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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 120 out of 6,867

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VAERS ID: 1618517 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-08-17
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Chest X-ray abnormal, Diarrhoea, Hypokalaemia, Hyponatraemia, Hypoxia, Lung infiltration, Lymphadenopathy, Pancytopenia, Pleural effusion, Pneumonia, Pneumonia viral, Pulmonary mass, Small airways disease, Throat irritation
SMQs:, Agranulocytosis (narrow), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Hypokalaemia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is an 80 yo female with a history of small cell pancreatic and lung cancer currently on chemotherapy, tobacco dependence, emphysema, generalized anxiety disorder, abdominal aortic aneurysm, restless leg syndrome, secondary polycythemia, HLD, HTN, carotid artery stenosis, hypercalcemia, who presented to the ED complaining of hypoxia at home, at 85% on 8/21/21. She does not use oxygen at home. Patient is fully vaccinated with Moderna in February 2021. She was diagnosed with COVID on 8/17/21. She had no prior diagnosis of COVID. She complains of scratchy throat and diarrhea; however, no SOB, fever/chills, loss of sense of taste or smell, abdominal pain. Patient is currently on 4L. CXR on 8/17/21 showed patchy airspace disease in both lungs. CXR on 8/21/21 showed mild worsening of multifocal pneumonia. CTA chest showed no evidence of pulmonary embolus. Stable right lower lobe mass. Stable midlung nodule. Interval new bilateral peripheral patchy but extensive infiltrates consistent with atypical/viral pneumonitis. Tiny right pleural effusion. Multiple mediastinal and hilar lymph nodes show interval increase in size. Laboratory values revealed pancytopenia, hyponatremia, and hypokalemia. She was started on remdesivir and dexamethasone.


VAERS ID: 1623015 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Dyspnoea, Electrocardiogram normal, Red blood cell sedimentation rate normal, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: chest pain described as burning over all anterior chest area with associated SOB


VAERS ID: 1623054 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Pruritus, Rash
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: she said she had swelling on her side-Medium, Additional Details: i dont know if she went to urgrent care or er but strongly recommeneded. she stated she didnt want to pay a copay and asked me for otc treatments but i suggested she have a physician check it out


VAERS ID: 1623286 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-12
Onset:2021-08-17
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: COVID 19 Antigen positive on 8/20/2021
CDC Split Type:

Write-up: Breakthrough case after full vaccination


VAERS ID: 1623322 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Decreased appetite, Dizziness, Extra dose administered, Eye pain, Feeling abnormal, Head discomfort, Headache, Hypergeusia, Lethargy, Muscle twitching, Pain, Pyrexia, Sinus congestion, Sinus disorder, Vision blurred, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: achiness, fever, lethargy; flu-like symptoms
Other Medications: Aleve Dual Action; Calcium + Vit D; B Supplement; Omeprazole; Claritan D
Current Illness: NA
Preexisting Conditions: RA; Connective Tissue Disease; Osteoporosis; Asthma; Spinal Fusion; Eczema; Elevated Liver Function Tests; Migraine
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Fever 101.3; achiness; frontal headache with sinus congestion; lethargy; no appetite. It took 4-5 days to feel like myself again. My sinuses were a mess and my head felt like a cinder-block. This was the longest recovery I had out of the 3 vaccines. My eyes were also affected as they were sore and my vision was also compromised - it was hard to focus. I also had some stability issues as I felt dizzy most of the time. There was also an odd sensation of muscle twitching predominantly in my chest cavity, but in my extremities as well. Even though I am feeling much better now, I am hyper-sensitive to some tastes like salt.


VAERS ID: 1623336 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Arthralgia, Blood gases, Chest X-ray, Chest discomfort, Chest pain, Computerised tomogram thorax, Fibrin D dimer, Full blood count, Headache, Metabolic function test, Pyrexia, Troponin, Ultrasound scan, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Venlafaxin, Pravastin, Metoprolol, levothyroxin, Levocetrizine, Ibprohen, HCTZ
Current Illness: None
Preexisting Conditions: Epstein-Barr Hypertension Hyperlipidemia hypothyroid
Allergies: Diphenhydramine, ciprofloxacin, Clarithromycin, Penicillin
Diagnostic Lab Data: CT angio chest, U/S soft tissue Left arm, CXR 2 view, Troponin, CBC, BMP, ABG, D Dimmer, U/A
CDC Split Type:

Write-up: Fever Started 8/17/2021 0000 headache and temp aching joints Friday experienced Chest Pain. SOA, Chest Tightness


VAERS ID: 1623338 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain, Peripheral swelling, Skin warm, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Motrin.
Current Illness:
Preexisting Conditions: None.
Allergies: Sulfa medication.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site, swollen arm after receiving the booster shot. Arm is still hot to touch, welts in the forearm area. Used ice pack and Benadryl, did not work.


VAERS ID: 1623357 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2020-12-23
Onset:2021-08-17
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Headache, Neck pain, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Fertility medications (Estrogen pills, patches, progesterone)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: +SARS CoV2 PCR on 8/18
CDC Split Type:

Write-up: Symptomatic breakthrough case. Exposed to vaccinated coworker with symptoms 8/14. Became symptomatic 8/17. Initially had sneezing, progressed to slight runny nose that evening, headache, neck pain, 100.5 fever. Continued to be symptomatic with cough, sore throat, loss of taste and smell. Fevers lasted 4 days, up to 101. Not hospitalized, did not require oxygen.


VAERS ID: 1623380 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Seizure, Convulsions, Fainting


VAERS ID: 1623487 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-08-17
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Chills, Cough, Dyspnoea, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Shortness of breath, fever, chills, dyspnea, cough, nausea, loss of taste and chills. Hospitalized.


VAERS ID: 1623544 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Dysphagia, Headache, Pain, Paraesthesia oral, Streptococcus test negative, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac- 20 mg, Propranolol-10mg
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim
Diagnostic Lab Data: Had a strep test done 8/21- results are negative
CDC Split Type:

Write-up: Hard time swallowing within 2 minutes, tongue felty tingly and swollen within 2 minutes, headache within 20 minutes, felt like a baseball bat to the throat within 1 hour, lost voice and pain talking within 2 hours. Still in pain 6 days post shot- PCP ordered steroid pack which I started taking on 8/21- still in pain. Took benedryl Thursday, 8/19- did not help


VAERS ID: 1623546 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-10
Onset:2021-08-17
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: POSITIVE COVID PCR TEST ON 8/17/21
CDC Split Type:

Write-up: PATIENT CONTRACTED COVID DESPITA BEING FULLY VACCINATED AT TIME OF EXPOSURE/POSITIVE COVID PCR TEST AND DIAGNOSIS. CURRENTLY ASYMPTOMATIC.


VAERS ID: 1623547 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-08
Onset:2021-08-17
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 RNA
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: KNA
Diagnostic Lab Data: 08/17/21: SARS-COV-2 RNA POSITIVE
CDC Split Type:

Write-up: SHOB, FEELS LIKE ASTHMA FLARE UP


VAERS ID: 1623549 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-08-17
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Dyspnoea, Influenza A virus test, Influenza B virus test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Arimidex, Oscal, albuterol, Fosamax, Ecotrin, Prozac, Lasix, C
Current Illness:
Preexisting Conditions: COPD, Obesity, malignant neoplasm of lower inner quadrant of left female breast,
Allergies: none
Diagnostic Lab Data: SARS-CoV-2 and Influenza AB antigens POC positive for SARS.
CDC Split Type:

Write-up: Pt received Pfizer vaccine on 3/4/21 and 3/25/21. Pt presented to the ED with complaints of SOB requiring increased levels of oxygenation. Pt''s SPO2 found to be at 77%. Pt was tested for COVID-19 and was found to be positive. Pt diagnosed with COVID-19 viral pneumonia.


