 11:13 130/86, 73, 99% -- $g 1123 120/82, 72, 100% Pt was given 25mg PO Benadryl @11:05AM. Swelling and dizziness improved. Pt denies SOB. Pt stable and released from the vaccination site. Pt returned to onsite residence via wheelchair. Pt verbalized understanding to call 911 or seek assistance if symptoms persist or worsen.


VAERS ID: 1591475 (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: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

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

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

Write-up: "15mins post vaccination pt c/o dizziness and nausea. Vitals: @17:08 BP 104/56, HR 76, RR18, SpO2 100% -- $g @17:13 112/68, 68, 16. Pt given water and rest. Symptoms resolved. Pt stable and released from the vaccination site @17:22 (32mins post vaccination)"


VAERS ID: 1591490 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
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 EW0173 / 1 LA / IM

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

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

Write-up: 15mins post vaccination, pt c/o nausea and lightheadedness. Vitals: BP 118/86, HR 93, RR 16, O2 SAT 100%. Pt given crackers and apple juice. Pt stable and released from vaccination site.


VAERS ID: 1591500 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-08-17
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Headache, Nasal congestion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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
Diagnostic Lab Data: SARS COVID-19 MOLECULAR (PMC) NASAL SWAB- POSITIVE
CDC Split Type:

Write-up: NIGHT TIME CHILLS, HEADACHE, NASAL CONGESTION, SLIGHT COUGH, FEVERISH


VAERS ID: 1591513 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Georgia  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PC3180 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Cardiac flutter, Chest pain, Hypoaesthesia, Pain in extremity, Palpitations
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: Infliximab 400 mg, Olanzapine 15 mg
Current Illness:
Preexisting Conditions: Ulcerative Colitis, Scizoaffective Disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain, joint pain, chest pain, heartbpounding, fluttering, left sided abdominal pain, soreness, loss of touch in extremities


VAERS ID: 1591566 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Virginia  
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 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Flushing, Headache, Malaise, Muscle spasms, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour
Current Illness: None; very healthy
Preexisting Conditions: None (previous papillary carcinoma)
Allergies: Penicillin allergy, gluten sensitivity, undiagnosed chemical sensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initially, flush and some minor sensitivity response (feeling like I was getting sick) In the evening, about 8 hours post injection, Fever, chills, cold shakes and muscle spasms Next day: headache, fever, muscle spasms - couldn?t lift head off pillow and had to sleep until the following morning ? except for the most incredible muscle spasms. Spasms continued 3rd day? large muscles, small muscles ? legs, abdomen, fingers, toes, back.


VAERS ID: 1591593 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, shortness of breath. Patient presented to the ER for evaluation of symptoms. Noted to have tachycardia upon arrival


VAERS ID: 1591598 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-08-17
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / SYR

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: patient has Covid


VAERS ID: 1591643 (history)  
Form: Version 2.0  
Age: 15.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Lymphadenopathy, Nausea, Oedema peripheral, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Had taken ibuprofen earlier in day to prepare for vaccine.
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, nausea, vomiting, fatigue lasted for 2 days. Pain and swelling in armpit area/lymph node in arm where injection given is still persisting.


VAERS ID: 1591661 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Computerised tomogram abnormal, Night sweats, White blood cell count
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: seasonal
Diagnostic Lab Data: 8/17/21 white blood cells above normal. CT scans show inflammation of the appendix
CDC Split Type:

Write-up: Night sweats daily since then. 8/17/2021 reacted to rare side effect of appendicitis


VAERS ID: 1591665 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
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 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Discovered during data entry that patient received Pfizer COVID vaccine, lot #ER8735 on 4/21/21.


VAERS ID: 1591699 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Clobetasol Propionate 0.05% ointment, Ibuprofen 200 mg 3 tablets 3 times a week, triamcinolone acetonide 0.1% cream, losartan potassium 25mg once a day, oxybutynin chloride ER 10 mg once a day, prilosec 20mg once a day, atorvastatin calcium
Current Illness: N/A
Preexisting Conditions: Hypertension, colitis, PAOD, hyperlipidemia, type II diabetes, GERD, overactive bladder
Allergies: Codeine, cataflam
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was accidentally given the 2nd dose in the Moderna vaccine series at 21 days instead of 28 days. Patient reported to us 8 days after getting the dose that they have had vomiting issues for 3 days. Patient was triaged by a nurse and deemed stable and not in need to go to ER. Patient will come into clinic to be evaluated further.


VAERS ID: 1591748 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Colorado  
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 FD8448 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: Not yet seek medical attention
CDC Split Type:

Write-up: Patient got 2nd dose of Pfizer Covid vaccine on 08/17/2021. On Friday 08/20/2021 ~ 12:50pm, patient called to report that her right arm has been really hurt/painful for the last couple days and it has not gone away. She also reported that it''s really painful that she can''t lift it up without any difficulty. She said she took some Ibuprofen but didn''t seem to help at all.