VAERS ID: 1623560 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-08-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Head discomfort, Laboratory test, Localised oedema, Lymphadenopathy, Ultrasound scan abnormal
SMQs:, Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: 8/17/21- U/S There is an elliptical hypoechoic nodule present right clavicle in the area of interest measuring 8 X 7 mm consistent with small benign appearing lymph node.
CDC Split Type:

Write-up: August 17 2021-Woke up at 5 AM had some pressure in my head that I had never noticed before. Then I noticed some edema on both sides of my neck and felt a swollen lymph node on the right side of my neck. I was scheduled for my yearly mammogram today so I called and ask if I should still get it she advised me no because I had the vaccine and that would make the results of my mammogram abnormal and I should wait until 4-6 weeks following my second dose of the vaccine. I got concerned regarding the edema on both sides of my neck and the pressure I was feeling in my head, I called my PCP and made an appointment for this afternoon. He was very concerned due to the large amount of edema on my neck he ordered a series of labs, soft neck ultrasound and a IM injection of Decadron. Also gave me a prescription of Decadron. He advised me if any of my symptoms get worse he was sending me to the ED for further treatment. Also advised me to not take the 2nd dose of the vaccine. I came over to the hospital got my prescription filled, labs and ultrasound of the neck done. August 18th I stayed home resting still having pressure in my head and edema in my neck. I?m taking the Decadron as directed and this is helping with the pressure in my head and neck. August 19, 2021 I returned to work. I?m feeling better only have the edema in my neck and feel a little more tired than usual.


VAERS ID: 1623596 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-08-17
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR LAB
CDC Split Type:

Write-up: COVID 19


VAERS ID: 1623637 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-25
Onset:2021-08-17
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, COVID-19, Inhibiting antibodies positive, Lung infiltration, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finasteride 10 mg po daily Carvedilol 6.25 mg po BID Sacubitril/valsartan 24 mg po daily Furosemide 20 mg po daily Atorvastatin 10 mg po daily Montelukast 10 mg po daily Glimperide 2 mg po daily Chromium one tablet po daily Ursodiol 300 mg
Current Illness:
Preexisting Conditions: Hypertension, COPD, BPH, Diabetes mellitus, type 2, Renal cell carcinoma. TURBT, L-nephrectomy, Esophageal dilation , Cataract repair.
Allergies: NKDA
Diagnostic Lab Data: 1. Prior COVID-19 Antigen on 7/3/2021 (-) 2. COVID-19 Antigen (+) on 8/17/2021 3. IgM (0.04) and IgG (0.04) on 8/18/2021 4. IgG II QT-SPIKE antibodies 117/5 on 8/18/2021
CDC Split Type:

Write-up: Hospitalized 8/17 with fever, right lower lobe infiltrate and ++COVID 19 testing.


VAERS ID: 1623644 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Hyperhidrosis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: fatigue, took ibuprofen, drank extra water, then woke up shivering sweaty vomitting, lasted 2 days, then cough , then fatigue that has lasted 5 days,


VAERS ID: 1623655 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuva-Ring, Spironolactone 50mg once daily, 2000 IU vitamin D3 Daily
Current Illness: None
Preexisting Conditions: exercise induced asthma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Painful Tracking bruise about 2 inches in length. Bilateral reddened rash to the left and right of the vaccine site. Rash subsided in 2 days and tracking bruise remains one week post-vaccine.


VAERS ID: 1623770 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Patient reported previous "reaction to a flu shot".
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she is an RN, she asked for 2 Benadryl because she "felt funny". Patient stated she has had a "reaction" to the flu shot in the past. at 8:55, BP- 148/90, Pulse Ox - 97, HR - 76, respirations - 18. Patient refused to get a ride home or for us to call an ambulance. Patient left our clinic at 9:10am.


VAERS ID: 1623914 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-28
Onset:2021-08-17
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 - / -

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1624008 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: Moderna COVID
Other Medications: Lisinopril (unknown strength)
Current Illness: None known
Preexisting Conditions: Unknown, possibly hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that night he had a rash appear on his arm. He then developed difficulty breathing and was sent to the ER. He was given diphenydramine and a steroid shot and his symptoms subsided.


VAERS ID: 1624066 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dyspnoea, Musculoskeletal chest pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Pain in ribs that spread to the back. trouble breathing in and out.


VAERS ID: 1624126 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-08-17
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/20/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: developed s/s of Covid 8/17, was admitted to the hospital 8/20 and tested positive COVID


VAERS ID: 1624171 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Cough, Diarrhoea, Fatigue, Headache, Impaired work ability, Myalgia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 25mg 1tab; K-tabs 10 meg 3 tabs daily; Benazepril Hcl 20mg 1tab; Levothyroxin 50 mcg 1 tab; Amlodipine 10mg 1tab.
Current Illness: none
Preexisting Conditions: Hypertension; diet -controlled Diabetes type 2; Asthma
Allergies: Tylenol, dairy products
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA. muscle pain, joint pain, diarrhea, cough, runny nose, headache, fatigue from 11pm on 8/17/21 until 08/22/21. I still have joint pain but was able to return to work on 08/23/21 while taking Ibuprofen for the pain.


VAERS ID: 1624253 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

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

Write-up: The patient self scheduled his follow up appointment for his second dose of Moderna not knowing there was a 28 day waiting period. He scheduled his appointment at 21 days and was administered the second dose at 21 days. Patient was completely fine after injection and educated on what to look for if any symptoms arise.


VAERS ID: 1624256 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-02-17
Onset:2021-08-17
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood test, Blood uric acid increased, Glycosylated haemoglobin increased, Vitamin D decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Arthritis (broad), Tumour lysis 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: multivitamin; potassium; blood pressure pill; 100 mf Januvia
Current Illness: None
Preexisting Conditions: PCOS
Allergies: Latex; Naproxen; arthritis drug
Diagnostic Lab Data: Blood work- vitamin D was surprisingly low, uric acid was very high, A1C was the highest it has ever been.
CDC Split Type: vsafe

Write-up: On march or April I had blood work done and everything was fine. I went to my regular trimonthly check up on 08/06/2021 and I had blood work done. I had an appointment on 08/17/2021 to discuss the results. My potassium was in range. My vitamin D was surprisingly low, which is weird since I take that daily. Everything is so out of range of how it used to be. My uric acid was very high, so he put me on a new medication. My A1C was the highest it has ever been and I have not done anything different besides the vaccine. I was diagnosed with arthritis 3-4 years ago and it bothers me only when the weather changes. Now I have joint pain very often. I only took Ibuprofen. Even with taking the extra vitamin D and multi vitamin I still have vitamin D deficiency.


VAERS ID: 1624526 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-23
Onset:2021-08-17
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal abscess, Abdominal infection, Abdominal pain, Abscess drainage, COVID-19, Cough, Dyspnoea, Explorative laparotomy, Gastrointestinal tube insertion, Incisional hernia repair, Intensive care, Intestinal adhesion lysis, Intra-abdominal fluid collection, Listeria test positive, Nasal congestion, Neutropenia, Oedema peripheral, Oropharyngeal pain, Parainfluenzae virus infection, Postoperative wound complication, Postoperative wound infection, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Tamsulosin, pantoprazole, aspirin, bortezomib
Current Illness:
Preexisting Conditions: 60 yo male s/p OLT 5/7/2019 for HCV cirrhosis, PVT, HCC, hx of multiple myeloma follows at MSK. S/p exlap / LOA and incisional hernia repair 6/4/21 after sx has been growing fluid collection presents to ED on 8/4/21 with abd pain and wound erythema over mercedes scar.
Allergies: NKDA
Diagnostic Lab Data: 8/17: COVID-19 PCR - positive 8/17: Antibody- negative IGG Anti-spike assay - negative
CDC Split Type:

Write-up: Patient tested for COVID-19 on 8/17: 61yo physician with h/o MM s/p ASCT on daratumumab/pomalidomide, HCV cirrhosis / HCC s/p OLT 5/2019 c/b incisional hernia s/p hernia repair with mesh 6/4/20, c/b infected mesh and abdominal abscess s/p ex-lap, washout and mesh removal on 8/5 with OR cx +listeria monocytogenes, now with fever and shortness of breath. He was discharged on 8/11 on augmentin, then over the weekend developed fever to 102 on 8/13 and progressive shortness of breath. Reports nonproductive cough as well and has been using nebulizer with partial improvement. No chest pain. No significant change in abdominal pain - mainly feels sore with using the incentive spirometer. Also reports nasal congestion and sore throat intermittently since having NG tube recently. No known sick contacts. He had recent parainfluenza virus infection prior to his last admission. He also complains of asymmetric RLE edema. Tested positive for COVID-19 on 8/17 and received compassionate use casirivimab-imdevimab, remdesivir, dexamethasone. Tocilizumab not given due to neutropenia. Received zosyn then unasyn for intra-abdominal infection. Patient remains in ICU on HFNC 100% Fio2 and 40 L.


VAERS ID: 1624597 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Gait inability, Headache, Impaired driving ability, Impaired work ability, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, triamterene-hydrochlorothiazide, estradiol, levothyroxine, valacyclovir, omeprazole, rizatriptan
Current Illness: None
Preexisting Conditions: Acid reflux, hyperlipidemia, hypothyroidism, migraines
Allergies: Codeine
Diagnostic Lab Data: Physical exam by otolaryngologist in clinic on 8/19/2021 and 8/23/2021.
CDC Split Type:

Write-up: patient her second Moderna COVID 19 shot on 8/16/21 at 3pm, and by 3am on 8/17/21 she had high fever and severe vertigo. She was unable to walk, stand. She has never had vertigo before in the past. She missed multiple days of work because she was too vertiginous to work. She also had headache. her migraine medication rizatriptan helped with headache, but did not help with vertigo. AS of her last ENT office visit she still had vertigo, still unable to drive, but was getting a little better. Physical exam ruled out BPPV and the rest of the vestibular physical exam did not localize to any peripheral vestibulopathy. history and physical consistent with central vertigo that I clinically believe was secondary to her second covid19 shot. By a week after this shot she was still too vertiginous to drive. I do not know how long this disability due to vertigo will last. I will continue to follow her.


VAERS ID: 1625431 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7486 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood urine present, Eye irritation, Fatigue, Feeling abnormal, Hypoaesthesia, Migraine, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms 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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had EXTREME abdominal pain, light blood in urine, fever of 102, nauseous, body aches, fatigue, mind fog, numb stomach, migraine, and eyes burning


VAERS ID: 1625447 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Balance disorder, Chest pain, Dizziness, Dysphagia, Dyspnoea, Ear pain, Facial paralysis, Hemiplegia, Insomnia, Migraine, Neuralgia, Pain in extremity, Palpitations, Vocal cord dysfunction
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine at age 23
Other Medications: Trazodone, midodrine, Fluvoximine, valtrex, gabapentin, IUD, pramipexole,
Current Illness: POTS, Ehlers Danlos Syndrome, Fibromyalgia, gastroparesis, immunocompromised, Vocal cord dysfunction, collapsed lung, IBS, chronic cough,
Preexisting Conditions: POTS, Ehlers Danlos Syndrome, Fibromyalgia, gastroparesis, immunocompromised, Vocal cord dysfunction, collapsed lung, IBS, chronic cough,
Allergies: Penicillin, amoxicillin, clindamycin, vancomycin, doxycycline, Minocycline, tetracycline, albuterol
Diagnostic Lab Data: Full exam in ER. Awaiting CT scan, speech therapy and rehab
CDC Split Type:

Write-up: Bells Palsy, chest pain, difficulty breathing, palpitations, dizziness, loss of balance, difficulty swallowing, paralysis of left side of face, nerve pain down left side of back and down the left leg. Severe ear pain, migraines, insomnia. Was put on 60mg of Prednisone for 7 days. No improvement after finishing coarse. Now trying therapy?s.


VAERS ID: 1627718 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site warmth, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: After the second vaccine my arm swelled up, turned red and became hot to the touch. I took some allergy medicine to help out, helped some but not much. A couple days later a rash appeared near the injection site, very red, itchy, hot to the touch, was also very sore. This reaction lasted for about 3 days before it went away


VAERS ID: 1627948 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-08-17
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 AR / 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: CHOL MED ?
Current Illness: NONE
Preexisting Conditions: HYPERLIPIDEMIA
Allergies: NKDA
Diagnostic Lab Data: COVID 19
CDC Split Type:

Write-up: POSITIVE COVID


VAERS ID: 1627963 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO217 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Muscular weakness, Premenstrual pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Persistent menstrual type cramps that lasted 5 days and intermittently since then even though I wasn?t on my period or even close to it. Intermittent chest pain and weakness in legs 1-3 days


VAERS ID: 1628032 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 Lortab, Perocet & Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash on torso began day after vaccine. Small red hives with no itch at first then has progressively gotten itchier. Still have rash as of 8/24/2021. Have not seen a doctor as no other major symptoms are evident.


VAERS ID: 1628150 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-08
Onset:2021-08-17
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0312620A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19
SMQs:, Supraventricular tachyarrhythmias (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalization for COVID/AFIB 8/17/21. Treated with Remdesivir for 5 days.


VAERS ID: 1628156 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-09
Onset:2021-08-17
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chest pain, Dyspnoea, Headache, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: PCR test collected on 8-20-21 and resulted positive on 8-21-21
CDC Split Type:

Write-up: Chest pain, headache, loss of taste and smell, difficulty breathing


VAERS ID: 1628184 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-08-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Pain in extremity, Tinnitus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hearing impairment (narrow), 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: Multiple vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin, eggs, pork, red food coloring
Diagnostic Lab Data: I have not seen a doctor yet. I was hoping it would stop but it''s louder on some days.
CDC Split Type:

Write-up: My arm was sore and it was black/bruised for a week and half. Two weeks later on August 17th, I develop a ringing in my ears. And it has not stopped.


VAERS ID: 1628406 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis, Pain, Toothache, Trismus
SMQs:, Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Two hours after the vaccine my left jaw locks up Throbbing tooth pain face droopy


VAERS ID: 1628433 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Pain, Pruritus, Somnolence, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? 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: Severe itching all over body, vomiting , body aches, feeling weak sleeping all day


VAERS ID: 1628445 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Nausea, Nodule, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Pain in arm for 7 days with knot like bump, nausea, headache chills, extreme tiredness for 7 days


VAERS ID: 1628449 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Anticoagulant therapy, Blood pressure increased, Chest pain, Laboratory test, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), 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: none
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: full set of labs and I was sent to the ER and they did another whole set of labs
CDC Split Type: vsafe

Write-up: On 08/17/2021 I had major heart palpitations throughout the day and night. Increased blood pressure and chest pain. I saw a Doctor on the morning of 08/19/2021-the doctor did a whole set of labs and I was sent to the ER and they did another whole set of labs. I have been ongoing with doctors and cardiologist, and everyone is coming to the conclusion that it was an adverse effect of the second dose of Pfizer. Treatments : hydroxychloroquine 200 mg at first it was 4 /bd and now I take 2/bd; baby aspirin 4/81 mg od; Prednisone. I would say unknown to recovering from the AEs. Its'' not as bad, but I''m still having heart palpitations and high blood pressure. I am also up to $5,000 of medical bills so far. Prior to the vaccination I did not have any heart palpitations and high blood pressure.