VAERS ID: 1591755 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
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 SB8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abscess, Burning sensation, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: severe body pain left side, burning sensation inside of body, next day several abscess, sore arm


VAERS ID: 1591806 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-08-17
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

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

Life Threatening? 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 COVID19 on 8/17/2021


VAERS ID: 1591813 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
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 FA7485 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? 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 BACK ON 8/20/21 AFTER RECEVING COVID-19 VACCINE ON 8/17/2021. SHE HAS A RED, WARM, FIRM WELT ON LEFT ARM IN THE TRICEPS AREA. SHE REPORTS IT IS WHERE THE VACCINE WAS GIVEN.


VAERS ID: 1591837 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
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 EW0164 / 2 LA / IM

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

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

Write-up: Hives appeared all over patient''s body and some "tightness" in throat. Symptoms started the afternoon of 8/17/21, after receiving the second dose of the Pfizer COVID-19 vaccine at Tthe Vaccination Center. Patient given a steroid injection Depo 80mg mixed with Celestone 6mg- IM in our office on 08/18/21. Patient also prescribed Pepcid AC (famotidine) tablet 20 mg, Take 1 tablet by mouth three times a day and hydroxyzine HCl (hydroxyzine hcl) tablet 25 mg, Take 1 tablet by mouth three times a day.


VAERS ID: 1591873 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-18
Onset:2021-08-17
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: DIABETES, HYPERTENSION
Allergies: N/A
Diagnostic Lab Data: POSITIVE PCR TEST. HOSPITALIZED INPATIENT AND RECEIVED MONOCLONAL ANTIBODIES TREATMENT.
CDC Split Type:

Write-up: CLIENT CONTRACTED COVID DESPITE FULLY VACCINATED AT TIME OF EXPOSURE AND POSITIVE PCR TEST. HOSPITALIZED INPATIENT AND RECEIVED MONOCLONAL ANTIBODIES TREATMENT.


VAERS ID: 1591879 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-19
Onset:2021-08-17
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Dysphonia, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test, Streptococcus test negative, Viral pharyngitis
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Contains critical data CORONAVIRUS (COVID 19) PCR Order: 276069873 Status: Final result Specimen Information: NASOPHARYNGEAL SWAB 0 Result Notes Ref Range & Units 8/19/21 0250 CORONAVIRUS SARS COV 2 PCR (RESP) NEGATIVE POSITIVE Panic
CDC Split Type:

Write-up: Patient is a 91-year-old female who presents today for evaluation of having a sore throat for the last 2-3 days with voice becoming more hoarse. No drooling. No dyspnea. She has rhinorrhea, congestion and a dry cough. No known ill contacts. Patient has been fully vaccinated for COVID-19 (Pfizer, 2nd dose 2/19/21. Patient denies fevers, chills, nausea, vomiting, chest pain, abdominal pain or urinary changes. She has noticed some diarrhea. No analgesics taken prior to arrival. Oxygenation is 92-93% RA on arrival. Speaking in full and non-labored sentences. Occasional coughing. ASSESSMENT & PLAN: Patient''s condition remained stable during ED monitoring. Available old records were reviewed. Data available relating to medications and allergies were also reviewed in charting system. Patient treated with tylenol PO and Dexamethasone PO On reassessments, tolerating oral. Oxygenation 92-98% RA. Multiple potential diagnoses were considered in this patient. Patient placed in both airborne with eye protection and contact isolation status. Patient tested for COVID-19 with COVID-19 PCR testing PENDING. Rapid strep testing is negative. I offered CXR and/or CT soft tissue neck along with laboratory assessment after initial rapid strep is negative however patient declines this testing at this time. She is afebrile and otherwise non-toxic appearing. No respiratory distress or drooling. No neck rigidity or mass on palpation. No erythema or bruising of skin. No clear evidence for retropharyngeal abscess, epiglottis, tracheitis among other considerations. Overall patient with likely viral pharyngitis with URI/cough. COVID-19 infection is possible although she is fully vaccinated, consideration of breakthrough infection. Patient should follow-up closely with PCP however can return to ER for any worsening symptoms and/or for any further concerns. After evaluation in the Emergency Department, my clinical impression is: CT(R) 1. Viral pharyngitis VIRAL PHARYNGITIS 2. URI (upper respiratory infection) UPPER RESPIRATORY INFECTION Script: NONE MD 08/19/21 0429


VAERS ID: 1591880 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-05
Onset:2021-08-17
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fall, SARS-CoV-2 test positive, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient admitted to hospital on 8/19 positive for COVID after being fully vaccinated. Presented with thrombocytopenia, weakness, and falls.


VAERS ID: 1591890 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Dakota  
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 FD8448 / 1 LA / IM

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

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

Write-up: hives, throat tightness


VAERS ID: 1591933 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Iowa  
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 (JANSSEN)) / JANSSEN 041A21A / UNK RA / IM

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

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

Write-up: We received a call from public health saying that we had given a Jansen dose to a patient who had already received a single Pfizer dose. The Pfizer dose was given at a different facility back March 2021. The patient signed up for a vaccine at our store online. on the form they indicated that they requested the Jansen shot and denied that they had had any other Covid vaccines. I called the patient and confirmed that they had had not adverse reactions to the shot. He also explained that this was done intentionally and that he wanted only a single dose of the Pfizer and Jansen.


VAERS ID: 1591941 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Blood lactic acid, Blood magnesium, Blood potassium, C-reactive protein, Cholecystitis acute, Culture urine, Differential white blood cell count, Full blood count, Influenza A virus test, Influenza B virus test, Laboratory test, Lipase, Metabolic function test, Nausea, Nucleic acid test, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin I, Urine analysis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID REFLEX TO REPEAT LIPASE MAGNESIUM POTASSIUM SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Unknown Icon Lab Tests in Progress CULTURE, BLOOD performed 2 times Icon Imaging Orders Placed Today Imaging Tests CT ABDOMEN PELVIS WITH CONTRAST EKG
CDC Split Type:

Write-up: abdominal pain, back pain, nausea, acute cholecystitis


VAERS ID: 1591947 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-03-21
Onset:2021-08-17
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Paranasal sinus discomfort, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Tested positive for COVID on 8/20/2021
CDC Split Type:

Write-up: Tested positive for COVID on 8/20/2021. Symptoms: Headache, congestion, sinus pressure, cough.


VAERS ID: 1591975 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
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 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autoimmune disorder, Condition aggravated, Glossodynia, Rash, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had a 1/2 dollar size lesion on tongue high fever lichen planus issues on scalp and vagina after hepatitis b series 3 rd shot
Other Medications: Glipizide metformin lantus ibuprofen aspirin, d, zinc probiotic calcium
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: Victoza
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have auto immune issues and began with a rash on my scalp ears upper back the morning after the skin in my mouth sloughed off and tongue was sore


VAERS ID: 1591991 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
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 EW0173 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Cold sweat, Dyspnoea, Electrocardiogram abnormal, Palpitations, Sinus tachycardia
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: "walking corpse" syndrome in 2015. No additional PMH or medication hx available to this writer.
Allergies: Pt w/ hx of allergy to Erythromycin Base (arrhythmia).
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ hx of allergy to Erythromycin Base (arrhythmia) and ""walking corpse"" syndrome in 2015. No additional PMH or medication hx available to this writer. 10mins post vaccination pt c/o palpitations and SOB. Pt abulated to triage area. Vitals:13:38 BP 150/83, HR 153, RR 16, O2Sat 99% -- $g 13:43 111/67, 107, 99%. Pt A&Ox4, denies sxs N/V, headache. NP recommended rest and water and continued to monitor. 14:00 pt c/o chest discomfort and a cold sweat. NP recommended to call 911. 911 Called @14:02. EMS arrived 14:15 and report was given to EMS. EKG showed sinus tachycardia. Pt was taken to Kaiser via ambulance, VSS at the time of departure."


VAERS ID: 1592000 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-08-17
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 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? 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: Positive COVID PCR
CDC Split Type:

Write-up: patient tested positive for COVID after being fully vaccinated


VAERS ID: 1592005 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
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 - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Chest pain, Full blood count, Metabolic function test, Pyrexia, Troponin, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: adderall XR
Current Illness: none
Preexisting Conditions: ADHD, hypercholesterolemia, overweight
Allergies: none
Diagnostic Lab Data: ck, troponin, ua, cbc, cmp
CDC Split Type:

Write-up: chest pain and fever


VAERS ID: 1592008 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
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 - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Nausea, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: HTN and DM2
Preexisting Conditions: HTN and DM2
Allergies: Eggs and Soy
Diagnostic Lab Data: My doctor advise: Benadryl 25 mg tablet every 6 hours until the swelling resolves. For the dizziness and nausea/vomiting, you can buy Meclizine 25 mg tablets over the counter and take 1 tablet up to 3 times daily when needed.
CDC Split Type:

Write-up: Inboxed my doctor with this message on 8/18/2021: I received my 1st Moderna COVID shot on 8/16/21 and having allergic reactions that I thought would pass by now. I woke up to swollen eyes on Tuesday, vomiting having dizziness with blurred vision ..as I am sending you this message I''m dizzy and lightheaded and it seems like the floor is elevating as I walk. What do I do now.


VAERS ID: 1592072 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
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 EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (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 Medications: atenolol 25mg PO Daily exemestane 25mg PO Daily gabapentin 300mg PO TID HCTZ 12.5mg PO QAM Omeprazole 20mg PO QAM 30mins before breakfast Vitamin B6 50mg PO BID with meals Simethicone 250mg PO TID PRN gassiness venlafax
Current Illness:
Preexisting Conditions: PMH significant for HTN, hx of DTV of RUE, breast cancer, depression, obesity, pre-diabetes.
Allergies: Pt w/ hx of allergy to naproxen (swelling in the face).
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ hx of allergy to naproxen (swelling in the face). PMH significant for HTN, hx of DTV of RUE, breast cancer, depression, obesity, pre-diabetes. Current Medications: atenolol 25mg PO Daily exemestane 25mg PO Daily gabapentin 300mg PO TID HCTZ 12.5mg PO QAM Omeprazole 20mg PO QAM 30mins before breakfast Vitamin B6 50mg PO BID with meals Simethicone 250mg PO TID PRN gassiness venlafaxine 24hr cap 75mg PO daily 10min post vaccination, pt c/o numbness of the mouth/lips and nose on the left side. Vitals: @10:30 BP 99/61, HR 66, RR 20, SpO2 97% on RA -- $g @10:45 93/60, 67, 18, 97% on RA -- $g @11:00 99/59, 62, 18, 98% on RA. Pt''s symptoms resolved. Pt stable and released from the vaccination site."