VAERS ID: 1628517 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-21
Onset:2021-08-17
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2, SARS-CoV-2 test, Suspected COVID-19
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ascorbic acid, vitamin C, (ascorbic acid with rose hips) 500 mg tablet codeine-guaiFENesin (ROBITUSSIN-AC) 10-100 mg/5 mL liquid diphenhydrAMINE (BENADRYL) 25 mg capsule LORazepam (ATIVAN) 1 mg tablet (Expired) magnesium chloride (SLOW-
Current Illness:
Preexisting Conditions: Nervous Hamartoma of brain Precordial pain Benign paroxysmal vertigo, unspecified ear Unspecified sensorineural hearing loss Chronic low back pain without sciatica, unspecified back pain laterality Respiratory Allergic rhinitis Cough Laryngopharyngeal reflux (LPR) Digestive Gastroesophageal reflux disease without esophagitis Genitourinary Menopausal symptoms Musculoskeletal Alopecia areata Endocrine/Metabolic Mixed hyperlipidemia Other Other screening mammogram History of cerebrovascular accident (CVA) involving cerebellum Dizziness and giddiness Anxiety
Allergies: AspirinSwelling Advil [Ibuprofen]
Diagnostic Lab Data: Probable COVID-19 Specimen information: Swab / Nares Added: 8/19/2021 by POCT COVID-19 Antigen (Collected 08/19/21) Onset date: 8/19/2021 Resolve Add: Rule-Out COVID-19 and Respiratory Viruses Add: SARS-CoV-2 (related to COVID-19) Add: Rule-Out SARS-CoV-2 (related to COVID-19)
CDC Split Type:

Write-up: Exposure to COVID-19 virus, DRY COUGH


VAERS ID: 1628559 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Nervousness
SMQs:, 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: vit d, zinc, iron
Current Illness: none
Preexisting Conditions: chronic cough from GERD. taking famotidine
Allergies: PHENAZOPYRIDINE
Diagnostic Lab Data: none. symptoms resolved the next day
CDC Split Type:

Write-up: patient was nervous going into the vaccination


VAERS ID: 1628567 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207AZCA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cognitive disorder, Dissociation, Feeling abnormal, Headache, Heart rate increased, Joint stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: For about 24hrs: Constant heart rushing $g108BPM. Feeling faint, dissociated, cognitively slowed. Splitting headache, with fever of 101.2?F. Pain, soreness, and stiffness in both hips in all positions.


VAERS ID: 1628612 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-31
Onset:2021-08-17
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Pain, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram (LEXAPRO) 10 mg tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray labetaloL (NORMODYNE) 100 mg tablet loratadine (CLARITIN) 10 mg tablet multivitamin, prenatal (STUARTNATAL PLUS) 27 mg iron- 1 mg tablet
Current Illness:
Preexisting Conditions: Circulatory Pre-existing secondary hypertension complicating childbirth Other Encounter for supervision of normal pregnancy in first trimester Pregnant 10 weeks gestation of pregnancy 34 weeks gestation of pregnancy Encounter for supervision of other normal pregnancy, third trimester High risk pregnancy, antepartum
Allergies:
Diagnostic Lab Data: Updated Procedure 08/17/21 0930 POCT COVID-19 PCR Collected: 08/17/21 0930 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1032625 Point of Care COVID-19 PCR Testing Method Abbott ID NOW Lot Expiration Date 10232021
CDC Split Type:

Write-up: Cough ? Generalized Body Aches ? Nasal Congestion LMP 06/27/2021/EDD 04/03/2022 25 y.o. G1P1001 IUP, 6w0d, Estimated Date of Delivery: 4/3/22.


VAERS ID: 1628678 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-19
Onset:2021-08-17
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Incontinence, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus tested 08/17/2021 positive.
CDC Split Type:

Write-up: Pt admited to faility on 08172021 with c/o worsening sob, myalgias, fever, cough and generalized weakness x1 week. Her husband was dx with covid 8/8. Her symptoms started 8/11. loose stools have continued with frequent episodes of incontinence. O2 Sats ~85% on RA prior to transport. Pt continues to be an inpatient at this time.


VAERS ID: 1628696 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-27
Onset:2021-08-17
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aggression, Spousal abuse
SMQs:, Dementia (broad), Hostility/aggression (narrow)

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

Write-up: Pt admitted on 8/17/2021 with hx of Alzheimers dz; He was admitted by police due to being combative and fighting with wife. Kept in the facility x2 days. Son stated all their family had been tested negative; unsure where he was exposed. Pt was discharged back to home on 08/19/2021.


VAERS ID: 1628699 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site inflammation, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fenofibrate, Vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Occurred during the couple days after the immunization occurred. Caused a rash on the left arm / shoulder that was inflamed.


VAERS ID: 1628712 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-07
Onset:2021-08-17
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lansoprazole (PREVACID) 30 mg capsule
Current Illness:
Preexisting Conditions: Respiratory Deviated nasal septum Digestive Gastroesophageal reflux disease Endocrine/Metabolic Hyperlipidemia Prediabetes High-density lipoprotein deficiency Other Attention deficit hyperactivity disorder, predominantly inattentive type
Allergies: Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data: 08/20/21 0800 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 08/17/21 0000 | Final result | Specimen: Swab from Nasopharynx COVID-19 POSITIVEAbnormal
CDC Split Type:

Write-up: URI


VAERS ID: 1628817 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-28
Onset:2021-08-17
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, Anticoagulant therapy, COVID-19, Chest X-ray, Cough, Dyspnoea, Headache, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test positive, Sick relative
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: furosemide, warfarin, apple cider vinegar
Current Illness:
Preexisting Conditions: Pulmonary embolism
Allergies: penicillins
Diagnostic Lab Data: 8/24/21 COVID-19 rapid - positive Chest X-ray - no acute process
CDC Split Type:

Write-up: On approximately 8/17/21, after exposure to ill family members, the patient began to experience cold/flu symptoms including headache, congestion, and cough. Patient also experienced loss of taste and smell. On 8/23/21, the patient started to feel short of breath. On presentation to ED, the patient has an O2 sat of 90% and was started on 2L nasal canula with improvement to 95%. Patient BMI is 78.9. Patient was started on dexamethasone and a heparin drip (for subtherapeutic INR on 1.3). Patient will be admitted to the hospital.


VAERS ID: 1628836 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chest pain, Nausea, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: sore arm first and second day. exactly one week later i vomited early tuesday morning my dinner and since then i?ve felt nauseous and an off feeling in my stomach. I?ve also been having chest pain.