VAERS ID: 1592077 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
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 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 14 year old female received Pfizer covid 19 vaccine for 1st dose and was inadvertently administered Moderna for 2nd.


VAERS ID: 1592086 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
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 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

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

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

Write-up: 12 year old male received Pfizer Covid 19 vaccine for 1st dose and was inadvertently administered Moderna for 2nd dose.


VAERS ID: 1592098 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
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 EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Pt w/ hx of allergies to seafood, sunscreen, and tetracycline.
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ hx of allergies to seafood, sunscreen, and tetracycline. 35mins post vaccination, pt c/o dizziness and mild itchiness in the throat. Vitals: @12:35 BP 124/76, HR 60, RR 18, SpO2 97% on RA -- $g @12:45 110/74, 64, 18, 97% on RA -- $g @13: 05 129/82, 57, 97% on RA Pt was given 25mg PO Benadryl @12:50. Pt symptoms resolved. Pt stable and released from the vaccination site."


VAERS ID: 1592126 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-08-17
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Respiratory tract congestion, Rhinorrhoea, 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: Runny nose, congestion started on 8/14. Test + 8/17. Is part has not done her 2nd/6 month lab draw. Instructed to quarantine and await further guidance from DOH. Instructed get her Quasar labs drawn after released from quarantine by DOH. Last day worked 8/14, called in sick 8/17/2021. Covid positive after vaccination


VAERS ID: 1592146 (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: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

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

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

Write-up: patient felt dizzy while in chair


VAERS ID: 1592320 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
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 045B / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ685AA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling
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: amlodipine-benazepril 5-20mg, vitamine d3 50000units, ventolin HFA
Current Illness: no
Preexisting Conditions: no
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: lip swollen


VAERS ID: 1592526 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Chest X-ray normal, Chest pain, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Fibrin D dimer, Hepatic enzyme increased, Hypertension, Immunoglobulin therapy, Injection site reaction, Myocarditis, Platelet count normal, Pyrexia, Troponin, Ultrasound abdomen abnormal, Vaccination complication, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Overweight (~100 Kg); Fatty Liver Disease; Anxiety
Preexisting Conditions: Overweight (~100 Kg); Fatty Liver Disease; Anxiety
Allergies: none
Diagnostic Lab Data: AST 56 ALT 118 serial troponins 0.6, 1.28, and 1.0 WSR 25 Platlets normal, CXR normal, all on 8-17-21. EKGs normal, Echo cardiogram normal, Abd US enlarged Fatty Liver, all over next day or two.
CDC Split Type:

Write-up: Pt admitted to medical facility 8-17-21 with fever, HTN, local shot site reaction, chest pain, and vomiting; elevated liver enymes, troponins, and D-dimer. Dx: covid vax related myocarditis in obese, anxious teen with liver disease. Treated with steroids, IVIG, clonidine, zofran, and benadryl. Four normal EKGs, Echo with ejection fraction 64%, BP stablized, patient improved, discharged home 8-20-21.


VAERS ID: 1592528 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
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 EW0169 / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Feeling abnormal, Headache, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine, Meloxicam,Cycobenzaprine,Atenolol,Mirtazapine,Losartan, Prazosin,Tramadol,Fluticasone Proplonate, Cetirizine, Niacin 250mg, Visibility-T, Omega 3
Current Illness: N/A
Preexisting Conditions: Hypertension / sleep issues, night terrors
Allergies: N/A
Diagnostic Lab Data: Self treatment at home with Cortizone cream/Tylenol/Advil
CDC Split Type:

Write-up: Fever 3 days/Diarrhea 3 days/Headache 4 days- still taking Tylenol for it and now Friday at 715pm and still with headache/ rash both arm pits starting going away at day 3. /Tired 4 days / 2 days Brain was foggy/ Body joint pains 2 days almost 3


VAERS ID: 1592530 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
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 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Patient completed Moderna series and received Janssen


VAERS ID: 1592581 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
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: Arthralgia, Bell's palsy, Facial pain, Facial paralysis, Laboratory test, Neck pain, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Hearing impairment (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: numbness of arm with flu vaccine
Other Medications:
Current Illness:
Preexisting Conditions: POTS, fibromyalgia, and Ehlers-Danlos syndrome
Allergies: Doxycycline, vancomycin, minocycline, penicillins, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling pain travelling down her left arm and up into her shoulder/neck 5 minutes after receiving her vaccine. The pain then continued to increase in intensity and travelled into her face. The patient was then encouraged to go to the emergency department (on-site), where she was evaluated. According to records, the providers in the emergency department noted "drooping" of the left side of her face. A full stroke work up was completed with negative results. The patient was eventually diagnosed with Bells Palsy and was treated with prednisone.


VAERS ID: 1592777 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
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 - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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)

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

Write-up: Swollen tongue, swollen throat, couldn''t breathe.


VAERS ID: 1592787 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
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 - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Vaccine positive rechallenge
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Covid 19 Pfizer dose 1 7-22-21 numbness and tingling on left side of face
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Cipro, sulfa drugs, Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling and numbness on left side of face


VAERS ID: 1592789 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Jersey  
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 (MODERNA)) / MODERNA 007021A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Dyspnoea, Hypoaesthesia, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: Rosuvastatin
Current Illness: High Cholesterol, High Uric Acid, Allergies-Food and environmental. Dry Eye issues
Preexisting Conditions: Allergies Food and environmental
Allergies: food allergies, spicy, greasy foods.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of Breath, Numbness in hands and arms, mouth. Confusion. Started 2 hours after injection. On and off for the past 3 days.


VAERS ID: 1592980 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-01
Onset:2021-08-17
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Hypoxia, SARS-CoV-2 test positive, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baby aspirin, insulin 75/25, hydrocortisone, levothyroxine, rosuvastatin
Current Illness:
Preexisting Conditions: Addison''s disease, CKE2, DM2
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 8/17/21.
CDC Split Type:

Write-up: Patient received COVID Moderna vaccine on 2/27/21 and 4/1/21. On 8/15/21, patient admitted to our facility for COVID 19 PNA, sepsis with AKI and mild hypoxia (patient had COVID exposure from son). Patient was hospitalized from 8/17/21-8/19/21 and was discharged home.


VAERS ID: 1592985 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-08-17
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, amlodipine, vitamin C, baby aspirin, atorvastatin, calcitriol, calcium carbonate, vitamin D, carvedilol, insulin glargine, insulin NPH, insulin regular, lisinopril, MVI, mycophenolate, prednisone, tacrolimus
Current Illness:
Preexisting Conditions: Chronic kidney disease status post related donor transplant maintained on mycophenolate/tacrolimus/prednisone, as well as type 2 diabetes, hypertension, hyperlipidemia.
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 8/17/21.
CDC Split Type:

Write-up: Patient received Janssen COVID vaccine on 3/13/21 at an outside facility. Patient recently attended a family reunion. On 8/17/21, patient admitted to our Medical Center for COVID pneumonia with acute respiratory failure/hypoxia. As of 8/20/21 (today), patient is still admitted in the med/surg unit.


VAERS ID: 1593181 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort, Headache, Hypoaesthesia, Paraesthesia
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? 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: Numbness and tingling to right side of body; from top of head (scalp) to right thigh area. burning sensation to right ear. extreme headache. have had persisting symptoms since day of vaccination.


VAERS ID: 1593222 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Back pain, Chest pain, Extra dose administered, Injection site pain, Injection site reaction, Lymph node pain, Pain, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Medication errors (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: Tirosint sol 75 micrograms X 1 daily Clonazepam .25 soluble X 3 daily Adderall 20mg X 3 daily Escatilopram 20mg X daily
Current Illness: N/A
Preexisting Conditions: Graves? disease post RAI hypothyroidism
Allergies: METHIMAZOLE, levothyroxine, Metrinodidazole HCL
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had my 3rd dose and never had a reaction to either 1st or 2nd back in Jan/Feb. This one makes my left under arm pit area have a sharp pinpoint pain as if it?s shooting into the lymph node with nerves going out to the front of the chest into my back. It is not gone away still there even as the injection site is not as sensitive touch anymore. But I do have a raised red rash the size of a cup ring, that is over injection site. And it HURTS BAD. Never had this before


VAERS ID: 1594387 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Fatigue, Nonspecific reaction, Pain, Yawning
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: ZYRTEC [CETIRIZINE HYDROCHLORIDE.]
Current Illness: Abstains from alcohol; Allergy multiple; Arthritis; Non-smoker; Sinusitis.
Preexisting Conditions: Comments: The patient had high blood and that doesn''t have anything to do with the shot and had no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210834831

Write-up: GENERAL ACHES/FEELS GENERALLY ACHY ALL OVER; TROUBLE GETTING OUT OF BED; YAWNING A LOT; FATIGUE; This spontaneous report received from a patient concerned a 63 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: normal allergies, sinus, non alcohol user, non-smoker, and arthritis, and other pre-existing medical conditions included: The patient had high blood and that doesn''t have anything to do with the shot and had no history of drug abuse or illicit drug use. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. Concomitant medications included cetirizine hydrochloride for sinus, and allergies. On 17-AUG-2021, the patient experienced general aches/feels generally achy all over. On 17-AUG-2021, the patient experienced trouble getting out of bed. On 17-AUG-2021, the patient experienced yawning a lot. On 17-AUG-2021, the patient experienced fatigue. The action taken with COVID-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from general aches/feels generally achy all over, fatigue, trouble getting out of bed, and yawning a lot. This report was non-serious.


VAERS ID: 1594393 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210834923

Write-up: VACCINE ADMINISTERED BEYOND THE TWO HOUR RECOMMENDED STORAGE WINDOW AT ROOM TEMPERATURE; INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist concerned a 20 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: UNKNOWN) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced vaccine administered beyond the two hour recommended storage window at room temperature. On 17-AUG-2021, the patient experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine administered beyond the two hour recommended storage window at room temperature and incorrect product storage was not reported. This report was non-serious.