VAERS ID: 1628868 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Hypertension, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (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? No
Previous Vaccinations:
Other Medications: Prenatal Vitamins and Vitamin C
Current Illness: none
Preexisting Conditions: none
Allergies: Erythromycin
Diagnostic Lab Data: Blood test 8/21/21 and EKG 8/17/21
CDC Split Type:

Write-up: Palpitations and High Blood pressure less than 5 mins after the vaccine


VAERS ID: 1628872 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site pain, Pain, Paraesthesia, SARS-CoV-2 test negative, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tynelol as advise by pharmacies. After 3days of no help they advise me to take ibuprohen which i have been taken until saturday 8/21. When i was seen by a doc at the urgent care who advise me to reduce the frequency of how i am taking it si
Current Illness: No.
Preexisting Conditions: Grow up with Asthma but never had to use any meds to treat. Other condition is seasonal allergy.
Allergies: Pennicilin. Any other drug am unaware of until I take it then 3days later I would start showing reactions.
Diagnostic Lab Data: On saturday 8/21. I took a covid test and it was negative.
CDC Split Type:

Write-up: Immediately after the shot I only feel a tingle to my middle finger. No othersympthoms. By midnight i feel a little numbness to my hand, no fever no other pain. Until about a hour later I feel the back of my head started to hurt I took tynelol and wentvto sleep woke up feel fine on saturday. With a little soar to the injection site which I use warm water and it was good as normal by end of day. Sunday no major pain just a few dizzy spell but noting that cause me an alarm.monday i woke up feel great no pain, tuesday i woke up woth a pain in the back of my head closer to my shoulder i took tynelol and by about 3:30pm i realise my entire body was hurting i had to take another tynelol. And since then I cant sleep or walk without any pain it hurt to lay down it hurt to sit and to dend is worse because i feel dizzy.


VAERS ID: 1629311 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Client arrived with father for first dose Pfizer vaccine. While sitting in medical monitoring the patient began to exhibit what appeared to be a vasovagal response. Vital signs BP 90/65, HR 60, RR 16. Patient appeared weak, nauseous, and diaphoretic with an immediate onset. Patient stated she did not eat and was given a snack of chips and water by charge nurse. Cool compress applied to cooling areas on patient''s body. Charge nurse ambulated patient and patient began to converse with nurse stating, " I feel better now." Patient appears in no apparent distress and answers appropriately. Charge nurse instructed patient and caregiver patient''s father to seek medical attention immediately if new symptoms arise or previous symptoms reoccur. Approximately 1 hr 15min later caregiver patients father returned to vaccine site and stated his daughter is feeling much better. Caregiver indicated daughter is eating and resting at present. Charge nurse instructed caregiver to provide fluids throughout the day and to monitor for any symptoms. Caregiver instructed to seek medical attention immediately if symptoms reoccur.


VAERS ID: 1631052 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse drug reaction, 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210837798

Write-up: UNSPECIFIED ADVERSE EVENT; EXPIRED VACCINE USED; This spontaneous report received from a health care professional concerned a patient of an unspecified age, sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: unknown, expiry: unknown) dose was not reported, frequency time was 1 total 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 had used expired vaccine (reporter stated that the patient administered vaccine at approximately 22:00, it was administered approximately 23 hours after the beyond use date 16-AUG-2021). On an unspecified date, the patient experienced unspecified adverse event, and was hospitalized (reported as for an unrelated issue, not related to the vaccine) for an unspecified number of days. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the unspecified adverse event and expired vaccine used was not reported. The reporter considered the causality between Covid-19 vaccine ad26.cov2.s and unspecified adverse event was not related. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210837798-covid-19 vaccine ad26.cov2.s-unspecified adverse event . This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1631074 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210817; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: Negative; Test Date: 20210820; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: Negative.
CDC Split Type: USJNJFOC20210843278

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 75 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805018, and expiry: 23-AUG-2021) dose was not reported, administered on 07-MAR-2021 on left arm around 13:00 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-21 patient had an antibody test with her healthcare professional. On 19-AUG-2021 her doctor called her and told she had no antibodies, the test came back negative (confirmed immunological vaccine failure). On 20-AUG-21 patient had another antibody test was performed. The results from the second test came back on the day of report as negative and with no antibodies. Both tests were SARS COV2 Spike Protein and IGG antibody tests. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210843278-covid-19 vaccine ad26.cov2.s -Confirmed Immunological Vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1631993 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-07
Onset:2021-08-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild.


VAERS ID: 1631994 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-07
Onset:2021-08-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild


VAERS ID: 1632006 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E1A / 1 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: pt noticed redness at injection site was not getting any better .. patient came into pharmacy on 8/24/2021 and pharmacits instructed her to call her dr to ask if she needs to be seen.. patient noticed itching, warm at site..she stills has complete mobility of arm just itching, redness and swelling not reducing


VAERS ID: 1632193 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-08-17
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (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: amitriptyline (ELAVIL) 25 mg tablet aspirin-acetaminophen-caffeine (EXCEDRIN MIGRAINE) 250-250-65 mg per tablet CAMBIA 50 mg powder in packet cyanocobalamin 100 mcg tablet magnesium oxide (MAG-OX) 400 mg tablet propranolol (INDERAL) 80
Current Illness:
Preexisting Conditions: Nervous Migraine without aura, with intractable migraine, so stated, with status migrainosus Other disorders of pituitary gland (CMS/HCC)
Allergies: Bee Venom Protein (Honey Bee)
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Cough


VAERS ID: 1632268 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-08-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dehydration, Dizziness
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Well controlled asthma
Allergies: None
Diagnostic Lab Data: None. Patient did not seek medical care
CDC Split Type:

Write-up: Patient woke with tightness in chest, sharp pain that lasted approx 1 hour then stopped. Tightness lingered for approx 24 hours then stopped. Patient reported feeling lightheaded two days later but had also been working in the heat and thought it could be related to dehydration as he felt better with fluids.


VAERS ID: 1632318 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Influenza like illness, Pain in extremity, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), 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: Lamotrigine 300mg Clonazepam 1mg Sertralime HCL 100mg Pravastatsin Sodium 20mg Vitamin D3 50,000 units
Current Illness: no
Preexisting Conditions: OCD High cholesterol
Allergies: Bugs Spray Neosporin Codeine
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Patient report that she has sore arm and sleepiness...after that she start having flu like symptoms that lasted for 24 hours. The next day her blood pressure shot up to 175/110 with the lowest reading of 165/106....Husband is an EMT and was checking her blood pressure.


VAERS ID: 1632385 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-25
Onset:2021-08-17
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Pyrexia, SARS-CoV-2 test positive, Sinus congestion
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN ORAL amoxicillin (AMOXIL) 500 mg capsule cholecalciferol, vitamin D3, 10 mcg (400 unit) tablet diclofenac sodium (VOLTAREN GEL) 1 % gel levothyroxine (SYNTHROID) 100 mcg tablet
Current Illness:
Preexisting Conditions: Nervous Heel pain Lower back pain Thigh numbness Weakness of left lower extremity Digestive Constipation Esophageal reflux Obesity Musculoskeletal Chondromalacia Eczema Lumbar facet arthropathy Endocrine/Metabolic Postoperative hypothyroidism Hyperlipidemia Prediabetes Other Decreased libido Menopausal and perimenopausal disorder
Allergies: NKA
Diagnostic Lab Data: Updated Procedure 08/21/21 0909 POCT COVID-19 PCR Collected: 08/21/21 0908 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000270419 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 06/12/2022
CDC Split Type:

Write-up: Patient with head congestion, cough, fever, fatigue, works at the hospital with COVID-19 patients, she has had the vaccine.