VAERS ID: 1594417 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Unknown  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient have no history of drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210835586

Write-up: ADMINISTERED DOSES TO PATIENT BEYOND THE 2 HOUR RECOMMENDED STORAGE WINDOW; This spontaneous report received from a pharmacist concerned a 23 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non-alcohol user, and non smoker, and other pre-existing medical conditions included: The patient had no known allergies. The patient have no history of drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: UNKNOWN) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced administered doses to patient beyond the 2 hour recommended storage window. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered doses to patient beyond the 2 hour recommended storage window was not reported. This report was non-serious.


VAERS ID: 1594426 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea
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: Perimenopause
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210836065

Write-up: HEAVY MENSTRUATION WITH PAINFUL CRAMPS; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: perimenopause. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 14-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-AUG-2021, the patient experienced heavy menstruation with painful cramps. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of heavy menstruation with painful cramps was not reported. This report was non-serious.


VAERS ID: 1594448 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210837503

Write-up: VIAL PUNCTURED OVER 48 HOURS WHEN ADMINISTERED; This spontaneous report received from a health care professional concerned a 54 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced vial punctured over 48 hours when administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vial punctured over 48 hours when administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210838123, 20210837775 and 20210837262.


VAERS ID: 1594459 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient did not have any known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210837775

Write-up: 48 HOURS PUNCTURED VIAL; This spontaneous report received from a health care professional concerned a 58 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient did not have any known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A and expiry: 21-SEP-2021) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced 48 hours punctured vial. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of 48 hours punctured vial was not reported. This report was non-serious.


VAERS ID: 1594461 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gastroparesis; Hepatic steatosis; Type II diabetes mellitus
Preexisting Conditions: Comments: No known drug allergies. Patient was on medications (not listed).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210837849

Write-up: INADVERTENT ADMINISTRATION OF JANSSEN COVID-19 VACCINE THAT WAS BEYOND THE BEYOND USE DATE; This spontaneous report received from a pharmacist concerned a 27 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: type 2 diabetes, gastroparesis, and hepatosteatosis, and other pre-existing medical conditions included: No known drug allergies. Patient was on medications (not listed). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-AUG-2021, the patient experienced inadvertent administration of janssen covid-19 vaccine that was beyond the beyond use date. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of inadvertent administration of janssen covid-19 vaccine that was beyond the beyond use date was not reported. This report was non-serious.


VAERS ID: 1594467 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210838123

Write-up: VACCINE ADMINISTERED AFTER VIAL PUNCTURED X48 HOURS; OUT OF SPECIFICATION PRODUCT USE; This spontaneous report received from a health care professional concerned a 19 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced vaccine administered after vial punctured x 48 hours. On 17-AUG-2021, the patient experienced out of specification product use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine administered after vial punctured x48 hours and out of specification product use was not reported. This report was non-serious.


VAERS ID: 1594473 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Diabetes; Non-smoker
Preexisting Conditions: Comments: Patient not have any known allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210839342

Write-up: EXPIRED VACCINE ADMINISTERED (VACCINE GIVEN 20 MINUTES AFTER THE 6 HOURS EXPIRATION MARK FOR A PUNCTURED VIAL STORED IN THE REFRIGERATOR); This spontaneous report received from a pharmacist concerned a 44 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: diabetes, non alcohol user, and non smoker, and other pre-existing medical conditions included: Patient not have any known allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced expired vaccine administered (vaccine given 20 minutes after the 6 hours expiration mark for a punctured vial stored in the refrigerator). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered (vaccine given 20 minutes after the 6 hours expiration mark for a punctured vial stored in the refrigerator) was not reported. This report was non-serious.


VAERS ID: 1595941 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Chest discomfort, Chest pain, Injection site pain, Neck pain, Pain, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? 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: Chest Tightness / Heaviness / Pain-Medium, Systemic: pteint complianed of radiating pain around neck area to back and blurry vision-Medium, Systemic: Weakness-Medium


VAERS ID: 1595969 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache
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: Simvastatin, tamsulosin, multi vitamins, CoQ10, Omega Fish Oil, Vitamin D, magnesium,
Current Illness:
Preexisting Conditions: prostate cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sever fatigue, joint pain, headaches for 48 hours


VAERS ID: 1595971 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling, Tinnitus
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Ringing in my ears. Swelling in my legs, feet and ankles.


VAERS ID: 1602568 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EUA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Illness, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: chills, fatigue, headache, fever up to 102.3, sore throat, lack of appetite Illness lasted about 27 hours.


VAERS ID: 1602689 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fenugreek, daily vitamin, nifedipine
Current Illness: none
Preexisting Conditions: hypertension
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: large, swollen, red, itchy (itching began day 3) rash on left arm after second PFIZER shot lasting longer than 4 days.


VAERS ID: 1602703 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chills, Hyperhidrosis, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: I am Hard of Hearing
Allergies: I?m allergic to dairy and tree nuts.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got a head around 10:00 pm and got a fever around 10:30 and got really bad back pains as well as my left arm hurting a lot. Thankfully my fever broke around 12:30am but I continued to have aches and pains throughout the next day as well as having shivers and sweating at certain points.