VAERS ID: 1632396 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-26
Onset:2021-08-17
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chest discomfort, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Feeling abnormal, Nausea, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 800 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler amLODIPine (NORVASC) 5 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet azithromycin 500 mg in sodium chloride 0.9 % 250 mL
Current Illness:
Preexisting Conditions: Hx of bone marrow transplant (CMS/HCC) Abnormal nuclear stress test Combined forms of age-related cataract of left eye
Allergies: NKA
Diagnostic Lab Data: Updated Procedure 08/18/21 1438 POCT COVID-19 PCR Collected: 08/18/21 1438 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000270419 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 6/12/22
CDC Split Type:

Write-up: cough, diarrhea, low-grade fever and shortness of breath Admission: Current 8/20/2021 - present (5 days) COVID-19 Principal problem History of Present Illness Patient is an 75 y.o. male. Pt presents via community referral for MAB infusion for recent COVID infection. Pt is fully vaccinated and doing well. Pt states that earlier in week he was outside leaf blowing and kicked up some dust and started coughing, he initially thought that this was the cause of his symptoms but by the next day he was feeling very poorly and was seen in the urgent care. Urgent care did COVID swab and his swab resulted as positive on 8/18. Pt was notified and d/t his hx of bone marrow transplant, obesity, T2DM, and age he was a candidate for MAB infusion. Pt agreed and was placed on list for infusion. Facility was consulted to help facilitate infusion. Pt was screened at home via telephone and notes that he has a niece that lives nearby and helps him, as well as family and many friends that are willing to help him if needed. Pt denies recent falls and states that he bowls on a league and is always active. Pt will be enrolled in facility for MAB infusion and continued following for several days to ensure improvement in symptoms. Pt was agreeable. Currently endorsing fatigue, loss of taste/smell, cough, SOB, chest tightness, mild nausea, lack of appetite, fevers, and body aches.


VAERS ID: 1632418 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-29
Onset:2021-08-17
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alfuzosin (UROXATRAL) 10 mg 24 hr tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 20 mg tablet blood sugar diagnostic (ONETOUCH VERIO) strip BRILINTA 60 mg tablet coenzyme Q10 (CO Q10) 100 mg capsule insulin glargine 100 unit/mL (3
Current Illness:
Preexisting Conditions: Circulatory Benign essential hypertension CAD (coronary artery disease) Dilated aortic root Genitourinary Nephrolithiasis Musculoskeletal Spondylosis Endocrine/Metabolic Dyslipidemia Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin Immune Psoriasis Other Electrocardiogram abnormal S/P drug eluting coronary stent placement Abnormal glucose
Allergies: ChlorhexidineHives / Urticaria Neomycin-bacitracnzn-polymyxnbHives / Urticaria, Rash
Diagnostic Lab Data: Updated Procedure 08/17/21 2136 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/17/21 1615 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/17/21 2136 COVID-19 PCR Collected: 08/17/21 1615 | Final result | Specimen: Swab from Nasopharynx
CDC Split Type:

Write-up: COUGH Internal Medicine COVID-19 virus infection Dx Medication Infusion Reason for Visit Progress Notes (Registered Nurse) ? ? Internal Medicine ? ? Encounter Date: 8/20/2021 ? ? Signed Patient is here for MAB Infusion O2 sats $g or = 90% Signs of potential reaction reviewed with patient. Tolerated IV start and MAB infusion without complication. Pt has access to pulse oximeter and thermometer for home monitoring Discharge instructions reviewed. Patient denies any questions Pt''s PCP is Dr Instructions COVID 19 Monoclonal Antibody (MAB) Infusion Patient Reference Guide MAB Infusion Treatment Team: Primary Care Physician: The physician that referred you for the infusion and who will conduct the follow-up appointments related to your infusion. COVID-19 MAB Navigator: The person who will schedule you for your infusion, ensure you schedule follow-up appointments as needed and that you have all the necessary tools to track your health. COVID-19 MAB Navigator Contact Information MAB Infusion Follow-up Plan: No COVID-19 vaccine for 90 days from your infusion date. Date: 11/20/2020 Day of Infusion: o You will be discharged home after your infusion. o You will begin recording your temperature and oxygen levels (pulse ox). Please log your temperatures and oxygen levels in your portal or on a piece of paper. The MAB Navigators will review these with you when they call. o Day 2-3 after Infusion: o You will receive a follow-up call from the COVID-19 MAB Navigator to review how you are feeling, your temperatures, oxygen levels and remind you to schedule your 7-day follow-up video visit with your Primary Care Physician. Day 10-11 after Infusion: o You will receive your final call from the Navigator. If you are doing well, you will graduate from the MAB Infusion Program. You will resume your routine appointments with your Primary Care Physician. When to call your Primary Care Physician: If you do not have a Primary Care Physician please go to the nearest Urgent Care: o Please call your Primary Care Physician if you have pre-existing health conditions that you feel need medical attention and are unrelated to your COVID-19 diagnosis and symptoms. o If you are experiencing non-life threatening COVID-19 symptoms and have additional questions. o Unrelieved temperature greater than 100.4 after taking Tylenol. When to call the COVID-19 MAB Navigator: o Please call the COVID-19 MAB Navigator if you have general questions regarding the infusion you received today, questions concerning follow up appointments, or home monitoring procedures & equipment. o You should receive a follow-up phone call from the Navigator within 2-3 days of receiving your infusion. o If you do not receive a follow-up phone call, please call the Navigator When to call 911 or Proceed to the closest Emergency Department: If you are experiencing life threatening COVID-19 symptoms including but not limited to: o high fever o trouble breathing o sustained oxygen level less than 90% after trying a different finger, deep breathing and coughing o persistent pain or pressure in the chest o new confusion o inability to wake or stay awake o blueish lips or face To help you breath easier: Try to spend as little time as possible on your back. When you lay on your back this causes fluid to pool in those parts of your lungs making it harder to breathe. Laying in different positions will allow all parts of your lung to expand properly. Eat meals sitting up in a chair when possible. Consider eating small frequent meals rather than three large meals. Try laying in a prone position, which is laying face down on your belly. Laying on your sides or sitting up in a chair is also helpful for breathing. If a position is too uncomfortable move to another position. Outpatient After Visit Summary (Printed 8/20/2021)


VAERS ID: 1632445 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Chest X-ray, Chest pain, Dizziness, Dyspnoea, Electrocardiogram abnormal, Headache, Nausea, Night sweats, Pain, Palpitations, Pruritus, Pyrexia, Sinus tachycardia, Tachycardia, Tenderness, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, CoQ10, Vitamin D3
Current Illness: None
Preexisting Conditions: GERD
Allergies: No known allergies
Diagnostic Lab Data: 8/20/21 - No tests at clinic. Given antihistamines and hydrocortisone cream. 8/21/21 - Went to urgent care. Had EKG showing sinus tachycardia. Confirmed fever. 8/24/21 - Went to clinic again for chest pain and shortness of breath. Had another EKG and chest X-ray. Still waiting on x-ray results to be called in by the MD.
CDC Split Type:

Write-up: Severe shortness of breath, chest pain, dizziness, tachycardia, heart pounding, tremors, hives with whelps, itchiness, fever, night sweats, fear of doom, shoulder pain, nausea, headaches, all over body aches and tenderness. Medications included Benadryl, hydrocortisone cream, famotidine, Vistaril, Allegra, Tylenol. Most of these symptoms have been going on for 7 days.


VAERS ID: 1632514 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Fatigue, Muscle spasms
SMQs:, Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zofran, Prozac, Losartin HTC, taxotere, perjeta, kanjinti, benadryl.
Current Illness: Metastatic breast cancer
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tired the next day. Lots of little muscle spasms in my left arm and left eye.


VAERS ID: 1632525 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A214 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Night sweats, Nightmare, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: upset stomach, bad dreams, fever, chills, vomiting, diaherra, pain throughout the body, night sweats


VAERS ID: 1632579 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site extravasation
SMQs:, Extravasation events (injections, infusions and implants) (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: None
Preexisting Conditions: High Blood Pressure, Hypothyroidism, Obesity, Parry-Romberg Syndrome
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine may have sprayed out onto forearm during administration as liquid was felt on my forearm as needle was removed from arm. Unclear if person administering the shot removed the needle while depressing plunger or if needle was too small for my arm size (over 320 lbs) which led to liquid being sprayed out on forearm. Also, site was not cleaned with alcohol prior to shot being given.


VAERS ID: 1632632 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: NAFLD, chronic RLQ pain, erectile dysfunction
Allergies: ciprofloxacin
Diagnostic Lab Data: EKG with diffuse ST elevations (8/20/2021), elevated troponin level (8/20/2021), echocardiogam with low-normal left ventricular function (8/22/2021)
CDC Split Type:

Write-up: Developed chest pain/pressure, evaluated in ED, and admitted to hospital, for acute myopericarditis for 3 days from 8/20/2021 until 8/22/2021. This form is broken and it won''t let me enter anything in the "Hospitalization" boxes to the right of this box, so i had to leave it unchecked so it would save.


VAERS ID: 1632659 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA HRSA052E21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Incorrect dose administered, Product preparation issue
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow)

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

Write-up: Our medical assistant had mixed 1.8mL of 0.9% NS with the Moderna Vial. Thereafter, she had given 0.5mL IM X 1 dose to the patient - left deltoid. Moderna and DOH contacted. Patient informed. Called patient on 8/18/2021, experienced fatigue and mild diarrhea for one day. 8/19/2021: Called patient, symptom resolved. DOH/CDC recommendation to readminister the dose immediately in the opposite arm. Patient would be fully vaccinated 2 weeks after the final dose. Patient has been informed and refusing the additional dose at the moment


VAERS ID: 1632689 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild.


VAERS ID: 1632731 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

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

Write-up: Fever- 100.8, chills, sweats, bodyaches, headaches 1 week Temp has resolved


VAERS ID: 1632812 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-08-17
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue, Nausea, Oropharyngeal pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: sore throat; fatigue, nausea/vomiting, cough


VAERS ID: 1632820 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA HRSA052E21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

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

Write-up: 8/17/2021: Our Medical Assistant mixed the 1.8mL Normal Saline Diluent with the Moderna Vaccine Vial. Thereafter, she had given 0.5mL IM Moderna with Diluent X 1 dose to the patient. Moderna contacted for recommendations. 8/18/2021: Patient contacted, doing well 8/19/2021: Called patient to follow up - mild headache and fatigue, which resolved. Denies any other symptoms DOH also contacted, advised patient to receive one additional dose of Moderna immediately on the opposite arm. 8/24/2021: Called patient - denies any symptoms. Patient notified of plan as discussed above and has an appt on 8/26/2021


VAERS ID: 1632872 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Feeling cold, Headache, Hyperhidrosis, Muscle spasms, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (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), 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: Allegra
Current Illness: None to report
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, extreme weakness, cold chills, sweatiness, muscle aches and cramps, headache, fever


VAERS ID: 1632890 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Aspartate aminotransferase normal, Blood creatinine increased, Glomerular filtration rate decreased, Liver injury
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Accidents and injuries (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Creatinine - 0.90 (before shot) / 1.37 (after shot) GFR - 70 (before shot) / 42 (after shot) AST - 22 (before shot) / 35 (after shot) ALT - 23 (before shot) / 50 (after shot)
CDC Split Type:

Write-up: Acute renal injury and acute hepatic injury. No treatment, only observation. TBD


VAERS ID: 1633017 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Fatigue, Injection site bruising, Pyrexia, Vaccination site erythema, Vaccination site pain, Vaccination site pruritus, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: After receiving the vaccine I started to run fever and chills a few hours after receiving the vaccine. Also at the vaccination site was very swollen as the size of a tennis ball, and it was very red and itchy. The site was also very swollen and very painful, the pain actually started to run up my arm and across my chest and it just felt very heavy. Also experienced a little bit of fatigue, and also symptoms as if I was experiencing symptoms. Around Friday after the vaccination I actually started to feel a little better. The injection site has subsided but the area was bruised.


VAERS ID: 1633062 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: patient is ran a high fever and had flu like symptoms


VAERS ID: 1633063 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Dutasteride Tamsulosin Bumetanide Allopurinol Potassium chloride Vitamin D Vitamin B12 Magnesium
Current Illness: None
Preexisting Conditions: CLL
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme shivering and shakes. Blanket 4 hours. Heavy sweating. Tylenol 10 hours


VAERS ID: 1633778 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FA7485 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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: Entecavir, Tylenol, Benadry, Vertisil
Current Illness: None
Preexisting Conditions: Inflamed liver, Rheumatoid Arthritis, sciatica, vertigo
Allergies: Penicillins, Strawberry, Soy
Diagnostic Lab Data: No yet seen by a doctor-having difficulty getting an appointment to see my primary doctor
CDC Split Type:

Write-up: Left chest pain, feeling of having a fast beating, fluttering or pounding heart


VAERS ID: 1633780 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Genital rash, Rash, Rash erythematous, Rash papular, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Common cold
Preexisting Conditions: None
Allergies: Pollen dust cats and.dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives or red swollen itchy rash developed on torso and genitals. First appeared one week after shot and is still present today, 8 days after it appeared. Doctor prescribed hydroxyzine and it seems to be helping after taking it for 2 days. But the hives/rash is still present. Very itchy. Makes me very worried about getting a second dose and would rather not do it


VAERS ID: 1633976 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-08-17
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016AB21A / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ventricular tachyarrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Torsade de pointes, shock-associated conditions (narrow)

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

Write-up: Patient hospitalized for ventricular tachyarrhythmia


VAERS ID: 1634865 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, SARS-CoV-2 test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202108; Test Name: COVID-19 antibody test; Result Unstructured Data: Negative; Comments: Antibody test came back negative today (8/23/2021); Test Date: 20210816; Test Name: SARS-CoV-2 test; Result Unstructured Data: negative antibody test; Comments: detects antibodies to spike protein, including receptor binding domain RBD
CDC Split Type: USJNJFOC20210846353

Write-up: CONFIRMED IMMUNOLOGICAL VACCINATION FAILURE; This spontaneous report received from a pharmacist concerned a 69 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, and expiry: UNKNOWN) dose was not reported, 1 total administered to left arm on 10-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-AUG-2021, SARS-CoV-2 test was done to detect spike protein and result came as negative antibody test on 17-AUG -2021 (Confirmed immunological vaccination failure). On unspecified date in AUG-2021, again covid-19 antibody test was done which came negative on 23-AUG-2021. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint 90000190644.; Sender''s Comments: V0. 20210846353-covid-19 vaccine ad26.cov2.s-Confirmed immunological vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1634880 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Headache, Middle insomnia, Muscle spasms, Nightmare
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210848914

Write-up: NIGHTMARES; WAKING UP EVERY HOUR IN PAIN; EXTREME MUSCLE CRAMPS; STOMACH PAIN; DIARRHEA; HEADACHE; This spontaneous report received from a patient concerned a 58 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On AUG-2021, treatment medications included: acetylsalicylic acid, and ibuprofen. On 17-AUG-2021, the patient experienced nightmares. On 17-AUG-2021, the patient experienced waking up every hour in pain. On 17-AUG-2021, the patient experienced extreme muscle cramps. On 17-AUG-2021, the patient experienced stomach pain. On 17-AUG-2021, the patient experienced diarrhea. On 17-AUG-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, diarrhea, nightmares, waking up every hour in pain, extreme muscle cramps, and stomach pain. This report was non-serious.