VAERS ID: 1602707 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-08-17
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

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


VAERS ID: 1602709 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-08-17
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1602786 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-08-17
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 OR EW018 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Dysstasia, Gait disturbance, Joint range of motion decreased, Joint swelling, Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have Graves disease since 9/2017 - taking low dose 50 mg 1. Thyroid is under control no issues for years.
Current Illness: Zero illnesses Extremely healthy and working fitness professional teaching 10 aerobic and weight lifting classes per week.
Preexisting Conditions: Zero other than my Graves? disease that is stable
Allergies: Zero , only Zantac allergy.
Diagnostic Lab Data: 8/17 tested blood for blood clots, blood infection, Lyme disease, Rheumatoid, gout and UTI Uric acid test all negative 8/17 ultrasound to see fluids 8/17 extracted 40 mls in left knee tested fluids and left for cultures all negative no infection 8/18 shot to left knee injecting steroids 8/19 shot to right knee injected steroids 8/18 began IV steroids energy 8 hours
CDC Split Type:

Write-up: 4 wks after injection 8/17 both of my knees swelled up to size of balloons, I couldn''t stand up, bend my knees, extend my knees or put any pressure- level pain at a 10 excruciating- I was tested for blood clots, blood infection, Lyme disease, gout, UTI, Rheumatoid Arthritis, septic, I had 60ml fluid drained from my left knee and it was tested for infection and cultures for 5 days came back clear no infections. My right knee was drained 20ml and also tested- all clear. I received 2 shots into the knees and received steroids IV every 8 hours- 5 days later I can finally stand walking with a Walker very gingerly. Taking ibuprofen every 8 hours as well.


VAERS ID: 1602869 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0187 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Dyspnoea, Heart rate increased, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), 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: Probiotics Magnesium
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Chest pain Shortness of breath Feelings of having a fast-beating, fluttering, or pounding heart


VAERS ID: 1602877 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Erythema, Headache, Illness, Influenza like illness, Movement disorder, Myalgia, Peripheral swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan. Synthroid
Current Illness: None
Preexisting Conditions: Cancer, colon, lung. This shot was a modern BOOSTER
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within hours severe headache, both head and ocular. Very swollen arm with beet red from shoulder to elbow. By following day extremely ill with flu like symptoms, affected all muscles bones and back ache. Couldn?t hardly move for two days, third day still pretty sick but up and moving. Ruffed it out no treatment, my husband talked with pharmacist who said it was good I got the booster.


VAERS ID: 1602964 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3138 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Dyspnoea, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient. Received her second dose of Pfizer (LOT#: EC3183) at 1835 on 8/17/21. Patient alerted EMT and reported feeling lightheaded, dizzy, was experiencing shortness of breathe and chest pressure. EMT took patients vital signs. BP: 158/78, HR: 49, O2: 100%. Patient stated that the same thing happened with her first dose 40 minutes after completing her observation time. Symptoms resolved with food and rest. Patient also stated that heart rate is low and is normal for her. At 1850 patient stated that she "feels chills" and the chest pressure and dizziness had improved and that she feels sleepy. EMT retook patients vitals signs at 1850. BP: 130/91, HR: 48, O2: 100%. At 1900 patient stated that she had not had any water today and no longer was experiencing any chills or any other symptoms. EMT retook patients vital signs at 1900. BP: 114/72, HR: 43, 02: 100%. EMT retook and reassessed patient at 1911. BP: 104/72, HR: 44, O2: 98%. Patient stated that she was no longer feeling any symptoms. EMT moved patient to zero gravity chair at 1920. Patient completed her observation time. EMT educated patient on adverse effects of COVID vaccine and when to seek EMS. Patient verbalized understanding of education. Patient stood up on her own and walked out of vaccination site with a steady gait at 1924.


VAERS ID: 1605736 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Hot flush, Musculoskeletal stiffness, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Just the mild side effects, but some were really intense. Crazy chills, body aches, joint pain, stiff muscles, fever, hot flashes, headache, vomiting. I only vomited day 2. The chills and body aches were day 1 and 2. The fever, stiff muscles, hot flashes were days 1, 2, 3 and 4. The headaches were days 3, 4 and 5 (today.) No insurance, so no doctor visit. Treated with a ton of sleep and an appropriate amount of fluids. Just reporting for science or whatever. Thanks!


VAERS ID: 1605756 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Metformin
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms after the vaccine: Severe chest pain and accelerated heart not sure if it is normal. I haven''t gone to the doctor because I''m scared. I just want to know if the pain is normal.


VAERS ID: 1605761 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Joint stiffness, Tenderness
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe pain in left armpit, especially when reaching down to grasp. It is painful to the touch. Also, right hip stiffness and pain.


VAERS ID: 1609050 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Myalgia, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), 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), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna COVID 19 vaccine
Other Medications: ASA Multivitamin Vitamin D elderberry Paxil
Current Illness: none
Preexisting Conditions: none
Allergies: MSO4
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: swollen lymph nodes under right arm, right chest wall, right neck, fever, pain in muscle, pain in hands, swelling in right leg, swelling in hands, headache, feet hurt under bottom,


VAERS ID: 1617437 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-23
Onset:2021-08-17
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site bruising, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Unexpected swelling of the left elbow and subsequent bruising ( I have images but there seems to be no place to upload them for your review) - I have reached out to my primary care provider about this as well.


VAERS ID: 1617468 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
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: Patient reports approximately 30 minutes after leaving pharmacy she felt a tingling and numbness in vaccinated arm (left). During the next several days the paresthesia like tingling went into both arms and both feet. No pain or itching reported. No inflammation or heat near injection.


VAERS ID: 1617536 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-14
Onset:2021-08-17
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: chronic kidney condition but no dialysis, gout, Hypertension, on blood thinners
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: received 2nd dose on 4/14/2021. Became symptomatic with cough, shortness of breath, extreme fatigue on 8/15/2021. Tested (+) on 8/17/2021 and admitted to Hospital. Discharged 8/21/22021 to home


VAERS ID: 1617545 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Condition aggravated, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: None
Preexisting Conditions: Previous Bell?s Palsy, Meniere?s Disease
Allergies: Levaquin, sugar
Diagnostic Lab Data:
CDC Split Type:

Write-up: Face twitching like recovering from Bell?s Palsy every day since shot


VAERS ID: 1617559 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030220 A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Fatigue, Nausea, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: 1st & 2nd Covid vaccine - mild symptoms similar to Covid booster mentioned above, but less severe.
Other Medications: Valacyclovir, vitamins, cal-mag-zinc.
Current Illness: none
Preexisting Conditions: COPD, history of NHL
Allergies: n/a
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever and nausea developed each afternoon for 4 days vaccination. Extreme tiredness for 5 days vaccination each afternoon. Left arm sore for 4 days & red for days 2-4. I took care of symptoms myself, with Acetaminophen, ginger ale, and going to bed early.


VAERS ID: 1617563 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-17
Onset:2021-08-17
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6203 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N 6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: chronic kidney disease, hypertension, diabetes, anxiety, radiation treatment for breast cancer, hysterectomy, arthritis
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: received 2nd dose 3/17/2021. Symptom onset 8/17/2021 beginning with SOHB which she thought was related to her anxiety Found to be (+) on 8/17/2021 . admitted to Hospital from 08/17/2021 through 8/22/2021 to home.


VAERS ID: 1617603 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-08-17
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Differential white blood cell count, Electrocardiogram, Full blood count, Metabolic function test, Pericarditis, SARS-CoV-2 test, Troponin I
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Allopurinol, Omeprazole
Current Illness:
Preexisting Conditions: Hypertension treated with Amlodipine Gout treated with Allopurinol
Allergies: Aspirin, Codeine
Diagnostic Lab Data: 8/17/21 Blood labs CBC and Differential Comp Metobolic panel Troponin 1, POC 2 times. Troponin 1, POCT 2 times. 8/17/21 ECG 3 times 8/17/21XR Chest 1 View 8/18/21 ECG 8/18/21 CT Scan 8/18/21 Blood Labs misc.
CDC Split Type:

Write-up: Pericarditis, Chest Pain. 2 trips to emergency room. Treatment ongoing/ anti inflammatory


VAERS ID: 1617617 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Sleep disorder
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Occasional use of over-the-counter Probiotics for IBS, but not used that day.
Current Illness:
Preexisting Conditions: Chronic but mild and very manageable Irritable bowel syndrome - managed by selective diet.
Allergies: Allergic to Ranitidine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 pm, 8/17/21 Left foot ''falls asleep'' - I noticed numbness and tingling in the top lateral side of my left foot, and radiating up into the lateral side of my left calf. Over the next hour, numbness radiates up lateral side of left leg, into left thigh. Numbness and tingling woke me up 2-3 times that night. Around 4 am, 8/18/21, woke up with numbness and tingling in left forearm and hand affecting left thumb, pointer finger, middle finger, and lateral forearm. 9 am, 8/18/21 Numbness and tingling continues in Left foot, thigh, forearm, and hand, and has now affected left side of scalp surrounding left ear. Numbness and tingling continues for several hours and fades from head after several hours. Numbness and tingling has continued in left foot, leg, hand and forearm continuously, but fading to less intensity, and including this moment when this was written 2 pm, 8/22/21


VAERS ID: 1617618 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKOWN / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Colitis ulcerative, Extra dose administered, Mononucleosis heterophile test negative, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Ischaemic colitis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: clonidine, metoprolol, omeprazole, sirolimus, vedolizumab
Current Illness: none
Preexisting Conditions: ulcerative colitis, liver & kidney transplant 15 years ago
Allergies: none
Diagnostic Lab Data: negative covid,negative strep, negative mono, two different antibiotics failed to help - diagnosed with ulcerative colitis flare of mouth/throat after 6 days of same and worsening symptoms.
CDC Split Type:

Write-up: rec''d 3rd dose (booster - dt autoimmune UC and transplant patient) Within 48 hours developed fever 100.7 and sore throat - appears to have triggered an ulcerative colitis flare in mouth and throat when prior to this has never had ulcerative colitis in this area, has only had issues in lower intestines.


VAERS ID: 1617832 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Insomnia, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to ibuprofen, pollen, dust, wheat sensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 15 minutes of having the vaccine, I developed several chicken pox/shingle-like spots on the back of my right leg. They itch very much. I didn''t return to the clinic, because they didn''t seem serious. In the following days, those spots have continued to itch and new spots on my left leg have broken out. I also have itching on other areas of my body that comes and goes. It doesn''t seem to affect any important functions, but is the itching is quite annoying and makes it difficult to sleep.


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