VAERS ID: 1636121 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-08-17
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Oropharyngeal pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: amLODIPine (NORVASC) 10 mg tablet aspirin 81 mg chewable tablet benzonatate (TESSALON) 100 mg capsule buPROPion XL (WELLBUTRIN XL) 300 mg 24 hr tablet fexofenadine (ALLEGRA) 180 mg tablet fluticasone propionate (FLONASE) 50 mcg/actuati
Current Illness:
Preexisting Conditions: Respiratory Mixed sleep apnea Chronic nonseasonal allergic rhinitis due to pollen Circulatory Benign hypertension Erectile dysfunction due to arterial insufficiency Endocrine/Metabolic Hypokalemia Other Dysthymia History of shingles
Allergies: LisinoprilCoughing
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Sore throat cough chills


VAERS ID: 1636172 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-20
Onset:2021-08-17
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram normal, Headache, Migraine
SMQs:

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

Write-up: Systemic: Headache-Severe, Additional Details: Stated she had a mild headaache for several days post injection but then began experiancing severe migraines. Stated that CT scan run by doctor returned with normal results. States she has never had migraines before receiving covid vaccination.


VAERS ID: 1636462 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / SYR

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

Write-up: Dizziness everyday since injection


VAERS ID: 1636535 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Musculoskeletal discomfort, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), 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: Synthroid, cosar blood pressure
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbing and tingling of arms - mainly in left arm - some shoulder discomfort.


VAERS ID: 1636547 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-18
Onset:2021-08-17
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Cough, Feeling abnormal, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler amLODIPine (NORVASC) 5 mg tablet amoxicillin (AMOXIL) 500 mg capsule atorvastatin (LIPITOR) 80 mg tablet azithromycin (ZITHROMAX) 250 mg tablet benzonatate (TESSALON) 100 mg c
Current Illness:
Preexisting Conditions: Nervous Right arm numbness Arterial ischemic stroke, PCA (posterior cerebral artery), left, acute Chronic right shoulder pain Circulatory Hypertension Digestive Acid reflux Obesity Vitamin B12 deficiency Endocrine/Metabolic Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin Hyperlipidemia Hypomagnesemia Other Anxiety Immunization not carried out because of patient refusal Need for prophylactic antibiotic Microalbuminuria Breast lump
Allergies: No Known Allergies
Diagnostic Lab Data: POCT COVID-19 PCR
CDC Split Type:

Write-up: sick in stomach cough chest feels weird


VAERS ID: 1636569 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Chest discomfort, Chest pain, Condition aggravated, Dyspnoea exertional, Electrocardiogram abnormal, Fatigue, Immune-mediated adverse reaction, Myocarditis, Painful respiration, Red blood cell sedimentation rate increased, Troponin I increased, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mixed connective tissue disease with disease flare presentation as pericarditis and myopericarditis.
Allergies:
Diagnostic Lab Data: Elevated CRP, ESR, and troponin. Abnormal ECG
CDC Split Type:

Write-up: I was admitted to the hospital on Fri 20Aug2021 to Sat 21Aug2021 for myopericarditis. I got my third dose of the Pfizer Covid vaccine on Monday 16Aug (5 months after my second shot) and this precipitated an overreactive immune response. I have autoimmune disease called mixed connective tissue disease in which my flares typically present as autoimmune pericarditis. Whether this instance of myopericarditis was a true flare, a side effect of the vaccine, or both is still undetermined. Symptoms were shortness of breath upon light exertion, chest pain upon inspiration, fatigue, chest tightness. I got labs done Friday morning upon the request of Dr. and my CRP and troponin I levels were elevated, so he suggested I start Prednisone immediately and go to the ER. My troponin continued to rise slightly during the night, but then started to decline. I was discharged Saturday 21Aug2021 evening.


VAERS ID: 1636646 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-15
Onset:2021-08-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Feeling abnormal, Hypoacusis, Memory impairment, Tinnitus
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 2000 IU - taken one day before and day of. No other supplements or medications.
Current Illness: none
Preexisting Conditions: Right side moderate to severe hearing loss.
Allergies: none
Diagnostic Lab Data: Setup appointment with physician and met with him. He did not run any tests or labs. He sent referral to ENT.
CDC Split Type:

Write-up: Reduced right ear hearing from approximately 25% to almost no ability to hear. Extremely loud tinnitus in right ear starting Aug 17th at 4:30 AM when reduced hearing was observed as well. Brain fog/forgetful/difficulty word-finding.


VAERS ID: 1636670 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-08-17
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Admitted 8/23 InPatient Hospital with Shortness of Breath and Diarreah at hospital. Pt still hospitalized three days now


VAERS ID: 1636695 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-08
Onset:2021-08-17
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01681 / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Headache, Immediate post-injection reaction, Migraine, Sinusitis
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: went into A fib after receiving flu vaccine in 2014
Other Medications: Allegra 180mg daily; gabapentin 600mg 1tab 3x daily; hydroxychloroquine 200mg daily; losartan 50mg daily; tizanidine 4mg daily; nortriptyline 10mg daily; omeprazole 40mg daily; orencia 250mg IV once a month at a clinic; hydrocodone 10mg/3.
Current Illness: no
Preexisting Conditions: Rheumatoid Arthritis; CLL-SLL-inactive; degenerative disc disease; cervical lumbar radiculitis; fibromyalgia; myalgia; interstitial cystitis; high blood pressure; shortness of breath; neuropathy
Allergies: Dilaudid and morphine- shortness of breath and dizziness; Darvon- shortness of breath; Celebrex- ulcers and esophagitis; Cymbalta- ulcers and esophagitis; Prestique- ulcers and esophagitis; Metals; bandaids- glue on them; flu vaccine
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I started having headache right after I received the second shot that weren''t real bad so dealt with them. Later that week they turned to migraines. So I went to urgent care and was told it was sinusitis they were extremely inflamed and gave me amoxicillin 75mg 2x daily and sad that will help, I still have the headaches.


VAERS ID: 1636705 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Costochondritis
SMQs:

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

Write-up: costochondritis


VAERS ID: 1636760 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-08-17
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Hypoxia, Intensive care, Respiratory disorder
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The case is in the ICU for respiratory issues/hypoxia caused by Covid and exacerbated by COPD.


VAERS ID: 1636874 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat
SMQs:, 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: Systemic: Chills-Medium, Systemic: Cold Sweats-Medium


VAERS ID: 1636969 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-08-17
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Blood test, Computerised tomogram, Facial paralysis, Magnetic resonance imaging, Neurological symptom
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine, clonazepam, colestipol, Gabapentin
Current Illness: None
Preexisting Conditions: Hypothyroidism, asthma
Allergies: Penicillin and Ambien
Diagnostic Lab Data: Trip to the emergency room on August 17th 2021. CT scans, blood work and MRI to rule out stroke and diagnosed with Bell''s palsy
CDC Split Type:

Write-up: Stroke symptoms with a diagnosis of Bell''s Palsy with right side face paralysis


VAERS ID: 1637011 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 34YN4 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Fatigue, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced a severe chest tightness a day after providing the vaccinations. Patient describe it as she was able to breathe but the tightness was very painful as she though twice about calling emergency number. She got headache, feverish and chills. She felt tired/exhausted and lasted for 4 days after the providing the vaccines.


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